Psychopharmacology & Somatic Therapies

Question 1

Patient is tachycardic, diaphoretic, mydriatic, has hyperthermia and clonus. They have AIDS and are taking a protease inhibitor and fluoxetine. What is the cause of their symptoms, and what is the mechanism?

Answer 1

Serotonin Syndrome from the fluoxetine.

Mechanism: the protease inhibitor is metabolized by P450 as well, which increases the circulating levels of psychotropic drugs

Question 2

Which labs need to be checked q6 months when taking lithium?

Answer 2

TSH for hypothyroidism

Question 3

Which antidepressant class is best tolerated by the elderly, and why?

Answer 3

SSRIs such as fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram. This is because they are less sedating and have less anticholinergic properties than TCAs. MAOIs have the main side effect of hypotension, and are therefore not tolerated in the elderly.

Question 4

What is the main side effect of MAOIs, which lead them to be less well tolerated in the elderly?

Answer 4

Hypotension

Question 5

What are effective medications for OCD?

Answer 5

Clomipramine is a TCA that is effective in OCD for both children and adults.

SSRIs are also effective for OCD

Question 6

Mainstays of treatment for ADHD

Answer 6

CNS stimulants:

Detroamphetamine, methylphenidate, pemoline

Question 7

Pemoline

Answer 7

Dopaminergic stimulant that is used for ADHD and narcolepsy

MAOIs are contraindicated with pemoline.

Cause hepatotoxicity - perform liver tests regularly

Question 8

Clozapine causes what blood cell disorder?

Answer 8

Agranulocytosis

If s/s of infection, discontinue and get more frequent CBCs:

• 2000-3000 = daily CBC
• 3000-3500 = 2x/week

Question 9

Lithium toxicity treatment

Answer 9

<3 meq/L = supportive with IV saline and frequent levels

> 3meq/L = dialysis

Question 10

Best medication to treat depression without weight gain

Answer 10

Sertraline

Question 11

Valproic acid, Lithium, Chlorpromazine, Haloperidol, Fluoxetine - which is highest risk for fetus?

Answer 11

Valproic acid

then lithium

Question 12

Bipolar disorder with fever, chills, bleeding gums, extreme fatigue, pallor after starting carbamazepine = what is pt experiencing?

Answer 12

Acute aplastic anemia

Question 13

Bipolar disorder with fever, chills, bleeding gums, extreme fatigue, pallor after starting carbamazepine = what is pt experiencing?

Answer 13

Acute aplastic anemia

Question 14

What levels should you monitor closely with NMS?

Answer 14

Creatine Phosphokinase (CPK)

Question 15

“Stiffness and twisting” of neck and jaw. On lithium and trifluophenazine. What should you do first?

Answer 15

Benztropine IM or diphenhydramine IM to stop dystonia

Question 16

What property do phenothiazines, TCAs, and antiparkinsonian agents share?

Answer 16

Anticholinergic

Question 17

What should you do first when you notice tardive dyskinesia?

Answer 17

D/C antipsychotics. If you cannot, then add clozapine

Question 18

Which sleep drugs can cause sleepwalking, binge-eating, aggressive outbursts, and night driving without the patient being aware?

Answer 18

Zolpidem and Zaleplon

Question 19

Akathisisa

Answer 19

Feeling or restlessness coupled with the need to move.

Best to stop the offending drug, but may also try propanalol

Question 20

If you have a serious suicide attempt + a lack of desire to eat or drink, what should you do with pt?

Answer 20

ECT! They are high risk for suicide again

Question 21

What drug should you give before ECT?

Answer 21

Methohexital - lower cardiac risk than other barbiturates, with duration of action of 5-7 minutes.

Question 22

Urinary retention, blurred vision, constipation, dry mouth = what kind of symptoms? Associated with what kinds of antidepressant drugs? Which is the worst in this class?

Answer 22

Anticholinergic.

Associated with TCAs.

Amitriptylene is the most anticholinergic.

Question 23

Best drug for hypoactive sexual desire disorder + stopping smoking?

Answer 23

Bupropion

Question 24

What should you advise a parent regarding Ritalin administration?

Answer 24

Do not give it after noon because it is known to cause insomnia

Question 25

Disulfiram + alcohol = what kinds of reaction?

Answer 25

Facial flushing, tachycardia, vomiting, nausea. Even with over-the-counter cough and cold medications.

Question 26

Pharm Tx for narcolepsy

Answer 26

Stimulants such as methylphenidate, pemoline, and amphetamine. Modafinil as well to decrease # of sleep attacks

Question 27

72 y/o with Parkinson's is convinced that someone is plotting against him. Thought disorder at evening and night. What antipsychotic do you give this patient?

Answer 27

Clozapine - relative sparing of nigrostriatal dopaminergic system. Typical antipsychotics aggravate the extrapyramidal symptoms

Question 28

Erythromycin, theophylline, and cisplatin effects on carbamazepine levels?

Answer 28

Erythromycin = increased cbm level Theophylline and cisplatin = decreased cbm level

Question 29

How long does it take for lithium to reach equilibrium?

Answer 29

4-5 half lives. Half life = 20 hrs; equilibrium achieved in 5-7 days of regular intake

Question 30

If you treat akasthisia with propanalol, what other condition will you worsen?

Answer 30

Asthma, because beta-blockade causes bronchospasm

Question 31

What hormone do you generally give when treating depression? Why?

Answer 31

Levothyroxine - because hypothyroidism is frequently occuring at the same time.

Question 32

Seizure on clozapine - what do you do?

Answer 32

Stop clozapine and begin phenobarbital. You can restart clozapine at 50% of original dose and gradually raise it back.

Question 33

Seasonal affective disorder benefit from what non-pharma treatment?

Answer 33

Phototherapy

Question 34

Best drugs for PTSD?

Answer 34

Clonidine and beta-blockers. Inhibit adrenergic activity, which reduces the symptoms of hyperarousal.

Question 35

Which neuroleptics are preferred in elderly patients with cardiovascular problems and prostatic hypertrophy?

Answer 35

Haloperidol and fluphenazine Less likely to cause postural hypotension

Question 36

SSRI withdrawal symptoms

Answer 36

Dizziness, nausea, vomiting, lethargy, flu-like symptoms, sleep disturbances. Irritability, anxiety and crying spells. Usually have symptoms in 1-3 days after the last dose.

Question 37

Which receptors do BZDs act upon?

Answer 37

GABA receptors These represent the main cortical and thalamic inhibitory system.

Question 38

Which medications can cause a hypertensive crisis in patients on MAOIs?

Answer 38

Sympathomimetic containing drugs such as pseudoephedrine.

Question 39

Aged vs. non-aged cheeses cause more of a problem with MAOIs?

Answer 39

Aged

Question 40

Which medications can be used to reduce and delay REM sleep?

Answer 40

SSRIs, TCAs, MAOIs | Desipramine

Question 41

Features of NMS

Answer 41

Hyperthermia, muscular rigidity, autonomic instability, changes in mental status.

Question 42

Lab findings of NMS

Answer 42

Increased CPK, liver transaminase activity, leukocytes, myoglobinuria

Question 43

Pharma Tx of NMS

Answer 43

Bromocriptine and / or dantrolene

Question 44

Pharma for nocturnal enuresis + anxiety or tics

Answer 44

Imipramine Can be helpful if pt doesnt tolerate stimulants or has past substance abuse

Question 45

Most important side effect of sildenafil

Answer 45

Myocardial infarction due to stress placed on the heart by sexual activity. NAION is possible but is rare.

Question 46

Biggest cardiac side effect of TCAs

Answer 46

Slow cardiac conduction Have a quinidine-like antiarrhythmic effect

Question 47

Lithium tremor

Answer 47

Benign, high-frequency, fine tremor that worsens during activities with fine motor control.

Question 48

Neuroleptic-induced dystonia

Answer 48

intermittent or sustained muscle spasms, usually involving the head and neck. Can have an oculogyric crisis (forced upward gaze)

Question 49

Coarse pill-rolling nonintentional tremor that improves with intentional movement

Answer 49

Parkinsonian tremor

Question 50

Rabbit syndrome

Answer 50

Extrapyramidal neuroleptic-induced syndrome. Rapid chewing movements without involvement of other parts of the body, including the tongue (no rapid tongue darting).