Psych Drugs

Question 1

CLASS: Anxiolytics

Give THREE examples

Answer 1

1. benzodiazepines (diazepam, lorazepam, midazolam, clonazepam)
2. barbiturates (phenobarbital)
3. buspirone

Question 2

CLASS: Antipsychotics

Give TWO examples

Answer 2

1. typical antipsychotics (chlorpromazine-low potency, haloperidol-high potency)
2. atypical antipsychotics (risperidone, clozapine, olanzapine, aripiprazole)

Question 3

CLASS: Antidepressants

Give FIVE examples

Answer 3

1. SSRIs (sertraline, paroxetine, fluoxentine, citalopram, escitalopram)
2. SNRIs (venlafaxine, duloxetine)
3. atypical antidepressants (buproprion)
4. TCAs (amitriptyline, clomipramine)
5. MAOIs (iproniazid, moclobemide, befloxatone, brofaromine)

Question 4

CLASS: Mood Stabilizers

Give TWO examples

Answer 4

Lithium

Lamotrigine

Question 5

CLASS: Stimulants

Give TWO examples

Answer 5

Amphetamine

Methylphenidate

Question 6

Benzodiazepines

GIVE EXAMPLES
MECHANISM
ADVERSE EFFECTS

Answer 6

benzodiazepines (diazepam, lorazepam, midazolam, clonazepam)

potentiate GABAa-mediated inhibition (increase frequency of opening)

ataxia, dizziness, somnolence, fatigue, memory difficulties

Question 7

Barbiturates

GIVE EXAMPLE
MECHANISM
ADVERSE EFFECTS

Answer 7

barbiturates (phenobarbital)

potentiate GABAa-mediated inhibition (increase the duration of opening)

sedation, ataxia, confusion, dizziness, decreased libido, depression

Question 8

Busprione
MECHANISM
ADVERSE EFFECTS

Answer 8

Serotonin 5-HT1a receptor partial agonist

dizziness, confusion, headache, blurred vision, nervousness

Question 9

Typical antipsychotics
GIVE EXAMPLES
MECHANISM
ADVERSE EFFECTS

Answer 9

typical antipsychotics (chlorpromazine, haloperidol)

antagonize dopamine D2 receptors

parkinsonian symptoms~esp high potency, neuroleptic malignant syndrome, tardive dyskinesia (delayed onset of dyskinesia), anticholinergic symptoms~esp low potency (dry mouth, urinary hesitation, constipation, blurry vision)

Question 10

Atypical antipsychotics
GIVE EXAMPLES
MECHANISM
ADVERSE EFFECTS

Answer 10

atypical antipsychotics (risperidone, clozapine, olanzapine, aripiprazole)

antagonize dopamine D2 receptors and serotonin 5-HT2 receptors.

clozapine and olazapine also antagonize D4 receptors

aripiprazole is a D2 and 5-HT1 partial agonist (meant to decrease side effects) AKA abilify

mild extrapydramidal symptoms (parkinsonian), anticholinergic symptoms, sedation, weight gain

Question 11

SSRIs
GIVE EXAMPLES
MECHANISM
ADVERSE EFFECTS

Answer 11

SSRIs ( fluoxentine, paroxetine, sertraline, citalopram, escitalopram)

“Flashbacks paralyze senior citizens.”

increase synaptic serotonin levels by inhibiting presynaptic uptake; downregulation of post synaptic receptors; overall synthesis of serotonin declines

serotonin syndrome (when used concomitantly with an MAOi), sexual dysfunction!!!, GI distress, flu like experience, grinding teeth

Question 12

SNRIs
GIVE EXAMPLES
MECHANISM
ADVERSE EFFECTS

Answer 12

SNRIs (venlafaxine, duloxetine)

inhibit serotonin reuptake and norepinephrine reuptake at the synapse

HTN, sweating, weight loss, GI distress, blurred vision, sexual dysfunction, neuroleptic malignant syndrome

Question 13

Atypical Antidepressant
GIVE EXAMPLES
MECHANISM
ADVERSE EFFECTS

Answer 13

Bupropion

weakly inhibit uptake of serotonin, NE, dopamine

tachyarrhythmia, pruritis, sweating, rash, dyspepsia, constipation, dizziness

Question 14

TCAs (tricycline antidepressants)
GIVE EXAMPLES
MECHANISM
ADVERSE EFFECTS

Answer 14

TCAs (amitriptyline, clomipramine)

inhibit serotonin and norepiephrine reuptake

heart block, bloating, constipation, dizziness, xerostomia, somnolence, urinary retention

vary narrow therapeutic range; high burden; not first line@

Question 15

MAOi (monoamine oxidase inhibitor)
GIVE EXAMPLES
MECHANISM
ADVERSE EFFECTS

Answer 15

MAOIs (iproniazid, moclobemide, befloxatone, brofaromine)

increase serotonin and NE levels in the presynaptic neurons and synapses by inhibiting their breakdown

tyramine toxicity, dizziness, somnolence, orthostatic hypotension, weight gain

Question 16

Lithium
MECHANISM
ADVERSE EFFECTS

Answer 16

mood stabilizer

MECHANISM NOT ESTABLISHTED. inhibits adrenergic, muscarnic, and serotonergic neurotransmission in the brain.

acute lithium intoxication (N/V, diarrhea, renal failure, ataxia, tremor), bradyarrhythmia, hypotension, hyperkalemia, nephrogenic diabetes inspidus, hypothyroidism, goiter, ECG and EEG abnormalities, acne

Question 17

lamotrigine
MECHANISM
ADVERSE EFFECTS

Answer 17

mood stabilizer

inhibit neurotransmission by blocking neuronal sodium channel

rash, ataxia, somnolence, blurred vision

Question 18

Stimulants
GIVE EXAMPLES
MECHANISM
ADVERSE EFFECTS

Answer 18

Amphetamine, Methylphenidate

increase catecholamne release from the synaptic terminal, block catecholamine reuptake, weakly inhibits MAO

HTN, tachyarrhythmia, restlessness, loss of appetite, addiction potential

Question 19

Pharmacotherapy for Delirium

Answer 19

Antipsychotics (1. typical antipsychotics: chlorpromazine, haloperidol 2. atypical antipsychotics :risperidone, clozapine, olanzapine, aripiprazole)

Benzodiazepines (ex. diazepam, lorazepam, midazolam, clonazepam)

Question 20

Pharmacotherapy for Schizophrenia

Answer 20

Antipsychotics (1. typical antipsychotics: chlorpromazine, haloperidol 2. atypical antipsychotics :risperidone, clozapine, olanzapine, aripiprazole)

haloperidol (long-acting and injectable useful for the uncooperative)

Question 21

Pharmacotherapy for Major Depressive Disorder

Answer 21

Antidepressants

1. SSRIs (sertraline, paroxetine, fluoxentine, citalopram, escitalopram)
2. TCAs (amitriptyline, clomipramine)
3. MAOIs (iproniazid, moclobemide, befloxatone, brofaromine)

ECT

Question 22

Pharmacotherapy for Bipolar Disorder

Answer 22

Lithium
Anticonvulsants
Antipsychotics (1. typical antipsychotics: chlorpromazine, haloperidol 2. atypical antipsychotics :risperidone, clozapine, olanzapine, aripiprazole)

ECT

Question 23

Pharmacotherapy for General Anxiety Disorder

Answer 23

1. Benzodiazepines (ex. diazepam, lorazepam, midazolam, clonazepam)
2. Buspirone
3. SSRIs (sertraline, paroxetine, fluoxentine, citalopram, escitalopram)
4. SNRIs (venlafaxine, duloxetine)

Question 24

Pharmacotherapy for PTSD

Answer 24

SSRIs 
MAOi
TCAs 
Benzo...for acute attacks 
Anticonvulsants

Question 25

Pharmacotherapy for Social Phobia

Answer 25

SSRI | Beta Blockers

Question 26

Pharmacotherapy for OCD

Answer 26

SSRIs (first line) | TCAs

Question 27

Pharmacotherapy for Bulimia Nervosa

Answer 27

Antidepressants

Question 28

Pharmacotherapy for ADHD

Answer 28

Methylphenidate (Ritaline) first line | SSRIs, TCAs (adjunctive)

Question 29

What Rx is contraindicated for patients with bulimia nervosa and anorexia nervosa?

Answer 29

Bupropion

Question 30

Antipsychotics are used in which disorders?

Answer 30

delirium schizophrenia bipolar 1. typical antipsychotics (chlorpromazine, haloperidol) 2. atypical antipsychotics (risperidone, clozapine, olanzapine, aripiprazole)

Question 31

Benzodiazepines are used in which disorders?

Answer 31

delirium general anxiety disorder PTSD

Question 32

SSRIs are used in which disorders?

Answer 32

``` MDD Social Phobia OCD GAD PTSD ADHD (adjunctive) ```

Question 33

TCAs (tricyclic antidepressants) are used in which disorders?

Answer 33

MDD PTSD OCD ADHD (adjunctive)

Question 34

MAOis are used in which disorders?

Answer 34

MDD | PTSD

Question 35

anticonvulsants are used in which disorders?

Answer 35

bipolar | PTSD

Question 36

tardive dyskinesia ``` what is it? what class of medication causes it? ```

Answer 36

delayed onset of dyskinesia permanent side effect caused by typical antipsychotics (first-generation)

Question 37

neuroleptic malignant syndrome ``` what is it? what class of medication causes it? ```

Answer 37

arises from massive dopamine (D1, D2) blockade muscle rigidity, fever, autonomic instability and cognitive changes MEDICAL EMERGENCY admit to ICU ``` Fever Encephalopathy Vital Signs are unstable Elevated WBC and CPK Rigidity ``` caused by typical antipsychotics (first-generation)