Psychiatry

Question 1

Methylphenidate

Answer 1

CNS stimulant
Increase catecholamines (NE and DA) at synaptic cleft.
ADHD, narcolepsy, appetite control

Question 2

Dextroamphetamine

Answer 2

CNS stimulant
Increase catecholamines (NE and DA) at synaptic cleft.
ADHD, narcolepsy, appetite control

Question 3

Methamphetamine

Answer 3

CNS stimulant
Increase catecholamines (NE and DA) at synaptic cleft.
ADHD, narcolepsy, appetite control

Question 4

Phentermine

Answer 4

CNS stimulant
Increase catecholamines (NE and DA) at synaptic cleft.
ADHD, narcolepsy, appetite control

Question 5

Haloperidol

Answer 5

Typical antipsychotic (neuroleptic)
Block dopamine D2 receptors (increase cAMP)
Schizophrenia (positive symptoms), psychosis, acute mania, Tourette syndrome
Stored in body fat, extrapyramidal side effects, hyperprolactinemia, dry mouth, constipation, hypotension, sedation. Risk of neuroleptic malignant syndrome and tardive dyskinesia.

Question 6

Trifluoperazine

Answer 6

Typical antipsychotic (neuroleptic)
Block dopamine D2 receptors (increase cAMP)
Schizophrenia (positive symptoms), psychosis, acute mania, Tourette syndrome
Stored in body fat, extrapyramidal side effects, hyperprolactinemia, dry mouth, constipation, hypotension, sedation. Risk of neuroleptic malignant syndrome and tardive dyskinesia.

Question 7

Fluphenazine

Answer 7

Typical antipsychotic (neuroleptic)
Block dopamine D2 receptors (increase cAMP)
Schizophrenia (positive symptoms), psychosis, acute mania, Tourette syndrome
Stored in body fat, extrapyramidal side effects, hyperprolactinemia, dry mouth, constipation, hypotension, sedation. Risk of neuroleptic malignant syndrome and tardive dyskinesia.

Question 8

Thioridazine

Answer 8

Typical antipsychotic (neuroleptic)
Block dopamine D2 receptors (increase cAMP)
Schizophrenia (positive symptoms), psychosis, acute mania, Tourette syndrome
Stored in body fat, extrapyramidal side effects, hyperprolactinemia, dry mouth, constipation, hypotension, sedation. Risk of neuroleptic malignant syndrome and tardive dyskinesia.

Question 9

Chlorpromazine

Answer 9

Typical antipsychotic (neuroleptic)
Block dopamine D2 receptors (increase cAMP)
Schizophrenia (positive symptoms), psychosis, acute mania, Tourette syndrome
Stored in body fat, extrapyramidal side effects, hyperprolactinemia, dry mouth, constipation, hypotension, sedation. Risk of neuroleptic malignant syndrome and tardive dyskinesia.

Question 10

Olanzapine

Answer 10

Atypical antipsychotic
Varied effects on 5HT2, DA, α, and H1 receptors.
Schizophrenia (positive and negative symptoms), bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome.
Fewer extrapyramidal and anticholinergic side effects than typical antipsychotics. Significant weight gain.

Question 11

Risperidone

Answer 11

Atypical antipsychotic
Varied effects on 5HT2, DA, α, and H1 receptors.
Schizophrenia (positive and negative symptoms), bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome.
Fewer extrapyramidal and anticholinergic side effects than typical antipsychotics. Hyperprolactinemia leading to lactation, gynecomastia, decreases in GnRH, LH, and FSH leading to irregular menstruation and fertility issues.

Question 12

Clozapine

Answer 12

Atypical antipsychotic
Varied effects on 5HT2, DA, α, and H1 receptors.
Schizophrenia (positive and negative symptoms), bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome.
Fewer extrapyramidal and anticholinergic side effects than typical antipsychotics. Significant weight gain, agranulocytosis (requires weekly WBC monitoring) and seizure.

Question 13

Aripiprazole

Answer 13

Atypical antipsychotic
Varied effects on 5HT2, DA, α, and H1 receptors.
Schizophrenia (positive and negative symptoms), bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome.
Fewer extrapyramidal and anticholinergic side effects than typical antipsychotics.

Question 14

Quetiapine

Answer 14

Atypical antipsychotic
Varied effects on 5HT2, DA, α, and H1 receptors.
Schizophrenia (positive and negative symptoms), bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome.
Fewer extrapyramidal and anticholinergic side effects than typical antipsychotics.

Question 15

Ziprasidone

Answer 15

Atypical antipsychotic
Varied effects on 5HT2, DA, α, and H1 receptors.
Schizophrenia (positive and negative symptoms), bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome.
Fewer extrapyramidal and anticholinergic side effects than typical antipsychotics. May prolong QT interval.

Question 16

Lithium

Answer 16

Mood stabilizer
Mechanism not established. Possibly related to inhibition of phosphoinositol cascade/interaction with cation transport in CNS.
Bipolar disorder (blocks relapse and acute manic events), SIADH
Tremor, sedation, edema, heart block, hypothyroidism, weight gain, polyuria (ADH antagonist, causes DI), teratogenesis (Ebstein anomaly and malformation of great vessels). Narrow therapeutic window requires close monitoring. Almost exclusively excreted by kidneys.
Early toxicity shows memory impairment, nausea, vomiting, and dysarthria; progresses to ataxia, hyperreflexia, incoordination, blurred visions, and scotoma. Late toxicity shows myoclonus, seizures, and coma.

Question 17

Buspirone

Answer 17

Anxiolytic
Stimulations 5HT1A receptors.
Generalized anxiety disorder.
Does not cause sedation, addiction, or tolerance. Does not interact with alcohol (compared to barbiturates, benzodiazepines). Takes 1-2 weeks to take effect.

Question 18

Fluoxetine

Answer 18

SSRI
5HT-specific reuptake inhibitor.
Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD.
Fewer side effects than TCAs. GI distress, sexual dysfunction (anorgasmia, decreased libido), serotonin syndrome (hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures).

Question 19

Paroxetine

Answer 19

SSRI
5HT-specific reuptake inhibitor.
Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD.
Fewer side effects than TCAs. GI distress, sexual dysfunction (anorgasmia, decreased libido), serotonin syndrome (hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures).

Question 20

Sertraline

Answer 20

SSRI
5HT-specific reuptake inhibitor.
Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD.
Fewer side effects than TCAs. GI distress, sexual dysfunction (anorgasmia, decreased libido), serotonin syndrome (hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures).

Question 21

Citalopram

Answer 21

SSRI
5HT-specific reuptake inhibitor.
Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD.
Fewer side effects than TCAs. GI distress, sexual dysfunction (anorgasmia, decreased libido), serotonin syndrome (hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures).

Question 22

Venlafaxine

Answer 22

SNRI
Inhibits 5HT and NE uptake.
Depression, generalized anxiety disorder, panic disorder.
SSRI side effects plus hypertension, stimulant effects, sedation, nausea, dizziness, diaphoresis.

Question 23

Duloxetine

Answer 23

SNRI
Inhibits 5HT and NE uptake.
Depression, diabetic neuropathy.
SSRI side effects plus hypertension, stimulant effects, sedation, nausea, dizziness, diaphoresis.

Question 24

Amitriptyline

Answer 24

Tricyclic antidepressant
Blocks reuptake of NE and 5HT
Major depression, fibromyalgia.
Sedation, α-1 blocking effects (postural hypotension), anticholinergic/atropine-like side effects (tachycardia, urinary retention, dry mouth). More anticholinergic effects than nortriptyline. Convulsions, coma, cardiac arrhythmias, respiratory depression, hyperpyrexia, confusion and hallucinations in elderly due to anticholinergic effects.

Question 25

Nortriptyline

Answer 25

Tricyclic antidepressant Blocks reuptake of NE and 5HT Major depression, fibromyalgia. Sedation, α-1 blocking effects (postural hypotension), anticholinergic/atropine-like side effects (tachycardia, urinary retention, dry mouth). Fewer anticholinergic effects than amitriptyline. Convulsions, coma, cardiac arrhythmias, respiratory depression, hyperpyrexia, less confusion and hallucinations in elderly than amitriptyline.

Question 26

Imipramine

Answer 26

Tricyclic antidepressant Blocks reuptake of NE and 5HT Major depression, fibromyalgia. Sedation, α-1 blocking effects (postural hypotension), anticholinergic/atropine-like side effects (tachycardia, urinary retention, dry mouth). Convulsions, coma, cardiac arrhythmias, respiratory depression, hyperpyrexia.

Question 27

Despiramine

Answer 27

Tricyclic antidepressant Blocks reuptake of NE and 5HT Major depression, fibromyalgia. Sedation, α-1 blocking effects (postural hypotension), anticholinergic/atropine-like side effects (tachycardia, urinary retention, dry mouth). Convulsions, coma, cardiac arrhythmias, respiratory depression, hyperpyrexia. Less sedating but has higher seizure incidence.

Question 28

Clomipramine

Answer 28

Tricyclic antidepressant Blocks reuptake of NE and 5HT Major depression, fibromyalgia, OCD. Sedation, α-1 blocking effects (postural hypotension), anticholinergic/atropine-like side effects (tachycardia, urinary retention, dry mouth). Convulsions, coma, cardiac arrhythmias, respiratory depression, hyperpyrexia.

Question 29

Doxepin

Answer 29

Tricyclic antidepressant Blocks reuptake of NE and 5HT Major depression, fibromyalgia. Sedation, α-1 blocking effects (postural hypotension), anticholinergic/atropine-like side effects (tachycardia, urinary retention, dry mouth). Convulsions, coma, cardiac arrhythmias, respiratory depression, hyperpyrexia.

Question 30

Amoxapine

Answer 30

Tricyclic antidepressant Blocks reuptake of NE and 5HT Major depression, fibromyalgia. Sedation, α-1 blocking effects (postural hypotension), anticholinergic/atropine-like side effects (tachycardia, urinary retention, dry mouth). Convulsions, coma, cardiac arrhythmias, respiratory depression, hyperpyrexia.

Question 31

Tranylcypromine

Answer 31

MAOI Nonselective MAO inhibition which increases levels of NE, 5HT, and DA Atypical depression, anxiety, hypochondriasis Hypertensive crisis (ingestion of tyramine in wine/cheese), CNS stimulation. Contraindicated with SSRIs, TCAs, St. John's Wort, meperidine, and dextromethorpan (prevent serotonin syndrome). Relatively safe cardiac profile.

Question 32

Phenelzine

Answer 32

MAOI Nonselective MAO inhibition which increases levels of NE, 5HT, and DA Atypical depression, anxiety, hypochondriasis Hypertensive crisis (ingestion of tyramine in wine/cheese), CNS stimulation. Contraindicated with SSRIs, TCAs, St. John's Wort, meperidine, and dextromethorpan (prevent serotonin syndrome). Relatively safe cardiac profile.

Question 33

Isocarboxazid

Answer 33

MAOI Nonselective MAO inhibition which increases levels of NE, 5HT, and DA Atypical depression, anxiety, hypochondriasis Hypertensive crisis (ingestion of tyramine in wine/cheese), CNS stimulation. Contraindicated with SSRIs, TCAs, St. John's Wort, meperidine, and dextromethorpan (prevent serotonin syndrome). Relatively safe cardiac profile.

Question 34

Selegiline

Answer 34

MAOI Selective MAO-B inhibition which increases levels of NE, 5HT, and DA Atypical depression, anxiety, hypochondriasis Hypertensive crisis (ingestion of tyramine in wine/cheese), CNS stimulation. Contraindicated with SSRIs, TCAs, St. John's Wort, meperidine, and dextromethorpan (prevent serotonin syndrome). Relatively safe cardiac profile.

Question 35

Bupropion

Answer 35

Atypical antidepressant Increases NE and DA via unknown mechanism. Depression, smoking cessation. Stimulant effects (tachycardia, insomnia), anxiety, dizziness, agitation, headache, seizures at high doses and in bulimic patients. No sexual side effects. Should not be used in patients who have abruptly stopped using CNS depressants.

Question 36

Mirtazapine

Answer 36

Atypical antidepressant Alpha-2 antagonist, increasing release of NE and 5HT, and potent 5HT2 and 5HT3 receptor antagonist. Depression with insomnia, anorexia nervosa Sedation, increased appetite, weight gain, dry mouth.

Question 37

Trazodone

Answer 37

Atypical antidepressant Blocks 5HT2 and α-1 receptors. Insomnia. High doses needed for antidepressant effects. Sedation, nausea, priapism, postural hypotension.