IC8 - Pharmacology of Antidepressants & Antipsychotics

Question 1

What does MAO inhibitors do?

Answer 1

Increase biological availability of monoamines

Question 2

Phenelzine is ______ for MAO.

Answer 2

non selective

Question 3

Is phenelzine an irreversible or reversible MAO inhibitor?

Answer 3

Irreversible

Question 4

List 3 adverse effects of MAOIs.

Answer 4

1. Postural hypotension
2. Restlessness
3. Insomnia

Question 5

What is one DDI of MAOIs?

Answer 5

Drugs increasing serotoninergic function

Question 6

What are the major food limitations of MAOIs?

Answer 6

Cheese and concentrated yeast products

Question 7

What are the side effect that may arise due to drug food interaction with MAOIs?

Answer 7

1. Acute hypertension
2. Severe throbbing headache
3. Intracranial haemorrhage

Question 8

Explain how consumption of cheese with MAOI can lead to undesirable effects.

Answer 8

1. Amines (e.g. tyramine) in foods (e.g. cheese) are broken down by MAO in the intestines and liver.
2. MAOIs can lead to accumulation of tyramine and sympathomimetic effects.

Question 9

Drug food interaction is less likely in ______, MAO-A selective inhibitor.

Answer 9

reversible

Question 10

List one reversible, MAO-A selective inhibitor.

Answer 10

Moclobemide

Question 11

Name one Tricyclic antidepressants that is selective for norepinephrine transporter.

Answer 11

Despiramine

Question 12

Despiramine is selective for _____ transporter.

Answer 12

norepinephrine

Question 13

Name three tricyclic antidepressants that is non-selective for norepinephrine or serotonin transporter.

Answer 13

1. Imipramine
2. Amitriptyline
3. Nortriptyline

Question 14

Imipramine, amitriptyline, nortriptyline are TCAs that are non-selective for ________ and ______ transporter.

Answer 14

norepinephrine, serotonin

Question 15

What are the adverse effects of TCAs?

Answer 15

1. Sedation (H1 Histamine antagonism)
2. Postural hypotension (α-adrenoceptor sympathetic block)
3. Dry mouth, blurred vision, constipation (muscarinic receptor antagonism)

Question 16

List two SSRIs.

Answer 16

1. Fluoxetine
2. Citalopram

Question 17

What are the advantages of SSRIs?

Answer 17

1. Low affinity for αadrenoceptors (Lack of cardiovascular effects, safer in overdose)
2. Lack of effect at histamine receptors (Reduced sedation)
3. Low affinity for muscarinic cholinergic receptors (Minimal anticholinergic side
   effects (e.g. dry mouth and constipation)

Question 18

What are the adverse effects of SSRIs?

Answer 18

Nausea, insomnia, sexual dysfunction

Question 19

What are the two adverse effects that may be arise due to discontinuation/ rebound symptoms of withdrawal when plasma levels of drug drop between doses?

Answer 19

Nausea, insomnia

Question 20

What is one of the SSRIs that has sedative effects?

Answer 20

Citalopram

Question 21

What are severe reactions of SSRIs that can results from DDI with MAOIs?

Answer 21

Serotonin syndrome such as tremor, hyperthermia, cardiovascular collapse

Question 22

List three examples of serotonin and noradrenaline reuptake inhibitors (SNRIs).

Answer 22

Venlafaxine, desvenlafaxine, duloxetine

Question 23

What are the advantages of venlafaxine?

Answer 23

1. Fewer adverse effects than TCAs.
2. Work slightly faster than other antidepressants.
3. Work better in treatment-resistant patients

Question 24

What are the adverse effects of SNRIs?

Answer 24

1. Serotoninergic adverse effects (Nausea, Insomnia, Sexual dysfunction)
2. Serotonin syndrome such as tremor, hyperthermia, cardiovascular collapse when combined with serotoninergic drugs and MAOIs.

Question 25

Withdrawal effects of SNRIs are ______ than for SSRI s and TCAs.

Answer 25

stronger

Question 26

All antipsychotic drugs are _____ antagonists.

Answer 26

D2 (dopamine)

Question 27

List 2 D2 receptor antagonists that are used as typical/ atypical antipsychotic.

Answer 27

1. Haloperidol 2. Clozapine

Question 28

What are the three dopamine pathways of the brain?

Answer 28

1. Mesocortical/ Mesolimbic pathway 2. Nigrostriatal pathway 3. Tuberoinfundibular

Question 29

Atypical antipsychotics usually have _____ antagnosim effects.

Answer 29

5HT2 (serotonin)

Question 30

List two typical antipsychotics drugs.

Answer 30

Chlorpromazine Haloperidol

Question 31

List 4 atypical antipsychotics drugs.

Answer 31

1. Amisulpride 2. Clozapine 3. Olanzapine 4. Risperidone

Question 32

Which antipsychotic drugs class has less extrapyramidal side effects?

Answer 32

Atypical

Question 33

What are the side effects of antipsychotic drugs?

Answer 33

1. Sedation (H1 Histamine antagonism) 2. Postural hypotension (α-adrenoceptor sympathetic block) 3. Dry mouth, blurred vision, constipation (muscarinic receptor antagonism)

Question 34

Haloperidol has _____ sider effects than chlorpromazine.

Answer 34

lesser

Question 35

Halperidol is selective for the _____ receptor.

Answer 35

α1-adrenoceptor

Question 36

Most atypical antipsychotics have greater affinity at ______ and _____.

Answer 36

5HT2, D4 Note: These do not define atypicality

Question 37

What is the core of action for most atypical antipsychotic drug?

Answer 37

Serotonin-dopamine antagonism

Question 38

What is a major side effect of clozapine?

Answer 38

Agranulocytosis

Question 39

Dry mouth, constipation and blurred vision are evident in atypical antipsychotics particularly _______.

Answer 39

Clozapine, olanzapine

Question 40

List two atypical antipsychotics drugs where sedation as side effect is mainly evident.

Answer 40

Clozapine, Olanzapine

Question 41

Postural hypotension and reflex tachycardia is especially evident in _____, an atypical antipsychotic.

Answer 41

Risperidone

Question 42

Which atypical antipsychotic drug is a selective D2/3 antagonist?

Answer 42

Almisulpride

Question 43

List three adverse effects of amisulpride.

Answer 43

1. Increased prolactin 2. Breast swelling, pain, lactation 3. Gynecomastia (males)

Question 44

List three atypical antipsychotics that can induce diabetes and weight gain

Answer 44

Clozapine Olanzapine Risperidone

Question 45

List 4 reasons for lack of EPS in atypical antipsychotics drugs.

Answer 45

1. Potent 5-HT2A receptor antagonism vs. weak D2 antagonism (clozapine, olanzapine) 2. High D3 to D2 antagonism ratio (amisulpride) 3. High D4 to D2 antagonism ratio (clozapine) 4. High D2 to D1 antagonism ratio (amisulpride, risperidone)