Psychopharmacology

Question 1

MAOIs

Answer 1

Block the breakdown of all 3 monoamine NTs (5HT, NE, DA)

Results in more NT available in the synapse

Question 2

TCAs (5HT& NE) & SSRIs

Answer 2

Block NE &/or 5HT reuptake channels on the presynaptic cell surface

Results in more NT available in the synapse

Question 3

Fluoxetine

Answer 3

SSRI
Long half-life: active metabolite (norfluoxetine)
- Important, stays in system for a long time, don’t have to actively taper it
Relatively more drug/drug interactions

Question 4

Paroxetine

Answer 4

SSRI
Most anticholinergic of the SSRI’s
- Important, more anticholinergic side effects
Relatively more drug/drug interactions
Relatively short half-life

Question 5

Sertraline

Answer 5

SSRI

Well tolerated, few drug interactions

Question 6

Fluvoxamine

Answer 6

SSRI
Notorious for many Drug/Drug interactions
Rarely used in elderly

Question 7

Citalopram

Answer 7

SSRI
Well tolerated
Few drug interactions
New concern about QT prolongation

Question 8

Escitalopram

Answer 8

SSRI
This is the “S” enantiomer of the racemic mixture, citalopram
Fewer side effects
Recently available in generic

Question 9

Bupropion

Answer 9

NDRI (NE & DA)
For smoking cessation & negative symptoms in schizophrenia
“Add on” med when a patient is only partially responding to an SSRI
Makes tobacco withdrawal & cravings less intense
Avoided in patients w/ a history of psychosis b/c it could exacerbate these symptoms due to its dopaminergic effects

Question 10

Venlafaxine

Answer 10

SNRI (5HT & NE)

Can cause hypertension

Question 11

Desvenlafaxine

Answer 11

SNRI (5HT & NE)

Question 12

Duloxetine

Answer 12

SNRI (5HT & NE)

Treats neuropathic pain from diabetes & depression

Question 13

Mirtazapine

Answer 13

NASA (NE & 5HT antidepressant)
Sedating
Stimulates appetite
Antihistaminic side effects

Question 14

Desipramine

Answer 14

TCA
Dual agents (block both 5HT & NE reuptake)
More side effects than SSRIs
Require serum blood level monitoring
fatal in overdose

Question 15

Nortriptyline

Answer 15

TCA
Dual agents (block both 5HT & NE reuptake)
More side effects than SSRIs
Require serum blood level monitoring
fatal in overdose

Question 16

Amitriptyline

Answer 16

TCA
Dual agents (block both 5HT & NE reuptake)
More side effects than SSRIs
Require serum blood level monitoring
fatal in overdose

Question 17

Imipramine

Answer 17

TCA
Dual agents (block both 5HT & NE reuptake)
More side effects than SSRIs
Require serum blood level monitoring
fatal in overdose

Question 18

Clomipramine

Answer 18

TCA
Dual agents (block both 5HT & NE reuptake)
More side effects than SSRIs
Require serum blood level monitoring
fatal in overdose

Question 19

Phenelzine

Answer 19

MAOI
Inhibit the enzyme responsible for breaking down the monoamine NTs in the pre-synaptic neuron
Results in back-up of NTs in synaptic cleft so more NTs are available to hit target receptors

Question 20

Tranylcypromine

Answer 20

MAOI
Inhibit the enzyme responsible for breaking down the monoamine NTs in the pre-synaptic neuron
Results in back-up of NTs in synaptic cleft so more NTs are available to hit target receptors

Question 21

Selegiline

Answer 21

MAOI
Inhibit the enzyme responsible for breaking down the monoamine NTs in the pre-synaptic neuron
Results in back-up of NTs in synaptic cleft so more NTs are available to hit target receptors

Question 22

Haloperidol

Answer 22

Typical antipsychotic
Potent
More commonly used in hospitals
Can be given IM/PO/IV
Available in long-acting injectable forms (Decanoate antipsychotics)

Question 23

Fluphenazine

Answer 23

Typical antipsychotic
Potent
More commonly used in hospitals
Can be given IM/PO/IV
Available in long-acting injectable forms (Decanoate antipsychotics)

Question 24

Risperidone

Answer 24

Atypical antipsychotic
Most extrapyramidal SE
Hyperprolactinemia
Most potent at blocking D2 receptors

Question 25

Olanzapine

Answer 25

Atypical antipsychotic Most weight gain Next most potent after Risperidone

Question 26

Clozapine

Answer 26

Atypical antipsychotic Most weight gain Rare agranulocytosis (--> decreased WBC count --> infection) Least potent Most effective (especially for treatment-resistant SCZ) Difficult compliance Not used as often

Question 27

Quetiapine

Answer 27

``` Atypical antipsychotic Sedation Weight gain Not very potent, so can dose in tiny increments Good if need small titrations ```

Question 28

Ziprasidone

Answer 28

Atypical antipsychotic Weight "neutral" QTc prolongation (can prolong cardiac repolarization time) Antidepressant effects

Question 29

Aripiprazole

Answer 29

Atypical antipsychotic Partial dopamine receptor agonist Low DA --> activate DA receptor High DA --> outcompetes DA for receptor but doesn't activate it as much

Question 30

Paliperidone

Answer 30

Atypical antipsychotic | Active metabolite of risperidone