Medication or Neuroscience-related Flashcards
Name the major dopamine pathways
Mesocortical, nigrostriatal, mesolimbic, tuberoinfundibular
What is the mechanism of action of propranolol (when used for psychiatric tx).
“Membrane-stabilizing effect and GABA-mimetic activity; 5-HT1a antagonist”
CHPD, 18th Ed. pg. 296
What is the mechanism of action of Prazosin when used in PTSD for nightmares/sleep disturbances?
Alpha-adrenergic antagonist
CHPD ed18, pg 298
What is the mechanism of action of Modafanil?
Psychostimulant which blocks dopamine transporter and increases dopamine;
Also activates neurons and increases release of histamine, dopamine, NE and 5-HT.
CHPD ed. 18, pg. 299
Melatonin:
- peak plasma concentration?
- metabolized by ?
- elimination 1/2 life?
- 60 mins
- liver
- 20-50 mins
CHPD ed. 18, pg. 307
What symptoms occur when disulfiram (Antabuse) is combined with alcohol?
Headache, sweating, flushing, N/V, tachycardia and hypotension; can occur 10-20 min after alcohol ingestion and may last for several hours.
CHPD ed. 18, p. 279
List 3 psychostimulants that are classified as a methylphenidate, and 3 that are classified as amphetamine and related drugs.
Methylphenidate
- Ritalin (plus SR and LA formulations)
- Biphentin
- Concerta
Amphetamines
- Dexedrine (plus spansules/ER)
- Vyvanse
- Adderall
CHPD ed.18, p. 216
What is the mechanism of action of atomoxerine (Strattera)?
Selective norepinephrine re uptake inhibitor; increases dopamine and norepinephrine in the frontal cortex (without increasing dopamine on sub cortical areas)
CHPD ed.18, p. 224
What is the mechanism of action of clonidine?
A central and peripheral alpha-adrenergic agonists; acts on presynaptic neurons and inhibits noradrenergic release and transmission at the synapse.
What is the mechanism of action of lithium?
The exact mechanism of action is unknown; postulated that lithium may stabilize catecholamine receptors, and may alter calcium-mediated intracellular functions and increase GABA activity.
CHPD 18 Ed., p. 187
What ECG changes are seen at therapeutic doses with lithium?
20–30% have benign T-wave changes (flattening or inversion] and QRS widening at therapeutic doses. Caused by the displacement of intercellular potassium by the lithium ion.
CHPD 18ed. P. 188/K&S p. 1059
What are symptoms of mild lithium toxicity?
Side effects such as ataxia, course tremor, confusion, diarrhea, drowsiness, fasciculation, and slurred speech may occur.
CHPD 18ed. p. 190
The risk of Ebstein’s anomaly of the tricuspid valves in lithium-exposed fetuses is __________?
1 in 1,000 which is 20 times the risk in the general population.
The teratogenic risk of lithium is 4-12% compared to 2-3% of the general population.
Note that lithium is present in breast milk at a concentration of 30-100%.
K&S, p1061
What initial medical work up should be completed when starting lithium?
Creatinine, electrolytes, thyroid function tests (TSH, T3/T4), CBC, ECG, pregnancy test in women of childbearing age.
K&S, p1062
About ____% of patients started on lamotrigine develop a benign maculopapular rash during the first four months of treatment.
8%
- the drug should be discontinued if a rash develops.
- Serious rash (SJS or TEN): incidence of 0.08-0.13.
K&S, p1054
What are the symptoms of an anti-cholinergic toxidrome?
Blind as a bat, mad as a hatter, red as a beet, hot as hades, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone.
True or False: In clinical trials of aripiprazole the incidence of QT prolongation was similar to placebo.
True
from Abilify Product Monograph
Name the most common side effects for Abilify
Akathesia, somnolence, tremor, weight gain, EPS, restlessness, rhinorrhea
from Abilify Product Monograph
Abilify is metabolised by which 2 CYP450 enzymes?
3A4 and 2D6
- thus any drug that inhibits 2D6 will increase abilify blood levels (ex., fluoxetine, paroxetine); and any drug that induces 3A4 will decrease abilify blood levels (ex., carbamazepine)
from Abilify Product Monograph
What medications/therapies were offered in the STAR*D trial?
Level 1: Citalopram
Level 2:
switch to sertraline, buproprion SR, venlafaxine
OR add either mirtazapine or buproprion SR
OR add/switch to CBT.
Level 3:
switch to nortriptyline or mirtazapine
OR add T3 or Lithium
Level 4: switch to MAOI (tranylcypromine: Parnate) or to mirtazapine + venlafaxine XR combo
STAR*D NIMH summary
What medications were offered in the CATIE trial and what were the major results of the trial?
Phase I: Olanzapine (Zyprexa) Risperidone (Risperdal) Ziprasidone (Geodon) Quetiapine (Seroquel) Perphenazine (Trilafon) Phase 2: Clozapine vs. atypical (efficacy pathway) Ziprasidone vs. atypical (tolerability pathway)
Level 1 Results:
- All meds comparable efficacy, with olanzapine having a slight advantage (less hospitalizations, stayed on drug longer).
- Olanzapine associated with more weight gain/metabolic changes, risk of diabetes than the other meds.
- High discontinution rates for all meds and 3/4 required at least a second med trial.
- No increased EPS with perphenazine.
Level 2 Results:
- Clozapine more effective
- Risperidone and olanzapine more tolerable in phase 2 compared to ziprasidone and quietiapine.
NIMH CATIE trial
Quetiapine is metabolized by ?
CYP3A4
uOttawa
What mechanisms contribute to Quetiapine’s antidepressant qualities?
- active metabolite N-Desalkylquetiapine has dual antidepressant activity. It has significant affinity for norepinephrine re uptake transporter AND agonistic binding affinity to 5-HT1A.
uOttawa
Tricyclic Antidepressants: name the TCA with,
- Most side effects
- The first TCA
- Most anti-histaminergic
- Most potent serotonergic
- Amitriptyline
- Imipramine
- Doxepin
- Clomipramine
uOttawa
What is the most common side effect among SSRI’s?
Nausea (worse with paroxetine and sertraline)
uOttawa
