Week 1

Question 1

Trazodone

Answer 1

Want to use in depressed pts with hard time going to sleep

- mixed
block post syn 5HT2
blocks reuptake of 5HT/NE
antagonist/agonist

Question 2

adequate antidepressant trial is ____ weeks

Answer 2

8-14 weeks

Question 3

Why would you pick SSRI over SNRI?

Answer 3

higher seizure risk
withdrawal syndromes (flu-like electric shocks)

(bupripion also has higher seizure risk)

Question 4

10 day supply of which antidepressant is lethal?

Answer 4

TCAs

dangerous in overdose

Question 5

Antidepressants Good against sexual side effects

Answer 5

Venlafaxine (SNRI)

Bubproprion (other)

Question 6

lesion to subthalamic nucleus

Answer 6

contralateral hemiballismus

Question 7

Which is easier to tx? Mania or depression?

Answer 7

mania

(treating bipolar depression is very hard)

only approved tx

• quetiapine +
• Olanzapine + Fluoxetine

Question 8

Best proven anti manic agent?

Answer 8

LITHIUM!

• best prove, best studies
• anti-suicical
• cheap
• narrow therapeutic window, hypothyroidism, diabetus

Question 9

Comorbidities for ADHD

Answer 9

substance abuse
anxiety disorders
depression
learning disorders
oppositional behavior

Question 10

5 models of why indiv with ADHD have comorbidities for other psychiatric disorders

Answer 10

1. genetic
2. developmental changes
3. psychological effects
4. living with others irritated by ADHD
5. self treating problem

Question 11

Most effective tx of ADHD

Answer 11

Stimulants

• well tolerated, most effective
• cause few symptoms
• make pt less annoying and give them better self-esteem

EARLY STIMULANT TX CAN DECREASE LATER RISK OF SUBSTANCE ABUSE AND DECREASE RELAPS IN SUBSTANCE ABUSE

Question 12

Sedative-hypnotic drugs facilitate what, leading to diminished neuronal excitability?

Answer 12

Fac. action of GABA at GABAA receptor-Cl channel complex →
GABA opens ion channels to increase CL- conductance →
hyperpolarization →
diminished neuronal excitability

Question 13

1st line tx for most anxiety disorders

Answer 13

SSRIs

Question 14

BDZ does not affect excitatory NTs compaired to barbs, why is this important?

Answer 14

BDZ are incapable of inducing and maintaining surgical anesthesia

Question 15

IM BDZ

Answer 15

Lorazepam

Question 16

Buspirone

• action
• sedative properties
• additive CNS depression?
• anticonvulsants
• myorelaxant

Answer 16

5HT1A partial agonist at presynaptic nerve terminal

No sedative/additive CNS depression
No Anticonvulsant, or myorelaxant properties.

Just an anxiolytic
- must be administered on routine schedule: less pt acceptance

Question 17

Post traumatic stress disorder #1 tx

Answer 17

CBT

- SSRI

Question 18

Drug toxicity
pinpoint toxicity
-tx?

Answer 18

Opioid

-tx with naloxone
immediate

Question 19

Clonidine

Answer 19

tx for withdrawl and relapse prevention
- good against opiod withdrawl

a2 agonist

Question 20

Methadone

Answer 20

Alleviate withdrawal symptoms by cross tolerance/dependence

Question 21

buprenorphine

Answer 21

partial agonist at mu opioid receptors

- helps with opioid withdrawal

Question 22

Naltrexone

Answer 22

blocks reinforcing action of heroin/alcohol

Question 23

CNS stimulants strong physical or psychological dependence?

Answer 23

Psychological
- lack of physical symptoms in withdrawal

not that bad
(OH, BDZ bad)

Question 24

Hallucinogens

Answer 24

agonist action at 5HT2 R → hallucinatory action

Also induce DA release @ DA receptors

Question 25

High dose of this drug induces rhabdo and kidney failure

Answer 25

Hallucinogens

Question 26

Disulfiram (antabuse)

Answer 26

tx for alcohol restraint

inhibits aldehyde dehydrogenase causing increase in acetaldehyde

• nausea, vomitting, resp collapse, convulsion

Question 27

Alcohol withdrawal syndrome tx

Answer 27

BDZ

a-2 adrenergic agonists (clonidine)

Question 28

acute alcohol intoxication tx

Answer 28

no specific antidote

• IV fluids (thiamine, glucose, electrolytes)
• Support respiration

Question 29

Reducing alcohol consumption

Answer 29

Disulfiram:
- alcohol sensitizing

Naltrexone:
- opioid antagonist

Acamprosate:
- NMDA receptor drugs

Question 30

tx for opioids

Answer 30

Methadone
- opioid agonist (taper off)

Naltrexone
- opioid antagonist

Buprenorphine
- Partial opioid agonist

Question 31

acamprosate

Answer 31

resembles GABA
- ENhances GABA transmission

Interferes with glutamate transmission and reduces CNS hyperexcitability