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Chen-Ching board review > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What region of the brain has been found to be hypometabolic in depression?

Hypermetabolic?

A

HypOmetabolic: Dorsolateral prefrontal cortex

HypERmegtabolic: Orbitofrontal cortex

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2
Q

What does MAO-A break down?

MAO-B?

A

MAO-A: Serotonin, dopamine, NE, tyramine
MAO-B: more selective for dopamine (also others including benzylamine and phenethylamine)

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3
Q

What amino acid are catecholamines derived from?

A

Tyrosine

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4
Q

Brain region most responisble for producing serotonin

A

Dorsal raphe (midbrain and pons

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5
Q

What receptors do triptans act at?

What non-neurologic effect do they have?

A

5-HT_1B and 5-HT_1D agonists

Vasoconstriction

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6
Q

Mechanism of action of ondansetron

A

5-HT3 receptor antagonist (this receptor is in the area postream)

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7
Q

Effects of serotonin outside the brain

A
  1. Vasoconstriction (5HT_1B and 5HT_1D)
  2. Platelet aggregation (5-HT_2A)
  3. Increased GI motility
  4. Bronchoconstriction
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8
Q

SSRIs with the least drug interactions

A

Citalopram and escitalopram (sertraline is also good)

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9
Q

Dopaminergic pathways. From where to where?

A
  1. Mesolimbic: midbrain to limbic system
  2. Mesocortical: midbrain to neocortex
  3. Nigrostriatal (SNc -> striatum)
  4. TUbuloinfundiblar (hypothalamus -> pituitary where inhibits prolactin release)
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10
Q

What receptors do TCAs act at other than serotonin?

A

Muscarinic
Alpha1-adrenergic
Histaminergic
(To varying degrees across medication)

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11
Q

Effect of TCAs on the bladder

A

Inhibit detrusor function and can lead to urinary retention (via antimuscarinic effects)

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12
Q

Which SSRI has the most anticholinergic activity

A

Paroxetine (so can lead to xerostomia and urinary retention)

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13
Q

Which first-generation antipsychotics have less antidopaminergic effects and more effects on muscarinic, adrenergic, and histaminergic receptors?

A

Chlorpromazine and thioridazine

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14
Q

What is another “high potency” first-generation antipsychotic, in addition to haloperidol?

A

Fluphenazine

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15
Q

Buspirone mechanism of action

A

5-HT_1A partial agonist (also some D2 antagonism)

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16
Q

What electrolyte effect can SSRIs have?

Which SSRIs are most prone to this?

A

Hyponatremia (especially in older individuals and those on diuretics)

Paroxetine and fluoxetine

17
Q

What receptor does baclofen act at?

What type of receptor is this?

A

GABA_B agonist

Inhibitory GPCR (Gi) (Metabotropic)

(GABA_A, benzo target, is ionotropic and opens Cl- channels)

18
Q

What receptor do benzos act at?

What type of receptor is this?

A

GABA_A agonist

Ionotropic (opens Cl- channels)

(GABA_B, baclofen target, is metabotropic GPCR, Gi)

19
Q

Mirtazapine mechanism of action

A

Mixed:
1. Alpha-2 antagonism (leads to increased serotonin and NE release)
2. Antagonism at 5-HT2A, 5-HT2C, and 5-HT3 (but not 5-HT1 receptors, so these are still stimulated)
3. Antihistaminergic (sleep effect)

20
Q

Receptor targets of trazodone

A
  1. 5-HT antagonism
  2. Antihistamine (sleep effect)
  3. Alpha1 antagonist
    (Also weakly inhibits serotonin reuptake)
21
Q

Which 2nd-gen antipsychotics are most and least likely to lead to weight gain?

A

Most: Clozapine and olanzapine
Least: Aripiprazole and ziprasidone
(Seroquel is in between)

22
Q

Which antipsychotic is least likely to lead to QT prolongation?

A

Aripiprazole

23
Q

Rare side effects of clozapine

A
  1. Myocarditis
  2. Agranulocytosis
24
Q

Antipsychotic associated with increased seizure risk

A

Clozapine (and to a lesser extent olanzapine)

25
Q

Antipsychotic with highest antimuscarinic activity

A

Olanzapine
(Clozapine also a lot)

26
Q

Most sedating 2nd-gen antipsychotics

A

Quetiapine and olanzapine

27
Q

Some lithium side effects

A
  1. Tremor
  2. Throid dysfunction
  3. Acne
  4. Nephrogenic DI -> hyperNa
  5. Bradycardia
28
Q

What brain region is a target for TMS in depression?

A

Left dorsolateral prefrontal cortex

29
Q

What is a potential TMS side effect?

A

Seizures

Chen-Ching board review (15 decks)

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