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Flashcards in Psychopharmacology Deck (138)
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1

This is the thought that the lack of 5-HT and NE results in depression, so replacement of these NT's will reduce depression

Amine hypothesis

2

All major anti-depressants except for which drug will work on the amine hypothesis?

Buproprion

3

True or False: all anti-depressants have a LONG latency, so they typically dont work right away.

True

4

What % of patients fail to respond to treatment with antidepressants?

1/3-1/2

5

Fluoxetine, Paroxetine, Sertraline, Citalopram, Fuvoxamine, and Excitalopram belogn to which drug class?

SSRI

6

What is the advantage of SSRI's over other AD classes (like MAOI's) as far as toxicities?

They do not have the toxicities like TCA's or MAOI's (anti-muscarinic, antihistaminic, and a-adrenroreceptor blocking actions) so theyre better tolerated

7

This is the metabolite of Fluoxetine, has a half life of 7-9 days, and thus extends the time fluoxetine is effective.

Norfluoxetine

8

Sertraline and Paroxetine have pharmacokinetics similar to what other drug class?

TCA's

9

What was the trial that looked at pts with major depression who did not respond to or could not tolerate therapy with 1 SSRI?

STAR*D

10

According to the STAR*D trials, what % of patients had a remission rate using an SSRI?

25%

11

What is the major adverse effect of citalopram, making it contraindicated with cardiac or eating disorders?

prolonged QT itnerval

12

Case: pt presents to the ER with a recent diagnosis of depression and complains of hyperthermia. The patient soon slips into a coma and experiences muscle rigidity, myoclonus, and rapid changes in mental status. What condition is he experiencing?

Serotonin syndrome

13

Giving SSRI's with what other drug class can precipitate Serotonin syndrome?

MAOi's

14

What is the DOC for serotonin syndrome to reverse the Sx?

Cyproheptadine

(5-HT2 antagonist)

15

What is the only SSRI apporved for the use in pediatrics?

Fluoxetine (prozac)

16

What must you monitor in kids taking prozac, because of the increased risk of suicide during the first weeks of Tx?

Mood

17

Case: a patient presents to you with depression and you consider starting him on pharmacotherapy. What other condition might be an indicator to use Bupropion?

A. Bulemia
B. Concurrent CAD
C. 20-pack year smoking Hx
D. Insomnia
E. Migrane

C. Smoking Hx

Bupropion slaps both depression and smoking in the face. The other answers are contraindications to use Bupropion.

18

True or False: Unfortunately, as with other antidepressants, Bupropion has a side effect of sexual dysfunction.

FALSE

There is NO sex side effects with buproprion

19

Which of the SSRI has the following antagonism to the receptors?

Sedative- +
Antimuscarinic- +
Serotonin- +++
NE- 0,+
DA- 0,+

Fluoxetine

20

Which of the SSRI's has the following antagonism to the receptors?

Sedative- +
Antimuscarinic- 0
Serotonin- +++
NE- 0
DA- 0

Sertraline

21

Which of the TCA's (Protriptyline, imipramine, Amtryptyline, Desipramine) has the following antagonism to the receptors?

Sedative- +++
Antimuscarinic- +++
Serotonin- +++
NE- +
DA- 0

Amitriptyline

22

Which of the TCA's (Protriptyline, imipramine, Amtryptyline, Desipramine) has the following antagonism to the receptors?

Sedative- +
Antimuscarinic- +
Serotonin- 0
NE- +++
DA- 0

Desipramine

23

Which of the TCA's (Protriptyline, imipramine, Amtryptyline, Desipramine) has the following antagonism to the receptors?

Sedative- ++
Antimuscarinic- ++
Serotonin- +++
NE- ++
DA- 0

Impiramine

24

Which of the TCA's (Protriptyline, imipramine, Amtryptyline, Desipramine) has the following antagonism to the receptors?

Sedative- 0
Antimuscarinic- ++
Serotonin- ?
NE- +++
DA- ?

Protriptyline

25

What does Bupropion do the antagonism to the receptors?

Sedative
Antimuscarinic
Serotonin
NE
DA

Sedative- 0
Antimuscarinic- 0
Serotonin- +,0
NE- +,0
DA- ?

26

What is the drug class that has a lot of side effects, like antimuscarinic, anti-a-adrenergic, and antihistaminergic (drowsiness)?

TCAs

27

What is the typical STARTING dose for TCAs?

Low doses (~100mg/day for inpatient and 10-75mg/day for outpatient)

28

How much do you increase the TCA's dose every 2-3 weeks?

25mg

29

All TCA's end in what 2 suffixes, except for doxpin and amoxapine?

-iptyline or -ipramine

30

What are the Sx of TCA OD?

Coma with acidosis, respiratory depression, agitation, seizures, bowel-bladder paralysis, cardiac arrhythmias

(Tri-C's = Convulsions, Coma, Cardiotoxicity)

31

What is the DOC for TCA OD?

NaHCO3

32

If a patient tries to commit suicide with TCA's, what 2 things must u do to avoid OD again?

1. Prescription for < 1.25g or 50 dose units with no refill
2. Entrust drug to relative

33

What are the 3 adjunctive therapies to antidepressants?

Li
Thyroid H's
Atypical anti-psychotics

34

What are the 5 "D's" of AD treatment?

Diagnosis (is the pt actually depressed?)
Drug (would a different AD work better?)
Dose
Duration
Different Tx (should we try ECT?)

35

What is the condition to which Clomipramine is used for?

OCD

36

To which class of drugs does Clomipramine belong?

TCA

37

Which drug class acts on the the GABA(A) receptors, and increases the frequency of GABA receptor openings?

Benzo's

38

What is the primary indication for Alprazolam?

Panic disorders

39

What is the primary indication for lorazepam?

Generalized Anxiety Disorder

40

What is the primary indication for Meprobamate?

Short-term anxiety and sedative hyponosis

41

What % must you taper off a benzo per week until the dose is 50% of the original?

25%

42

Once the dose reaches 50% of the original dose while you taper a benzo, what amount do you decrease the dose?

↓ 1/8 dose every 4-7 days

43

Which type of patient is Meprobamate a contraindication?

Pregnant ladies cuz it's a teratogen

44

What receptors does Azapirones act on, which inhibits serotonin release?

5HT1A

45

What is the main indication for Buspirone?

Generalized anxiety disorder

"I'm always anxious if the BUS will be ON time, so I take BUSpirONe."

46

In terms of side effects, what is the advantage of Buspirone over Benzos?

No sedation, addiction, tolerance, or interaction with alcohol.

47

What is the site of Z-hyponotics action?

GABA(A) typ`e 1 receptors

48

Sedative actions, anterograde amnesia, exhaustion, and intoxication are all Sx of intoxication to what drug class?

Benzo's

49

During which trimester is the fetus at risk of congenital malformations if mom uses a benzo?

1st trimester

50

After what time of prolonged use does dependence become a big problem with benzo use?

2-3 weeks

51

Which benzo can cause seizures with abrupt discontinuance, especially 24-72 hours after the discontinuance?

Alprazolam (xanax)

52

What is the dose of Alprazolam that is given to treat panic disorder but also causes withdrawal Sx?

4 mg daily

53

What is the deal with the demonstrated efficacy of chlordiazepoxide for long term use (> 4 mo)?

The efficacy has not been established, so u gotta keep reassessing to make sure it's working

54

This is the drug u give for preop sedation, anxiolysis, and anterograde amnesia.

Midazolam

55

What are the 2 routes of administration for Midazolam?

IM or IV

56

What is the receptor that Buspirone stimulates?

5-HT1A

57

True or False: Buspirone is effective in panic disorder just like it is for Generalized Anxiety Disorder.

FALSE

It has a gradual onset of action and therefore is not effective in Panic disorder.

58

How long does it take to see the effects of Buspirone?

2-4 weeks

(2013 first aid says 1-2)

59

Which receptor does Serotonin bind to induce B-endorphin secretion, which allows the antidepressant effects?

5-HT1A

(same one Buspirone binds)

60

Which form of Zelpidem tartrate had the adverse effects of drowsiness, dizziness, diarrhea, headache, amnesia, vertigo, falls, nausea, and vomiting?

conventional Tablet

61

Which form of Zelpidem tartrate caused just headache, somnolence, and dizziness?

Extended release tablet

62

What class of drugs does Zolpidem belong to?

ZopiDEM = Ambien, which is a nonbenzodiazepine hypontoics

63

What are the main indications for ZOLEPLON use?

Sleep-driving, making phone calls, or preparing and eating food while asleep.

64

What is the mg of Midazolam that is given 30-60min before surgery in adults < 60 y/o?

5mg

65

What are the 3 conditions where the dose of midazolam is adjusted before surgery?

1. COPD pts
2. High risk pts
3. Pts who take opiate agonists or other CNS depressants.

66

What is the mg of Midazolam that is given to adults > 60 y/o?

2-3mg

67

There is a hypothesis that psychosis is caused by a relative excess of what NT in the dorsal and/or ventral striatum?

Dopamine

68

There is also a hypothesis that states that an excess of what NT causes + and - symptoms of schizophrenia?

Serotonin

69

Where is the majority of Serotonin made in the CNS?

Raphe nucleus

70

Where does the dosal and rostral raphe nuclei connect in the brain, which is throught to be associated with schizophrenia?

Dorsal raphe nuclei --> substantia nigra

Rostral raphe nuclei --> cerebral cortex

71

Which DA pathway gives + symptoms, increased in schizophrenics, and causes hallucinations/delusions?

Mesolimbic pathway

72

Which DA pathway gives negative Sx, is decreased in schizophrenics, and cuases the slowing, avolition, and confusion characteristics?

Mesocortical pathway

73

Which DA pathway gives extrapyramidal Sx and tardive diskinesia, and is decrased in schizophrenics?

Nigrostriatal pathway

74

Which DA pathway is normal in schizophrenics, but can cause hyperprolactinemia if anypsychotics block it?

Tuberoinfundibular pathway

75

All "typical" antipsychotics block what receptor?

D2

76

What are the typical antipsychotics?

(doll's like magazines)

Haloperidol, droperidol, fluphenazine, thorazine, chlorpromazine

DOLls like magaZINEs

77

Which 3 typical antipsychotics have a high potency (2-20mg/day) and can therefore cause extrapyramidal Sx?

Trifluoperazine, Fluphenazine, and Haloperidol

(Try to Fly High)

78

Which 2 typical antipsychotics have a low potency (300-800 mg/day) and can therefore cause non-neurological SE like anticholinergic, antihistamine, and a1-blockade?

Chlorpromazine, Thioridazine

(Cheating Thieves are LOW)

79

Which 2 typical antipsychotics have a medium potency (10-100mg/day) and are neuroleptics?

Loxapine, Perphenazine

80

What class of antipsychotics are 5-HT2, D2, alpha, and H1 blockers?

Atypicals

81

To remember the atypical antipsychotics, what does the following sentence mean?

"It's atypical for old closets to quietly risper from A to Z"

Olanzapine, clozapine, qutiapine, risperidone, aripipazole, ziprasidone

(also, "I am DONE with OLE PINE trees" is another mnemonic)

82

Though 1st generation antipsychotics improve + Sx, they have a lot of what SE?

EPS

83

But yay! 2nd gen antipsychotics improve Sx with less EPS... HOWEVER, what is their main SE?

They make u fat

84

You need to check weight, BP, fasting glucose, and fasting lipid panels at what checkpoints in antipsychotic therapy?

Baseline, 1 mo, 3 mo.

85

So you got through the 3 months of checkpoints all good, now what 3 things must u check every year while a pt is on antipsychotics?

Weight, BP, fasting glucose.

86

And what must u check every 3 years while a pt is on antipsychotics?

Fasting lipid panel

87

Other than making u fat, having deposits in the cornea/lens are SE of clorpromazine, what other SE is specific for this drug?

Photosensitivity

(Chlorpromazine = Cornea)

88

Which typical antipsychotic is associated with retinal deposits, resembling retinitis pigmentosa and causes browning of the vision?

Thioridazine

(Thioridazine = reTina)

89

Which antipsychotics is used for emisis becuase it blocks DA centrally in the CTZ and peripherlally in the stomach?

Prochlorperazine

90

Which antipsychotics is used for perioperative sedation cuz it blocks H1?

Promethazine

91

Which antipsychotics is used for neuroleptanesthesia cuz it blocks H1?

Droperidol (+ fentanyl)

92

What is the most effective antipsychotic, but has a SEVERE side effect of agranulocytosis?

Clozapine

(Watch CLOZapine CLOZely!)

93

Which antipsychotic is first line for acute psychosis but can cause weight gain, sedation, dry mouth, and constipation?

Olanzapine

94

Which antipsychotic is used for the psychosis in parkinsons pts because it has a low D2 effect?

Quetiapine

(Parkisons are Quiet)

95

Which atypical antipsychotic has a big risk for QT interval prolongation and is metabolized by aldehyde oxidase?

Ziprasidone

96

Which receptor in the body is inhibited if you have SE like EPS and ↑ PRL?

D2

97

Which receptor in the body is inhibited if you have SE like cognitive deficits, dryu mouth, constipation, tachycardia, urinary retention, and blurred vision?

M1

98

Which receptor in the body is inhibited if you have SE like sedation, weight gain, and dizziness?

H1

99

Which receptor in the body is inhibited if you have SE like hypoTN?

a1

100

Which receptor in the body is inhibited if you have SE like anti-EPS?

5-HT2A

101

Which receptor in the body is inhibited if you have SE like satiety blockade?

5-HT2C

102

In summary, what drugs cause SE like EPS?

High potency

(Try to Fly High)

103

In summary, what drugs cause SE like weight gain?

Olanzapine and Clozapine

104

In summary, what drugs cause SE like hyperPRL?

all typicals and risperidone + paliperidone

105

In summary, what drugs are cheaper (typicals or atypicals)?

Typicals

106

Increased sensitivity of the DA receptors can cause what condition?

Tardive dyskinesia

107

What is the condition characterized by autonomic instability, muscle rigidity, diaphoresis, profound hyperthermic, and myoglonemia?

Neuroleptic malignant syndrome

108

What is the mortality rate in NMS?

20%

109

What are the drugs for the treatment of NMS?

Bromocriptine- for the D2 blockade
Dantroline- for the rigidity
Benzo- for the muscle relaxant.

110

What is the medicaiton that can be used as monotherapy for less severe manic of mixed episodes?

Li

111

What 2 conditions that Li can be used prophylactically for?

Mania and Depression

112

Polyuria, polydipsia, tremor, mental confusion, withdrawal, and bizarre movements are all SE of what medication?

Li

113

What condtion is Li a contraindication for, as it depresses the SA node?

Sick sinus syndrome

114

What condition often coexists with bipolar disorder, but is treated when you use Li because of the additional actions?

Alcoholism

115

What is the metabolism and excretion mechanism for Li?

It;s not metabolized and renally excreted

116

What are the Sx in infants if mom took Li whilst breastfeeding?

Lethargo, cyanosis, poor suck response and Moro relfexes.

117

In addtion to the CBC, urinalysis, and blood tests, what other test must u get in older patietns before starting Li due to side effects?

EKG

118

What substance in the Gq pathway is inhibited to form by Li?

IP3

(inhibits IP2 --> IP3)

119

Li is used with what other drug class in acute manic episodes?

Anti-psychotics or Anti-convulsives (carbamazepine)

120

What is the dose of carbamazepine that is given with Li in acute manic episodes?

200mg

121

What is the term for continuing Li therapy after the relief of manic Sx?

Maintenance or prophylactic therapy

(keep them on it if theyve had a lot)

122

What is the antiseizure drug that is contraindicated in pregnant ladies due to teratogenic effects?

Valproic acid

123

Which class of antipsychotics (typical or atypical) give the following changes in the dopamine pathways?

Mesolimbic- normal
Mesocortical - ↓↓
Nigrostriatal- ↓
TUberoinfundicular- ↓

1st generation

(remember the ↑ risk of EPS/TD and they worsen the negative Sx of psychosis)

124

Which of the following atypical antipsychotics have a better maintenance control?

Quetiapine, Risperidone, Ziprasidone, Aripiprazole, Olanzapine

Quetiapine
Aripiprazole
Olanzapine

125

Which of the following atypical antipsychotics have a better induction control?

Quetiapine, Risperidone, Ziprasidone, Aripiprazole, Olanzapine

Risperidone
Ziprasidone

126

Which of the following antiepileptics have a better effect on mixed episodes?

Valproate/divalproex sodium, Carbamazepine, Lamotrigine

Valproate/divalproex sodium

127

Which of the following antiepileptics have a better effect on depressed episodes?

Valproate/divalproex sodium, Carbamazepine, Lamotrigine

Lamotrigine

(sad Lamb)

128

Which of the following antiepileptics have a better effect on manic episodes?

Valproate/divalproex sodium, Carbamazepine, Lamotrigine

Carbamazepine

129

What is the most effective mood stabilizer and also prevents suicidal thoughts?

Li carbonate

130

Which class of antidepressants is just as effective as TCAs but way safer?

SSRIs

131

Which class of antidepressants are just as effective as SSRIs and TCA's, but their action is similar to TCAs but have a lower SE than TCAs?

SNRIs

132

Which class of antidepressants is less effective than MAOi's but are good for pain, headaches, and insomnia?

TCAs

133

TCAs carry a huge risk for what event due to their narrow therapeutic index?

Overdose

134

Case: pt presents to the ER with a BP of 190/120 after eating at a pizza parlor. His friend stated he just got placced on a medication for depression. What class of drugs is the pt on?

MAOi's

(Tyramine causing hypertensive crisis)

135

Which drugs are best for panic disorders and acute anxiety, but carry a risk for addiciton, dependence, and withdrawal Sx (szrs)?

Benzos

136

Antihistamines, Benzos, Barbs, and "Z" drugs (zolpidem, eszopiclone, zaleplon) and Trazodone all can be used for what condition?

Sleep disorders

137

What is the class of drugs for ADHD that causes fast arousable and produce a "high"?

Amphetamines

138

What is the ADHD drugs that are arousable but dont produce the same rush, and are slower release?

Mehtylphenidates