Random Questions

Question 0

How do TCAs work?

Answer 0

blocks reuptake of of NE (and sometimes serotonin)

Question 1

How do SSRIs work?

Answer 1

increases the amount of serotonin in the synapse.

Serotonin or 5-hydroxytryptamine (5-HT) is a monoamine neurotransmitter. derived from tryptophan, serotonin is primarily found in the gastrointestinal (GI) tract, platelets, and in the central nervous system (CNS) of animals including humans. It is popularly thought to be a contributor to feelings of well-being and happiness.

Approximately 90% of the human body’s total serotonin is located in the enterochromaffin cells in the alimentary canal (gut), where it is used to regulate intestinal movements.[6][7] The remainder is synthesized in serotonergic neurons of the CNS, where it has various functions. These include the regulation of mood, appetite, and sleep. Serotonin also has some cognitive functions, including memory and learning. Modulation of serotonin at synapses is thought to be a major action of several classes of pharmacological antidepressants.

Question 2

How do MAOIs work?

Answer 2

Inhibit metab of dopamine, Epi, NE, serotonin and tyramine

Question 3

How does lithium work?

Answer 3

distributed throughout total body water, excreted by kidneys, reabsorbed in proximal tubules, Competes with Na

Question 4

What is the mechanism of action of neuroleptics?

Answer 4

dopamine receptor antagonist (block dopamine receptors)

Question 5

What is the mechanism of action of anti-epileptics?

Answer 5

Na channel blocker (also Ca, NMDA)

Question 6

How does levodopa work? what is it used for?

Answer 6

Used for Parkinson’s. its a dopamine agonist

Question 7

What drug interactions do you need to be aware of with pats on TCAs?

Answer 7

Drug interactions- related to TCA’s anticholinergic effects and blocking of NE

• exaggerated pressor response, esp indirect acting agents - AVOID ephedrine
• Atropine - inc likelihood of postop delirium - and inc risk of central anticholinergic syndrome
• Potentiation of opioids and barbs - enhanced analgesia & ventilatory depressant
• protein binding is affected by phenytoin and ASA
• DO NOT give to pts w/seizure disorder or w/ drugs that cause seizures

Question 8

What drug interactions should you be aware of with SSRIs?

Answer 8

Potential for Serotonin Syndrome esp w/ MAOIs, carbamazepine, and Linezolid

it is a potent inhibitor of certain hepatic cytochrome P450 enzymes (esp w/prozac/fluoxetine) so there will be inc levels of TCAs, some neuroleptics, and anti-arrhythmics like metoprolol

Question 9

Why are MAOIs rarely prescribed?

Answer 9

Complex dosing
orthostatic HTN
anticholinergic
sexual dysfunction
weight gain
lethal OD
tyramine free diet for non-selective MAOI and MAO-A selective

Question 10

What are the symptoms of Serotonin Syndrome?

Answer 10

anxiety
restlessness
chills
ataxia
insomnia

Question 11

What are the side effects of glucocorticoid therapy?

Answer 11

Suppression of the HPA axis-> risk of CV collapse

Immunosuppression: bacterial/fungal infection
Osteoporosis
Peptic ulcer disease
CNS:psychosis (“roid rage”), depression, cataracts

Electrolyte/Metabolic changes: hyperglycemia, hypokalemic metabolic acidosis -> weight gain, edema, HTN, buffalo hump, moon face, abdominal striae, tissue paper skin.

Question 12

What drug class are Extrapyramidal Effects and NMS (neuroleptic malignant syndrome) associated with?

Answer 12

Anti-psychotics like haloperidol and Droperidol

also seen with abrupt cessation of Levodopa

Question 13

What is the relationship between anti-psychotics and Levodopa?

Answer 13

Anti-psychotics = dopamine receptor antagonist

Levodopa = dopamine receptor agonist

Question 14

What happens with opioids in pts on antipsychotics?

Answer 14

potentiation of opioids

Question 15

What is the difference between tardive dyskinesia and acute dystonic reaction?

How are they treated?

Answer 15

Tardive Dyskinesia = abnormal involuntary movement of face, neck, and tongue

Acute Dystonic Reaction = acute muscle rigidity/cramping of face, neck, tongue, and larynx

Tx = Benadryl or benztropine (anticholinergic)

Question 16

What is NMS? Symptoms? Treatment? Differential diagnosis?

Answer 16

Neuroleptic Malignant Syndrome = hyperthermia, muscular hypertonicity, autonomic instability, mental status changes
[rigidity -> dec ventilation & myonecrosis (renal failure)]

Tx = Dantrolene (relax muscles) & DA agonists

DD = MH - Nondep MR -> flaccid paralysis in NMS but not MH - Sux and halothane are ok for NMS but not ok for MH

Question 17

What are potential side effects of neuroleptic drugs?

Answer 17

1. Extrapyramidal Effects - movement disorders (all except clozapine)
   a. tardive dyskinesia
   b. acute dystonic reaction - tx: benadryl or benzotropine (anticholinergic)
   c. Parkinsonism
   d. Akathesia - restlessness
2. NMS
3. CV - A-block = orthostatic HTN, prolonged QT -> V-tach
4. Endocrine - dec corticotropin release(dec corticosteroids), wt gain, hyperglycemia

Question 18

What conditions could the following be prescribed for:

Clozapine (Clozaril)
Chloropromazine (Thorazine)

Answer 18

These are anti-psychotics. They are prescribed for schizophrenia (psychosis) and bipolar disorder (manic depression)

Haloperidol (Haldol), Droperidol, and Risperidal are others