Psych Drugs- GOOD

Question 1

Gold standard ADHD tx?

Answer 1

-stimulants

methylphenidate, amphetamines

Question 2

DOC for alcoholic withdraw?

Answer 2

Benzos

Question 3

Bipolar:

What are your three treatment options?

Answer 3

• lithium
• valproic acid
• atypical antipsychotics

…NOT SSRIs (one of the few psych things you cannot use this for.)

Question 4

DOC for schizophrenia

Answer 4

atypical antipsychotics

Question 5

Two treatment options for tourettes:

Answer 5

• atypical antipsychotics (fluphenazine, pimozide)

- tetrabenazine and clonidine

Question 6

Bulimia, Depression, GAD, OCD, panic disorder, social anxiety disorder & PTSD can all be treated with?

Answer 6

-SSRIs

may also us sNri’s except in bulimia and depression= SSRI only

Question 7

Performance Social Anxiety Disorder may be treated with? (2)

Answer 7

• BBers

- Benzos

Question 8

CNS stimulants (i.e. methylphenidate):
MOA
3 conditions for which these may be useful

Answer 8

^^ Dopa/ NE at synaptic cleft

-ADHD, narcolepsy, appetite control

Question 9

Haloperidol + psych drugs that end in –azine are of what class?

Answer 9

-CLASSIC antipsychotics (neuroleptics)

Question 10

Neuroleptics:

• MOA
• lipophilic or hydrophilic?
• aside from desired MOA, what other receptors in body may be targeted?

Answer 10

• block D2 receptors, ^^ cAMP
• lipophilic, long t1/2
• muscarinic, H1, a1 all blocked.

Question 11

What are three high potency neuroleptics?

What neuroleptic ADR is highly likely when taking these drugs?

Answer 11

• Try to Fly High
• Trifluoperazine, fluphenazine, haloperidol = HIGH potency
• assc with extrapyramidal ADRs (i.e. parkinsonism, tardice dyskinesia)

Question 12

Endocrine effects assc with neuroleptics?
Cardio?
Neuro?

Answer 12

• endo = gynecomastia due to ^^ PRL
• cardio= orthostatic hypoTN (a1 block), QT prolongation
• neuro= tardive dyskinesia, parkinsonism, NMS, sedation (H1 antagonism)

Question 13

Chlopromazine: strange ADR
Thioridazine: strange ADR

Answer 13

Chlorpromazine: “C”orneal deposits
Thioridazine: re”T”inal deposits

Question 14

Signs of NMS (neuroleptic malignant syndrome)?
WHAT DRUG REVERSES?
(If you don’t know this by now, you’re doomed.)

Answer 14

• fever, encephalopathy, rigid muscle contractures

- give them some DANTROLENE. Inhibits Ca release from SARCOPLASMIC RETICULUM.

Question 15

Describe tardive kinesia assc with haloperidol and the –azine drugs (neurolpetics)

Answer 15

orofacial chorea

looks like bunny twitching nose

Question 16

What receptors are effected by ATYPICAL antipsychotics?

Answer 16

-D2, 5HT2, a, H1

Question 17

Which symptoms of schizo can atypical antipsychotics treat? Which can typical psychotics treat?

Answer 17

• atypical: positive + neg sx

- typical: positive symptoms only

Question 18

What effect can all antipsychotics have on the heart? (both typical and atypical?)

Answer 18

QT prolongation

Question 19

What do atypical anti-psychotics ending in –pine cause?

Answer 19

-metabolic syndrome

Question 20

Special ADR assc with clozapine? olanzapine?

What kind of drugs are these and how do we know?

Answer 20

• end in –pine, do NOT end in –azine= atypical antipsych
• clozapine= agranulocytosis, must watch marrow CLOZEly
• all –pines can cause metabolic syndrome, but “O”lanzapine is esp known for causing “O”besity

Question 21

Risperidone:
What ADR is it most known for?
What kind of psych drug is this?
How do you know?

Answer 21

• known for hyperprolactinemia
• you know its ATYPICAL antipsych because it sounds like one of those crazy drugs you learned in psych and it isn’t haloperidol/ doesnt end in –azine.
• also, they probably gave it to someone with psych issues in the question stem!

Question 22

Lithium:

• mechanism unkown
• classically used to treat what disorder?
• Key ADRs (4)

Answer 22

-bipolar
-LMNOP
Lithium = Movement (tremor), Nephrogenic di, hypOthyroid, Preg problems.

**Please note: lithium +thiazide combo will ^^^ risk nephrogenic DI

Question 23

Where is lithium reabsorbed in the kidney?

Answer 23

-PCT with Na

Question 24

What birth defect is lithium assc with?

Answer 24

-Ebstein anomaly (tricuspid anomaly)

Question 25

``` Buspirone: MOA Use Benefit over other treatments? Downfall? ```

Answer 25

- stimulates 5HT1a receptors - treats GAD - no sedation/ addiction/ tolerance/ alcohol/benzo interaction (= good choice for addicts) - will take 1-2 weeks to begin working

Question 26

List the four SSRIs

Answer 26

- Flashbacks Paralyze Senior Citizens - Fluoxetine - Paroxetine - Sertraline - Citalopram

Question 27

How long does it take for SSRIs to begin working? | What are three ADRs worth mentioning?

Answer 27

- 4-8 weeks | - 3 S's: SIADH (tx with demeclocycline), sex prob (decreased libido), & serotonin storm (MAOi, SNRI, TCA)

Question 28

Desvenlafaxine, levomilnacipran, milnacipran are what kind of drugs? What are two BETTER KNOWN drugs in this class, whose names are worth being able to regurgitate?

Answer 28

- SNRIs | - venlafazine, duloxetine

Question 29

Of the SNRIs, which has the most DIVERSE use?

Answer 29

-venlafaxine | choose THIS to treat most psych conditions-- other SNRIs may be limited to depression/ pain/ diabetic neuropathy.

Question 30

Most common ADR assc with SNRIs?

Answer 30

HTN

Question 31

Serotonin storm: | What does this look like?

Answer 31

1. Hyperthermia, flushing 2. Myoclonus/ Seizures 3. Cardiovascular instability 4. Diarrhea

Question 32

Treatment for serotonin storm?

Answer 32

-cyproheptadine (5HT2 antagonist)

Question 33

Amitryptyline, nortryptyline are what kind of psych drugs?

Answer 33

-TCAs *others worth reading: imipramine, desipramine, clomipramine (notice the pramine trend), doxepine, amoxapine

Question 34

MOA for TCAs

Answer 34

-block NE/5HT reuptake

Question 35

TCA commonly used in OCD?

Answer 35

-clomipramine

Question 36

What are three non-psych indications for TCA use?

Answer 36

- migraine px - chronic pain - peripheral neuropathy

Question 37

ADRs for TCA are very similar to what other psych drug class?

Answer 37

- typical antipsychtoics (without the parkinsonism) | - blocks a1/ has atropine like ADRs, prolongs QT

Question 38

What are the "three C's" of TCA overdose? | Whats the most common cause of death in TCA overdose? How do you prevent it?

Answer 38

- cardiotox, coma, convulsions | - #1 COD is fast Na channel block --> arrhythmia, give NaHCO3

Question 39

Anticholinergic symptoms assc with TCAs may cause confusion or hallucination in the elderly. Which of the TCAs is LEAST likely to have this effect?

Answer 39

-nortyptilline

Question 40

What are the four MAOis? | Which is MAO-B specific?

Answer 40

- MAO Takes Pride In Shanghai - trancyclopromine - phenelzine - isocarboxazaid - selegiline (MAO-B only, parkinsons)

Question 41

What are two most noteworthy ADRs assc with MAOis?

Answer 41

- serotonin storm with any drug that also causes ^^^ 5HT - stop this drug TWO WEEKS before starting another that will ^^5HT - hypertensive crisis w/ tyramine (wine, cheese)

Question 42

What three NTs are ^^^ in response to MAOis?

Answer 42

-^^ NE,Dopa, 5HT

Question 43

Buproprion: MOA Special benefit Use

Answer 43

- ^^NE, Dopa only-- not 5HT - no sexual ADRs - used for depression and also smoking cessation

Question 44

Varenicline: MOA | Use, ADR

Answer 44

- nicotinic Ach receptor partial agonist - used for smoking cessation - causes sleep changes

Question 45

Mirtazapine, a weird antidepressant, has several MOAs. List them. Sorry, Just try.

Answer 45

- a1 antagonist --> ^^ NE, 5HT - 5HT2/3 antagonist - H1 antagonist

Question 46

Trazadone MOA + use

Answer 46

- blocks 5HT2, a1, H1 receptors + weakly blocks 5HT reuptake - treats insomnia + ED (traZZZZaBONE)