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Flashcards in Psychiatry - Pharmacology Deck (93)
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1
Q

What is the drug class of choice for treating anorexia and bulimia?

A

Selective serotonin reuptake inhibitors

2
Q

What are the three first-line drug classes for the treatment of anxiety?

A

Selective serotonin reuptake inhibitors, benzodiazepines, and buspirone

3
Q

What are the three first-line drugs (all mood stabilizers) for the treatment of bipolar disorder?

A

Lithium, valproic acid, and carbamazepine; atypical antipsychotics can also be used

4
Q

What are the three first-line drug classes for the treatment of depression?

A

Serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, and tricyclic antidepressants

5
Q

A patient presents with depressed mood, decreased interest, decreased appetite, and poor sleep. He reports sleeping only approximately 3 hours a night. What are two treatment options for this patient?

A

Trazodone and mirtazapine; both are sedating antidepressants

6
Q

What two drug classes are used in the treatment of atypical depression?

A

Monoamine oxidase inhibitors and selective serotonin reuptake inhibitors

7
Q

What drug classes are used in the treatment of panic disorder?

A

Selective serotonin reuptake inhibitors, tricyclic antidepressants, and benzodiazepines

8
Q

What two drugs or drug types are used in the treatment of obsessive-compulsive disorder?

A

Selective serotonin reuptake inhibitors and clomipramine

9
Q

What is the drug class of choice for the treatment of schizophrenia?

A

Antipsychotics; typical or atypical

10
Q

What is the treatment for Tourette's syndrome?

A

Antipsychotics; often haloperidol

11
Q

What are the two drugs (one is a drug class) used to treat attention-deficit hyperactivity disorder?

A

Methylphenidate and amphetamines

12
Q

A Vietnam War veteran presents with flashbacks, nightmares, and avoidance of his closet where his wife keeps his uniform. What is a treatment option for this patient?

A

Selective serotonin reuptake inhibitors could be used to treat his posttraumatic stress disorder

13
Q

Explain the mechanism of action of methylphenidate.

A

It increases presynaptic norepinephrine vesicular release (like amphetamines) and is used to treat attention-deficit hyperactivity disorder

14
Q

Name the typical antipsychotics

A

Thioridazine, haloperidol, fluphenazine, trifluoperazine, and chlorpromazine

15
Q

How do antipsychotics cause galactorrhea?

A

Dopamine receptor antagonism releases inhibition on the prolactin-secreting cells of the pituitary

16
Q

Approximately 4 weeks ago, a patient started taking a neuroleptic medication. She now states that she is unable to sit still and that she has a desire to be constantly fidgeting and moving. What adverse effect is she experiencing?

A

Akathisia

17
Q

What adverse effect of neuroleptic medications is characterized by the inability to initiate purposeful movement?

A

Akinesia

18
Q

What are the symptoms of acute dystonia? When does dystonia develop after use of neuroleptics?

A

Abnormal muscle contractions and involuntary twisting movements; it usually develops 4 hours after drug administration

19
Q

Typical antipsychotics block which receptors?

A

D2-dopamine receptors

20
Q

What extrapyramidal adverse effect of neuroleptics is irreversible?

A

Tardive dyskinesia

21
Q

A patient presents with rigidity, myoglobinuria, autonomic instability, and hyperpyrexia after recently starting a medication for schizophrenia. What adverse effect is this patient experiencing?

A

Neuroleptic malignant syndrome; he should be treated with dantrolene and bromocriptine

22
Q

The antimuscarinic effects of neuroleptics cause what adverse effects?

A

Dry mouth and constipation

23
Q

The antihistamine effects of neuroleptics cause what adverse effect?

A

Sedation

24
Q

Blockade of the α-receptors by neuroleptics cause what adverse effect?

A

Hypotension

25
Q

What is the treatment for neuroleptic malignant syndrome?

A

Dopamine agonists and dantrolene

26
Q

Which neuroleptics are low-potency drugs with a low incidence of neurologic adverse effects?

A

Thioridazine and chlorpromazine

27
Q

Which neuroleptics are high-potency drugs with neurologic adverse effects?

A

Haloperidol, fluphenazine, and trifluoperazine

28
Q

Place the following extrapyramidal adverse effects of neuroleptics in the order in which they occur: akathisia, akinesia, dystonia, tardive dyskinesia.

A

Dystonia (within 4 hours), akinesia (within 4 days), akathisia (within 4 weeks), and tardive dyskinesia (after 4 months)

29
Q

In reference to neuroleptic malignant syndrome, what is the FEVER mnemonic?

A

FEVER: Fever, Encephalopathy, Vitals unstable, Elevated enzymes, Rigidity of muscles

30
Q

Which two neuroleptics cause ocular adverse effects?

A

Thioridazine causes retinal deposits whereas chlorpromazine causes corneal deposits

31
Q

What is the reason for the long half-life of neuroleptics?

A

They are highly lipid soluble, so there is a large volume of distribution; therefore, it takes a long time for them to be removed from the body

32
Q

Name the atypical antipsychotics.

A

Clozapine, olanzapine, and risperidone

33
Q

A patient on haloperidol experiences torticollis and tremor. What is an alternative treatment option?

A

Atypical antipsychotics, because these drugs have a lower risk of extrapyramidal symptoms

34
Q

What blood tests do patients need if they are taking clozapine?

A

They need periodic complete blood cell tests since clozapine can cause agranulocytosis

35
Q

What are the indications for atypical antidepressant use?

A

Schizophrenia, mania, Tourette's syndrome, and obsessive-compulsive disorder

36
Q

Atypical antidepressants useful in treating _____ (positive/negative/both) types of schizophrenia symptoms.

A

Both

typical antipsychotics are useful only in treating positive symptoms

37
Q

What is the most common adverse effect of long-term atypical antipsychotic use?

A

Severe weight gain, which can lead to type II diabetes

38
Q

True or False? Olanzapine is contraindicated in the treatment of mania.

A

FALSE

olanzapine can be used to treat mania

39
Q

Atypical antipsychotic medications block what type of receptors in addition to dopamine receptors?

A

5-hydroxytryptamine2, α, H1

40
Q

Lithium is primarily used to treat patients with what psychiatric diagnosis?

A

Bipolar disorder

41
Q

A patient with a history of bipolar disorder, controlled with lithium, presents with massively increased urination and thirst. Can this patient be treated with exogenous antidiuretic hormone?

A

No, this patient is suffering from nephrogenic diabetes insipidus secondary to lithium use, which will not respond to antidiuretic hormone

42
Q

In what population is lithium absolutely contraindicated?

A

Pregnant women

43
Q

What lab test should be ordered on a patient taking lithium who complains of lethargy, constipation, and feeling cold?

A

Thyroid-stimulating hormone test; lithium can cause hypothyroidism

44
Q

What might be seen on an electrocardiogram of a patient taking lithium?

A

Electrocardiogram consistent with heart block

45
Q

What are the toxicities of lithium use?

A

Tremor, nephrogenic diabetes insipidus, hypothyroidism, teratogenicity (remember: LMNOP to recall Lithium adverse effects, Movement [tremor], Nephrogenic diabetes insipidus, HypOthyroidism, Pregnancy problems)

46
Q

What is the mechanism of action of buspirone (a psychiatric medication)?

A

It stimulates serotonin receptors (class 1A receptors)

47
Q

What is buspirone used for clinically?

A

Anxiolysis; it is commonly used to treat generalized anxiety disorder

48
Q

What adverse effects are avoided with use of buspirone?

A

Sedation, addiction, and tolerance, which are seen with benzodiazepines and barbiturates

49
Q

True or False? Patients treated with buspirone must avoid alcohol.

A

FALSE

buspirone does not interact with alcohol, but most other treatments for anxiety (eg, barbiturates, benzodiazepines) do

50
Q

Do monoamine oxidase inhibitors work on noradrenergic neurons, serotonergic neurons or both?

A

Both

51
Q

Both tricyclics and maprotiline act on which type of neuron?

A

Noradrenergic

52
Q

Selective serotonin reuptake inhibitors and trazodone act on which type of neuron?

A

Serotonergic

53
Q

Mirtazapine acts on what type of neuron and specifically, which receptor on that neuron?

A

Noradrenergic neuron; α2 receptor

54
Q

Name the tricyclic antidepressants.

A

Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, and amoxapine

55
Q

A 17-year-old male presents with nocturnal bedwetting. What antidepressant is a treatment option for this patient?

A

Imipramine

56
Q

Which tricyclic antidepressant is specifically indicated for obsessive-compulsive disorder?

A

Clomipramine

57
Q

What are the major toxicities of tricyclic antidepressant overdose?

A

Convulsions, coma, and cadiotoxicity (remember: Tri-C's: Convulsions, Coma, Cardiotoxicity [arrhythmias])

58
Q

An elderly patient presents to the emergency room with delirium associated with hallucinations of her deceased husband. She recently started a new drug for depression. What could cause her presentation?

A

The anticholinergic effects of her depression treatment (tricyclic antidepressant)

59
Q

Tricyclic antidepressants block the reuptake of what two neurotransmitters?

A

Serotonin and norepinephrine

60
Q

What is the least sedating tricyclic antidepressant?

A

Desipramine

61
Q

What adverse effects of tricyclic antidepressants are the result of anticholinergic action?

A

Tachycardia and urinary retention

62
Q

What tricyclic antidepressant should be used in the elderly to treat depression, to lessen the chances of anticholinergic adverse effects?

A

Nortriptyline

63
Q

How is tricyclic antidepressant toxicity treated?

A

Intravenous NaHCO3 to prevent cardiac arrhythmias

64
Q

Name the selective serotonin reuptake inhibitors.

A

Fluoxetine, sertraline, paroxetine, and citalopram

65
Q

Selective serotonin reuptake inhibitors are indicated in the treatment of which conditions?

A

Obsessive-compulsive disorder, bulimia, social phobias, and depression

66
Q

It normally takes how many weeks for an antidepressant to show some clinical benefit?

A

2-3 weeks

67
Q

What are the common adverse effects of selective serotonin reuptake inhibitors?

A

Gastrointestinal upset, sexual adverse effects

68
Q

A patient on treatment for depression presents with a temperature of 105° F and rigidity. What is the treatment for this condition?

A

Cyproheptadine, a serotonin receptor antagonist

69
Q

Which sexual side-effect is seen with selective serotonin reuptake inhibitors?

A

Anorgasmia, the inability to have an orgasm

70
Q

If a person is taking both a selective serotonin reuptake inhibitor and a monoamine oxidase inhibitor, what is the potential serious adverse effect?

A

Serotonin syndrome (muscle rigidity, hyperthermia, and cardiovascular collapse)

71
Q

Name two serotonin-norepinephrine reuptake inhibitors.

A

Venlafaxine, duloxetine

72
Q

What effects do serotonin-norepinephrine reuptake inhibitors have on neurons?

A

Inhibition of serotonin and norepinephrine reuptake

73
Q

What are the indications for venlafaxine?

A

Depression and generalized anxiety disorder

74
Q

What are the indications for duloxetine?

A

Depression and diabetic peripheral neuropathy

75
Q

What are the adverse effects of serotonin-norepinephrine reuptake inhibitors?

A

Increased blood pressure, sedation, nausea

76
Q

Name the monoamine oxidase inhibitors.

A

Phenelzine and tranylcypromine

77
Q

Which drugs must be avoided while taking monoamine oxidase inhibitors to prevent a hypertensive crisis?

A

α-Adrenergic agonists

78
Q

What is the mechanism of action of monoamine oxidase inhibitors?

A

Inhibition of monoamine oxidase prevents breakdown of neurotransmitters

79
Q

To prevent serotonin syndrome, patients should avoid which drugs while taking monoamine oxidase inhibitors?

A

Selective serotonin reuptake inhibitors and meperidine

80
Q

What psychiatric disorders are monoamine oxidase inhibitors used to treat?

A

Atypical depression, anxiety, hypochondriasis

81
Q

What foods must be avoided while on monoamine oxidase inhibitors? Why?

A

Wine and cheese

wine and cheese are high in tyramine that can lead to hypertensive crisis if ingested while taking monoamine oxidase inhibitors

82
Q

Which heterocyclic antidepressant is also used in smoking cessation programs?

A

Bupropion

83
Q

True or False? Sexual adverse effects are major adverse effects of bupropion.

A

FALSE

bupropion is the one heterocyclic antidepressant that does not cause sexual adverse effects

84
Q

Maprotiline, a heterocyclic antidepressant, blocks the reuptake of what substance?

A

Norepinephrine

85
Q

A patient presents with priapism after starting an antidepressant medication for insomnia and depression. What medication is this patient taking?

A

Trazodone, which is a heterocyclic antidepressant

86
Q

Bupropion is contraindicated in what patients?

A

Patients with bulimia or history of seizure disorders

87
Q

Why might a patient complaining of sedation with a prior antidepressant be prescribed bupropion?

A

Bupropion may cause insomnia

88
Q

What neurotransmitter receptors are blocked by mirtazapine?

A

An a2 - and serotonin antagonist

89
Q

What are the adverse effects of mirtazapine?

A

Sedation, increased appetite, weight gain, dry mouth

90
Q

What effect does trazodone have on neurons?

A

Inhibits serotonin reuptake

91
Q

What are the adverse effects of maprotiline?

A

Sedation, orthostatic hypotension

92
Q

Which antidepressant is commonly used for insomnia?

A

Trazodone

93
Q

What are the adverse effects of trazodone?

A

Sedation, nausea, priapism, postural hypotension