Psycopharmacology

Question 1

What mechanisms mediate de cardiovascular side effects of cyclic antidepressants?

Answer 1

• blocking Alfa 1 receptor and block 5HT re-uptake

Question 2

What is the treatment for sexual dysfunction by cyclic antidepressant and Serototin syndrome by SSRI? How does it work?

Answer 2

• Cyproheptadine

- Serototin antagonist (also anticholinergic, antihistamine)

Question 3

Some cautions with cyclic antidepressants are

Answer 3

Seizure, alcohol, drive, first trimester pregnant, respiratory illness, manic
“First rest for your man and don’t drink” and seizure

Question 4

Most common reason to stop SSRI

Answer 4

Anorgasmia and delayed orgasm (15-20%)

Question 5

Why MAOIs when combine with Tyramine containing food causes hypertensive crisis?

Answer 5

• Tyramine is not metabolized (is metabolized by MAO) - ⬆️⬆️

- it’s a catecholamine releasing agent - ⬆️ NE, EPI, DOPA via sympathetic.

Question 6

Treatment for hypertensive crisis by MAOIs + tyramine

Answer 6

• phentolamine (Alfa block)

- chlorpromazine (antipsychotic with hypotensive effects)

Question 7

Highly indication of electro convulsive therapy (ECT)

Answer 7

• highly suicidal patients

- depressed pregnant patients

Question 8

How do the cyclic antidepressants work?

Answer 8

• block re-uptake: 5HT, NE

- block Alfa 1 receptor, muscarinic receptor

Question 9

Which antidepressant is approved for smoking cessation, has increase risk of seizure and suppress the appetite?

Answer 9

Bupropion

Question 10

1. Before initiate lithium what functions you must be sure are normal?
2. Why some side effects are polyuria and polydipsia?

Answer 10

1. • thyroid, causes hypothyroidism
   • kidney, is nephrotoxic (long term use too)
2. Diabetes insipidus

Question 11

For what alterations are valproate and carbamazepine recommended?

Answer 11

Acute mania, rapid cycling bipolar disorder, impulse control

Question 12

Hematologic side effects of valproate and carbamazepine

Answer 12

Agranulocytosis - both

Mild leukopenia and aplastic anemia - carbamazepine

Question 13

Effect of alcohol and oral contraceptive in benzodiazepines

Answer 13

• Alcohol: potentiate the effect (rise sensibility of the GABA-Cl receptor), and benzo lowers tolerance to alcohol
• oral contraceptives: ⬇️ metabolism

Question 14

Effects of overdose and ABRUPT withdrawal of benzo

Answer 14

• overdose: apnea and respiratory depression

- abrupt withdrawal: seizure (no abrupt withdrawal: insomnia, anxiety and agitation)

Question 15

Symptoms of serotonin syndrome, how is it produce?

Answer 15

• general restlessness, sweating, insomnia, nausea, diarrhea, cramps, delirium; seizures, high fever arrhythmia (life threat)
• ⬆️⬆️ Serotonin. Normally; central nervous system ▶️ serotonin regulate attention, behavior and body temperature

Other sites (primarily intestines) ▶️ serotonin regulate digestive process, blood flow and breathing.l

Question 16

Most common causes of serotonin syndrome

Answer 16

• high doses of SSRI
• SSRI + MAOI combo
• MAOI + sinthetic narcotic combo

Question 17

Which antipsychotic produces agranulocytosis and seizures as side effects?

Answer 17

Clozapine

Question 18

Which antipsychotic have the lowest risk of movement side effects and is used for schizophrenia and bipolar too?

Answer 18

Quetiapine

Question 19

Gold standard treatment for schizophrenia

Answer 19

Atypical antipsychotics

Question 20

Mention some MAOI’s

Answer 20

• Rasagiline (Azilect)
• Selegiline (Eldepryl, Zelapar, Deprenyl, topical patch Emsam)
• Isocarboxazid (Marplan)
• Phenelzine (Nardil)
• Tranylcypromine (Parnate)
• Moclobemide (Aurorix, Manerix)
• Pirlindole (Pirazidol)
• Toloxatone (Humoryl)