Psych

Question 1

TCAs

Give an example of a tertiary amine and a secondary amine.

What is the difference in side effect profile between tertiary versus secondary amines?

Answer 1

Tertiary amines: amitriptyline, clomipramine, imipramine, doxepin

Secondary amines: nortriptyline, desipramine, protriptyline

(ex. amitriptyline -> nortriptyline)

Tertiary amines have MORE antihistaminic and anticholinergic activity than secondary amines

Question 2

List major side effects of TCAs

Answer 2

• Cardiac toxicity (QT prolongation, ventricular arrhythmias)
• anticholinergic
• antiadrenergic (orthostatic hypotension)
• antiserotonergic (sedation, weight gain)

Question 3

Which SSRI is the most anticholinergic?

Answer 3

Paroxetine

Question 4

Which SSRI has the longest half life?

Answer 4

Fluoxetine

Question 5

Which antidepressant medication has been shown to inhibit warfarin metabolism?

Answer 5

Sertraline

Question 6

Which SSRI is most selective?

Answer 6

Citalopram

Question 7

Which SSRI also blocks DA transporter?

Answer 7

Sertraline

Question 8

Describe symptoms of lithium toxicity

What medications are known to increase lithium toxicity?

Answer 8

Delirium, tremor, ataxia, renal failure, seizure, QT prolongation, diarrhea

NSAIDs and phenytoin

Question 9

Which atypical antipsychotic is least likely to cause extrapyramidal symptoms?

Answer 9

Clozapine
(can use for PD related psychosis)

(Quetiapine is second least likely to cause EPS and is also useful in PD, no risk of agranulocytosis)

Question 10

Which atypical antipsychotic has the greatest likelihood to cause extrapyramidal symptoms?

Answer 10

Ziprasidone

Question 11

Which medications can worsen catatonia?

Answer 11

DA antagonists (atypical antipsychotics)
Baclofen

Question 12

Which three neurotransmitters are likely involved in the pathogenesis of schizophrenia?

Answer 12

Dopamine
Serotonin
Glutamate

Question 13

Which three neurotransmitters are primarily involved in the pathogenesis of anxiety

Answer 13

Norepinephrine
Serotonin
GABA

Question 14

List two pharmacologic treatment options for OCD

Answer 14

SSRIs

Clomipramine

Question 15

List the Cluster A personality disorders

Answer 15

“odd, suspicious”

Paranoid
Suspects deception in others, doubts loyalty, believes other intend malice

Schizoid
No desire for close interpersonal relationships, few nonfamilial friends, emotionally cold, little pleasure, difficult to engage

Schizotypal
Ideas of reference, magical thinking, inappropriate affects, unusual behavior, odd thinking or speech

Question 16

List the Cluster B personality disorders

Answer 16

“dramatic, impulsive”

Histrionic
Strives to be center of attention, uses physical appearance to drawl attention, overvalues relationships, theatrical

Narcissistic
Inflated self-importance, fantasizes about unlimited success, power or ideal love, can only be friends with other special people, requires admiration

Antisocial
Hx of conduct disorder as a child, repeated unlawful acts, deceitfulness, impulsive, violent

Borderline
Frantic avoidance of perceived abandonment, unstable and intense relationships, unstable self imagine, recurrent suicidal behavior or self-mutilation

Question 17

List the Cluster C personality disorders

Answer 17

“anxious”

Avoidant
Avoids activities involving interpersonal contact, fears shame/ridicule/rejection/criticism

Dependent
Requires reassurance/advice to make decisions, needs other to be responsive for their life, unable to express disagreement, must be involved in a relationship

Obsessive compulsive
Preoccupation with rules, details, order. Perfectionism interferes with progress, excessively devoted to work, inflexible about morality, ethics or values, unable to delegate

Question 18

Describe the clinical and radiologic features of Marchiafava-Bignami disease

Answer 18

Bilateral frontal lobe dysfunction, sexual disinhibition

Demyelination of the middle of the corpus callosum