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Brain Power: Neuropharmacology > Psychiatry > Flashcards

Psychiatry Flashcards

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1
Q

Differentiate old and new generation anti-psychotics based on the receptors that they affect.

A

Old gen: D2 receptor affinity

new gen: 5HT2 receptor affinity

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2
Q

Classify if new or old gen

  1. Chlorpromazine
  2. Fluphenazine
  3. Risperidone
  4. Quetiapine
  5. Clozapine
  6. Thioridazine
A

In general newer agents either end in -apine or -done

  1. Chlorpromazine: Old
  2. Fluphenazine: Old
  3. Risperidone: New
  4. Quetiapine: New
  5. Clozapine: New
  6. Thioridazine: Old
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3
Q

Which among the antipsychotics are also effective for bipolar disordes?

A

Olanzapine

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4
Q

What is the general drug class of the ff:

  1. Haloperidol
  2. Chlorpromazine
  3. Fluphenazine
A
  1. Butyrophenones
    2 and 3. Phenothiazines

These drugs can cause durg induced parkinsonism

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5
Q

Based on the dopamine hypothesis how would levodopa affect psychotic patients?

A

Ldopa would exacerbate psychosis by stimulation of the dopamine receptors

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6
Q

What is the only antipscyhotic with NO EFFECT on the H1 receoptor?

A

Haloperidol

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7
Q

Indicated the function of these dopamine utilizing pathways in the brain:

  1. Mesocortical mesolimbic pathways
  2. Tuberoinfundibular pathways
  3. Chemoreceptor trigger zone
  4. Nigostriatial tract
A
  1. Mentation and mood
  2. Control of prolactin release
  3. Emesis
  4. Extrapyramidal function

Pathway #1 is the desired target for psychotic medications old gen

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8
Q

What newer antispsychotics has an almost equal effect on D2 and 5-HT2?

A

Risperidone and Ziprasidone

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9
Q

What symptoms of schizophrenia are not too affected by older gen antipsychotics?

A

Negative symptoms of emotional blunting, social withdrawal and lack of motivation

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10
Q

What are the possible treatment options for extrapyramidal effects of antipsychotics?

A

Muscarinic blockers and diphenhydramine

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11
Q

When do tardive dyskinesias occur?

A

After years of using antipsychotics but can be as early as 6 years

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12
Q

Which of the antipsychotics have has the strongest autonomic effects?

A

Thioridazine and Clozapine have strong effects due to blocakde of muscarinic receptorsa nd alpha adrenoreceptors– atropine like effects: dry mouth, constipation, retention and visual problems

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13
Q

What side effects should be expected from antipsychotics because of their effect on the tuberoinfundibular dopamine pathway?

A

Hyperprolactinemia, gynecomastia, and amenorrhea galactorrhea syndrome

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14
Q

Why does aripiprazole not have common Dopamine blocking side effects?

A

The newer antipsychotic agent aripiprazole is A PARTIAL AGONIST AT D2 and 5-HT1A receptors but is a strong antagonist at 5-HT2A receptors.

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15
Q

What drug is mainly used to treat neuroleptic malignant syndrome?

A

Dantrolene

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16
Q

Block on the alpha adrenoreceptors by antispychotics cause what adverse event that increases fall risk?

A

Orthostatic hypotension

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17
Q

What cardiac adverse effect can be expected with the new generation antipsychotics like quetiapine and ziprasidone?

A

Prolongation of QT interval

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18
Q

Why do blood counts need to be monitored for clozapine?

A

The drug can cause agranulocytosis

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19
Q

How do the ff drugs affect lithium levels: NSAIDS, ACEi, thiazides

A

They can increase lithium to toxic levels

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20
Q

What is the half life of Lithium

A

20h

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21
Q

Which symptoms of bipolar disorder is more affected by lithium?

A

Mania that’s why it is usually give with antidepressants as well

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22
Q

What is the renal adverse effect associated with lithium?

A

Nephrogenic diabetes insipidus

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23
Q

What other drug has antimanic effects equivalent to lithium?

A

Valproic acid

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24
Q

How long after drug initiation should you expect effects of lithium to kick in?

A

1-2 weeks

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25
How can thiazides affect lithium levels?
it is a distal tubule diuretic resulting in natriuresis and a reflex increase in in the proximal tubule reabsorption
26
What other drugs besides VA and Lithium can be used for bipolar disorder?
Olanzapine and quetiapine
27
What antipsychotic can cause retinal deposits?
Thrioridazine
28
Identify the mechanism of action of the following antidepressants: 1. Escitalopram 2. Trazodone 3. Duloxetine 4. Bupropion 5. Amitiptyline 6. Tranylcypromine
1. Escitalopram SSRI 2. Trazodone Serotonin antagonist 3. Duloxetine Serotonin Norepinephrine reuptake inhibitors 4. Bupropion Hetetrocyclic antidepressants 5. Amitiptyline Tricyclic antidepressants 6. Tranylcypromine MAO inhibitors
29
What ist he amine hypothesis of mood?
Increased levels of NE and 5HT results in mood elevation and vice versa
30
Why is there a once weekly formulation of fluoxetine?
Because it forms an active metabolite with a half life of several days
31
Differentiate MAO A and MAO B based on the transmitters that they metabolize.
MAO A Norepinephrine, serotonin and tyramine | MAO B Dopamine
32
How do nefazodone and trazodone work?
They inhibit serotonin receptors by blocking these-- this CONTRADICTS the amine hypothesis of moood!
33
How do venlafaxine and duloxetine work?
they bind to transporters for both serotonin and NE enhancing the acitons of both transmitters
34
How do escitalopram, fluoxetine and sertraline work? How about duloxetine?
E F S: They are SSRI | D: SNRI! Similar mechanism to TCA's! But structure is different
35
How do imipramine and amitryptyline work?
They are TCA-- they inhibit the reuptake of NE and Serotonin
36
What is the special MOA of Mirtazapine?
It antagonizes the presynaptic alpha 2 adrenoreceptors involved in feedback inhibition
37
What class of antidepressants cause sedation?
TCA's Mirtazapine and 5HT2 receptor antagonists: nefadozone and trazodone
38
What class of antidepressants cause stimulation?
SSRIs (fluoxetine, escitalopram, sertraline) and MAOi (Tranylcypromine)
39
What 2 classes of antidepressants lower seizure threshold?
TCAs (imipramine, amitriptyline) and MAOi (tranylcypromine)
40
Which group of antidepressants cause weight loss? How about weight gain?
LOSS: SSRI's (Fluoxetine, Escitalopram, Sertraline) GAIN: Mirtazapine
41
Which antidepressants have evidence for neuropathic pain?
SNRI duloxetine | TCA amitriptyline
42
Which antidepressant have evidence for quitting smoking?
Bupropion-- a heterocyclic with uncertain MOA
43
Which group of antidepressants have the following atropine like effects? Dry as a bone, mad as a hatter, red as beet, hot as a hare, blind as a bat
TCA's (amitriptyline, imipramine) and mirtazapine due to strong M receptor blockade
44
What are the 3 C's of TCA toxicity?
Coma, Convulsions, Cardiotoxicity
45
A patient on these drugs: MAOi, SSRI and TCA's develop myoclonus, rigidity, hyperthermia, cardiovascular instability, seizures, what happened?
The patient developed Serotonin syndrome
46
Withdrawal of which antidepressant can cause severe withdrawal symptoms even after missing a single dose?
Venlafaxine SNRI
47
Why should patients on MAOi be cautious in eating aged cheese, cured meats like sausages and salami, fava beans?
Because these food contain tyramine, an indirect sympathomimetic --> Hypertensive crises might occur
48
What group of antidepressants causes jitters hence are best taken in the morning?
SSRI Escitalopram
49
Can dialysis be used to take out OD of TCA's?
NO. But bicarbonate and potassium can be given for acidosis and hypokalemia
50
Why can't fluoxetine be given with tamoxifen
It inhibits CYP2D6 so lower active tamoxifen
51
Re: Anti-psychotics 1. What class of drugs end in -apine and -done? Give 2 examples 2. What class of drugs end in -zine and -dol? Give 3 examples 3. Enumerate all the bipolar drugs used besides lithium?
1. New agents with 5HT2 receptor affinity: Clozapine, Olanzapine, Quetiapine, Risperidone, Ziprasidone 2. Old classic drugs with D2 receptor affinity: Haloperidol, Chlorpromazine, Thioridazine, Flulphenazine, Trifluoperazine, Perphenazine 3. Valproic acid, Carbamazepine, Olanzapine, clonazepam
52
What is the effect of amphetamines and levodopa on psychotic individuals? Why?
Exacerbate psychotic symptoms. The dopamine hypothesis of schizophrenia states that there is an excess in the functional functional activity of dopamine.
53
What are the MOA of aripiprazole on D2, 5HT1A, 5HT2A?
Partial agonist at D2 and 5HT1A and a strong antagonist at 5HT-2A
54
What is the only anti-psychotic that DOES NOT block the H1 receptor to some degree?
Haloperidol
55
What is the MOA of Clozapine?
D4 and 5HT2 blocking WITH NO AFFINITY FOR D2 receptors
56
T or F: Almost all anti-psychotics block alpha 1 a1 and histamine H1 receptors to some extent?
T
57
What are the 4 dopaminergic tracts? Explain how anti-psychotics affect each one.
1. Mesocortical mesolimbic: regulating mentation and mood-- responsible for antipsychotic effects 2. Nigrostriatal tract: extrapyramidal dysfunction 3. Tuberoinfundibular pathways: control of prolactin release-- responsible for hyperprolactinemia in some drugs; Will also cause gynecomastia, amenorrhea galactorrhea as a result 4. Chemoreceptor trigger zone: emesis-- responsible for the antimemetic properties of some drugs
58
What are the only 2 antipsychotics with D4 blocking?
Clozapine and aripiprazole
59
Which drug has the strongest muscarinic blocking effect?
Thioridazine 2nd is Clozapine but all have some blocking effects
60
What are the two advantages in the use of newer anti-psychotics?
With effect on the negative symptoms Less extra-pyramidal symptoms BUT MORE EXPENSIVE
61
Which anti-psychotics are approved maintenance for bipolar disorder?
Aripiprazole and Olanzapine
62
What are the indications for the use of Molindone besides its use as an antipsychotic?
Tourette's syndrome | Undersocialized conduct disorder
63
What is the only phenothiazine without anti-emetic property?
Thioridazine
64
Re: tardive dyskinesia: choreoathetoid movements of lips and buccal cavity T or F 1. Can be attenuated temporarily by increasing neuroleptic dose 2. Can be halted by giving antimuscarinics like in other extrapyramidal effects
1. T | 2. F
65
How do older drugs such as phenothiazenes cause atropine-like effects (dry mouth, constipation, urinary retention, visual problems), postural hypotension and sexual dysfunction? Which new anti-psychotic has the same intensity of adverse effects?
Peripheral blockade of muscarinic receptors Alpha receptor blockade: atropine life effects and failure to ejaculate Clozapine has strong M and alpha block as well. Aripiprazole has strong alpha block as well but NO M block
66
T or F Hyperglycemia and weight gain are diabetogenic effects of anti-psychotics.
Most with clozapine and olanzapine Aripiprazole and ziprasidone have LITTLE OR NO TENDENCY to causes these
67
Which anti-pyschotics are the most likely cause the ff: 1. prolonged QT: 2. agranulocytosis: 3. visual impairments from retinal deposits:
1. prolonged QT: the atypicals especially quetiapine and ziprasidone 2. agranulocytosis: clozapine 3. visual impairments from retinal deposits: thioridazine
68
What is the half life of lithium? What is the target therapeutic plasma concentration? Maintenance concentration?
20h 0. 8-1.2mEq/L 0. 4-0.7mEq/L
69
What are the adverse effects of Lithium?
1. Nephrogenic DI 2. Ebstein's anomaly (cardiac) if used during pregnancy-- PREGANANCY CATEGORY D 3. Edema 4. Acne 5. Leukocytosis
70
How is lithitum eliminated? What drugs increase clearance?
Renal | NSAIDs and thiazides
71
What is the MOA of the ff: 1. Duloxetine 2. Fluoxetine 3. Venlafaxine 4. Nefadozone 5. Tradozone
1. Duloxetine: 5HT and NE reupotake inhibitor 2. Fluoxetine: SSRI 3. Venlafaxine: 5HT and NE reupotake inhibitor 4. Nefadozone: Serotonin antagonist 5. Tradozone: Serotonin antagonist
72
What is the MOA: 6. Buproprion 7. Mirtazapine 8. Clomipramine 9. Amitriptyline 10. Phenelzine 11. Tranylcypromine
6. Buproprion: Heterocyclic antidepressant 7. Mirtazapine: Heterocyclic antidepressant-- blocks the alpha 2 adrenoreceptor involved in feedback inhibition of norepinephrine release 8. Clomipramine: TCA 9. Amitriptyline: TCA 10. Phenelzine: MAOi 11. Tranylcypromine: MAOi
73
What are the functions of MAO A and MAO B?
A: metabolizes NE, 5HT, tyramine B: metabolizes dopamine Selegiline is selective for B for dopamine
74
How do SNRIs differ from TCAs?
While both NE and 5HT is increased in the synaptic junction they DONT HAVE BLOCKING EFFECTS ON H1 AND Alpha receptors
75
``` Which of these are sedating and which are CNS stimulating? TCAs Mirtazapine 5HT2 receptor antagonists MAOIs SSRIs Buproprion ```
Sedating TCA Mirtazapine 5HT2 receptor antagonists Stimulating MAOIs SSRIs Buproprion
76
What antidepressant can be used for weaning off nicotine dependence?
Bupropion
77
What are the 3 Cs of TCA toxicity?
Come Convulsions Cardiotoxicity
78
What 2 antidepressants when taken together can cause serotonin syndrome?
MAOIs and SSRIs A serotonin syndrome was first described for an interaction between fluoxetine and an MAOI (see later discussion). This life-threatening syndrome includes severe muscle rigidity, myoclonus, hyperthermia, cardiovascular instability, and marked CNS stimulatory effects, including seizures.
79
Which is the most sedating antidepressant with the strongest muscarinic receptor block?
Amitriptyline
80
Which group of anti-depressants have NO sedating or muscarinic receptor blockade?
SNRIs and SSRIs

Brain Power: Neuropharmacology (5 decks)

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