Banderas: Just the Stuff in Red

Question 1

Etiology of positive symptoms of schizophrenia

Answer 1

Excess DA in mesolimbic system

Question 2

Etiology of negative symptoms of schizophrenia

Answer 2

Deficiency of DA in mesocortical system (2ry to excess 5HT)

Question 3

Goals of treatment of schizophrenia?

Answer 3

Decrease DA in the mesolimbic system

Increase DA in the mesocortical system via 5HT block

Question 4

Low potency 1st gen antipsychotic?

Answer 4

Chlorpromazine

Question 5

High potency 1st gen antipsychotic?

Answer 5

Haloperidol

Question 6

2nd gen antipsychotics?

Answer 6

Quick, Zippy CAR

Q = quetiapine
Z = ziprasidone
C = clozapine
A - aripiprizole
R = risperidone

Question 7

MOA of 1st gen antipsychotics

Answer 7

Non-specific D2 antagonism

Question 8

MOA of 2nd gen antipsychotics

Answer 8

5HT2A antagonism

Weak D2 block

Question 9

Special considerations with clozapine

Answer 9

Decreases seizure threshold (dose-dependent)
QT prolongation risk
Agranulocytosis (requires monitoring)
Most metabolic effects (DM II, lipids, etc)

Question 10

Tx for antipsychotic-induced dystonia?

Answer 10

Anticholinergics (often prescribed with first gen antipsychotics)

Question 11

What to do when patient develops tardive dyskinesia?

Answer 11

D/c 1st gen antipsychotic and switch to 2nd gen antipsychotic

Question 12

Consideration with IV haloperidol?

Answer 12

Especially likely to cause QT prolongation

Question 13

Compare AE of low- and high-potency 1st gen anti psychotics

Answer 13

Low: more anti-HAM effects
High: more EPS effects

Question 14

2nd gen antipsychotics causing QT prolongation?

Answer 14

Greatest risk with clozapine and ziprasidone

Question 15

Buzzword: cataracts

Answer 15

Quetiapine

Question 16

Antipsychotics with least potential for weight gain

Answer 16

Aripiprazole and ziprasidone

Question 17

Action of SSRIs

Answer 17

Inhibit reuptake of serotonin; effect of 5HT1A receptors mediates antidepressant effects

Question 18

Your patient runs out of his SSRI medication before leaving town and cannot refill it while away. What may occur?

Answer 18

Discontinuation effects (anxiety, rebound depression, flu-like symptoms, etc)

Fluoxetine has long half-life (“self-tapering”) and can help avoid this problem, but also can cause interactions if initiating another therapy.

Question 19

Which SSRIs hold the highest risk of QT prolongation

Answer 19

Es/citalopram

Question 20

Which SSRI has the worst sexual side effects?

Answer 20

Paroxetine

Question 21

Which SSRIs should not be used in a patient who has insomnia?

Answer 21

Fluoxetine and sertraline - these are mildly stimulating

Question 22

What is the MOA of trazadone?

Answer 22

SSRI
5HT2A antagonism
H1 antagonism

Question 23

What might be a good adjunctive therapy for a patient currently taking an SSRI but struggling with insomnia?

Answer 23

Trazadone

Question 24

Which antidepressant is most associated with orthostatic hypotension?

Answer 24

Trazadone

Question 25

MOA of SNRIs

Answer 25

Antagonizes POSTsynaptic a2 receptors Antagonizes 5HT POSTsynaptic receptors Inhibit reuptake of serotonin and NE

Question 26

Which antidepressant might be prescribed to a patient concerned about sexual side effects?

Answer 26

Bupropion

Question 27

Should bupropion be taken in AM or PM?

Answer 27

AM - mildly stimulating

Question 28

Special considerations with mirtazapine

Answer 28

High incidence of sedation and weight gain

Question 29

When using cyclic antidepressants to treat depression-related insomnia, what should be considered?

Answer 29

Much lower dose is used for sleep than for antidepressant effect

Question 30

What is the action of benzodiazepines?

Answer 30

Promote GABA binding to GABAa receptors --> Cl conductance

Question 31

A low dose of benzo is good for what effect?

Answer 31

Calming and decreased anxiety (higher dose = sedation)

Question 32

What is an appropriate tx for an acute, severe anxiety crisis?

Answer 32

Benzodiazepine, IV or PO

Question 33

What are appropriate tx options for chronic anxiety?

Answer 33

SSRIs/antidepressants Buspirone Antipsychotics

Question 34

What is the goal of ADHD pharmacotherapy?

Answer 34

Optimal dosing to improve NE signaling and better direct DA firing

Question 35

What is the association between ADHD treatment and subsequent substance abuse disorders?

Answer 35

Kids with untreated ADHD are 1.9 fold more likely to develop a substance abuse disorder later in life than those kids who are appropriately treated