Psychopharmacology

Question 1

HAM

Answer 1

anti- HISTAMINE
anti- ADRENERGIC
anti- MUSCARINIC

Dry mouth, blurred vision, urinary retention

Seen in TCA’s and low potency anti-psychotics

Question 2

Serotonin Syndrome

Answer 2

Confusion, Flushing, diaphoresis, tremor, myoclonic jerks, hyperthemia, hypertonicity and rhabdo

Seen when mixing SSRI’s with MAOi’s

Question 3

Hypertensive Crisis

Answer 3

MAOi’s + Foods with Tyramine (red wine, cheese etc)

Question 4

Extrapyramidal Effects

Answer 4

Parkinsonism, Akathisia (restlessness and agitation.), Dystonia

High Potency Antipsychotics
Reversible

Question 5

Hyperprolactinemia

Answer 5

due to low DA levels

Seen with high potency traditional antipsychotics and risperidone.

Question 6

Tardive Dyskinesia

Answer 6

Chroeotheoid muscle movements

Occurse after years of anti-psychotic use

May be irreversible

Question 7

Neuroleptic Malignant Syndrome

Answer 7

Fever, Tachycardia, HTN , tremor, elevated CPK, lead pipe rigidity

High Potency traditional anti-psychotics.

Question 8

CYP450 Inducers

Answer 8

Carbamazepine

Barbituates

Question 9

CYP450 Inhibitors

Answer 9

Fluvoxamine
Fluoxetine
Paroxetine
Duloxetine
Sertraline

Question 10

Classes of Anti-depressants

Answer 10

SSRI’s
TCA
MAOi

Most have a withdrawal phenomenon characterized by dizziness, headaches, nausea insomnia and malaise

Question 11

Fluoxetine (Prozac)

Answer 11

Longest Half-Life SSRI.

Safe in pregnancy and approved for use in children

Question 12

Sertraline (Zoloft)

Answer 12

Highest risk for GI disturbance

Question 13

Paroxetine (Paxil)

Answer 13

sedation, constipation, WEIGHT GAIN

Withdrawal phenomenon

Question 14

Fluvoxamine (Luvox)

Answer 14

Approved only for use in OCD

Question 15

Citalopram (Celexa)

Answer 15

Fewest Drug interactions

Question 16

Escitalopram ( Lexapro)

Answer 16

Possibly less side effects ?

Question 17

Major Side Effects of SSRIs

Answer 17

Sexual dysfunction
GI disturbance
Insomnia
Headache
Anorexia
Restlessness
Seizures 

INCREASED SUICIDAL THOUGHTS AND BEHAVIORS (Black Box Warning)

Question 18

SNRI’s

Answer 18

Venlafaxine

Duloxetine

Question 19

Venlafaxine (Effexor)

Answer 19

Used for GAD and for use in ADHD with depression

Can lead to increased BP

Question 20

Duloxetine (Cymbalta)

Answer 20

Often used for people with depression and neuropathic pain.

More dry mouth and GI disturbances than SSRI

Question 21

Buproprion (Wellbutrin)

Answer 21

Norepinephrine- Dopamine Reuptake Inhibitor

Lack of sexual side effects
INCREASED RISK OF SEIZURE (lowers threshold)

Question 22

Trazadone/Nefazadone

Answer 22

Good for refractory major depression and insomnia

PRIAPISM and sedation are side effects
Nefazadone carries a black box warning

Question 23

Mirtazapine (Remeron)

Answer 23

A2 Adrenergic Receptor Antagonist

Good for refractory MDD

SE: Weight Gain

Question 24

mode of action for TCA’s

Answer 24

Inhibit the reuptake of NE and Serotonin
Long Half Lives
Can be lethal in overdose

Question 25

Amitryptiline (Elavil)

Answer 25

Used in chronic pain migraine and insomnia

Question 26

Imipramine

Answer 26

Enuresis and Panic Disorder

Question 27

Doxepin

Answer 27

Useful in chronic pain

Question 28

Clomiprimine

Answer 28

Most serotonin specific, used in OCD

Question 29

Nortryptiline

Answer 29

2nd amine

Question 30

Desipramine

Answer 30

Least Anticholinergic More Activating, Least Sedating

Question 31

Treatment of TCA overdose

Answer 31

Sodium Bicarbinate

Question 32

Mode of action for MAOi's

Answer 32

block MAO and stop the breakdown of active amines like NE, serotonin and dopamine MAO-A --> pref for serotonin MAO-B --> Pref for NE/EPI Phenelzine Tranylcypromine Isocarboxazid

Question 33

SE of MAOi

Answer 33

Serotonin Syndrome occurs with MAOi's and SSRI's Hypertensive Crisis: MAOis taken with tyramine rich food MOST COMMON IS ORTHOSTATIC HTN

Question 34

MoA fro Gen 1 Anti-psychotics

Answer 34

Block D2 Receptors

Question 35

MoA for atypical or Second Gen Anti-psychotics

Answer 35

Block both D2 and Serotonin (2A) receptors.

Question 36

Low Potency Typical Antipsychotics

Answer 36

Chlorpromazine (blue skin discoloration, cause photosensitivity) Thioridizine (Retinitis pigmentosum)

Question 37

Midpotency Typical Antipsychotics

Answer 37

Loxapine Thiothixene Trifluperazine Perphenazine

Question 38

High Potency Typical Antipsychotics

Answer 38

Haloperidol: Fluphenazine Pimozide: Heart SE's

Question 39

Neuroleptic Malignant Syndrome

Answer 39

``` Fever Autonomic Instability Leukocytosis Tremor Elevated CPK Rigidity Excessive Sweating Delirium ``` Treatment: Bromocriptine, Dantrolene and amantadine.

Question 40

Advantage of Atypical ANtipsychotics

Answer 40

Less likely to cause EPS, Tardive Dyskinesia, or NMS

Question 41

CLozapine

Answer 41

Tachycardia and hypersalivation Can cause neutropenia Can reduce the risk of suicide !

Question 42

Risperidone

Answer 42

Has a long acting injectable form

Question 43

Quetiapine (Seroquel)

Answer 43

edndndndnd

Question 44

Olanzapine (Zyprexa)

Answer 44

Weight GAIN !

Question 45

Aripiprazole

Answer 45

don't care ... its abilift

Question 46

SE's of Atypical AS's

Answer 46

METABOLIC SYNDOME Weight gain, hyperlipidemia

Question 47

Mood Stabilizers

Answer 47

Used to treat acute mania and prevent relapses

Question 48

Lithium

Answer 48

DOC in acute mania Metabolized by the kidney (cannot give in renal dysfunction) Can cause Diabetes Insipidus . Low therapeutic window Takes 5-7 days to take action NOT SAFE IN PREGS ! Can cause Ebstein Anomaly

Question 49

Atinconvulsants

Answer 49

Carbamazepine | Valproic Acid