(Iii-Psych) Psychiatric Pharmacology

Front 1

Which of the following of SSRIs is the most 'activating'?

Fluoxetine
Citalopram
Paroxetine
Sertraline
Fluvoxamine

Back 1

Fluoxetine

Front 2

Which of the following is most sedating?

Fluoxetine
Citalopram
Paroxetine
Sertraline
Fluvoxamine

Back 2

Fluvoxamine

Front 3

Which of the following has the longest half life?

Fluoxetine
Citalopram
Paroxetine
Sertraline
Fluvoxamine

Back 3

Fluoxetine (2 weeks)

Front 4

Which of the following has the shortest half life?

Fluoxetine
Citalopram
Paroxetine
Sertraline
Fluvoxamine

Back 4

Fluvoxamine (15 hours)

Front 5

What is fluvoxamine mostly used for?

Back 5

OCD

Front 6

Which of the following has the most anticholinergic effects?

Fluoxetine
Citalopram
Paroxetine
Sertraline
Fluvoxamine

Back 6

Paroxetine (Paxil)

Do NOT prescribe this to someone who could possibly have dementia
Thus not a good choice for pseudodementia

Front 7

Which of the following is most associated with weight gain?

Fluoxetine
Citalopram
Paroxetine
Sertraline
Fluvoxamine

Back 7

Paroxetine (Paxil)

Front 8

What percentage of folks on paroxetine will have trouble with discontinuing Paxil?

What determines how difficult it is to discontinue an SSRI?

Back 8

20% will have trouble

Depends on how potent a drug is and how long its half life is.

Thus drugs with long t1/2 like Fluoxetine will not be problemmatic,
while Paroxetine (t1/2 = 1 day) will be

Front 9

Which of the following interferes least with P450?

Fluoxetine
Citalopram
Paroxetine
Sertraline
Fluvoxamine

Back 9

Citalopram

Front 10

What is the generic for Effexor?

Back 10

Venlafaxine

Front 11

What is the major neurotransmitter that venlafaxine relies on?

What are the clinical implications of this?

Back 11

NE. Implies that it is good for chronic pain

Front 12

What is the major unique side effect for Venlafaxine?

Back 12

Raises blood pressure (especially diastolic)

Note that this isn't a contraindication for its usage

Front 13

Is buproprion good or bad for anxiety?

Back 13

Bad – it is very stimulating

Front 14

List two contraindications for buproprion

Back 14

Seizures
Anorexia (electrolyte imbalances can induce seizures)

Front 15

List three second generation antidepressants that have pretty low sexual side effects?

Back 15

Buproprion, metazepine, Nefazodone

Front 16

Which second generation antidepressant can also be used to treat ADHD in adults?

Back 16

Buproprion

Front 17

What is the generic name for Remeron?

Back 17

Mertazepine

Front 18

What neurotransmitters does mertazepine work on?

Back 18

NE and 5HT

Front 19

Which second generation antidepressant may be a good choice for nursing home patients?
Why?

Back 19

Mertazepine (Remeron)

It causes weight gain and is less anticholinergic

Front 20

Which second generation antidepressant may be a bad choice for nursing home patients?
Why?

Back 20

Cymbalta (Duloxetine)

It has a lot of anticholinergic properties and is metabolized by P450 (2D6)

Front 21

Which second generation antidepressant has been associated with priapism?

Back 21

Trazodone

Note that it also has been associated with orthostatic hypotension

Front 22

Because it is so sedating, this second generation antidepressant is not often used for depression, but is instead used as a hypnotic.

Back 22

Trazodone

Front 23

Why would Mertazepine be an okay choice as a sedative hypnotic?

Back 23

It does not interfere with REM sleep

Front 24

Is the half life of Cymbalta (Duloxetine) short or long?

Back 24

Short

Front 25

Outside of TCAs, this antidepressant is most associated with weight gain:

Back 25

Remeron 9Mertazepine)

Front 26

Two long acting typical antipsychotics:

Back 26

Haldol and Fluphenazine

Front 27

Would you expect the long acting typical antipsychotics to have larger or smaller doses compared to the short acting ones?

Back 27

Smaller doses

Front 28

Which has more EPS, long acting, or short acting typical antipsychotics?

Back 28

Long acting

Front 29

Name two short acting typical antipsychotics?

Back 29

Thorazine (Chlorpromazine) and Melllaril (Thioridizne)

Front 30

What side effect is associated with Thioridizine?

Back 30

Retinosa Pimentosa

Front 31

Three side effects of Clozapine:

Back 31

Agranulocytosis, Seizures, Drooling

Front 32

In terms of drug action / side effects, what happens as you increase the dosage of Respiridone?

Back 32

It acts more like a typical antipsychotic

Thus, you see more EPS/ TD and prolactin elevation

Front 33

Which atypical antipsychotic is most associated with weight gain and diabetes?

Back 33

Olanzepine

Front 34

What is the brand name for Olanzepine?

Back 34

Zyprexa

Front 35

This atypical antipsychotic is associated with QT prolongation and is not good for pts with heart disease:

Back 35

Geoden (Ziprasiden)

Front 36

How does the half life of aripiprazole compare to other atypical antipsychotics?

Back 36

Pretty long half life

Front 37

Aripiprazole has very little EPS / TD, but can instead casue this condition?

Back 37

Akanthasia

Front 38

What is the idea blood level for Depakote?

Back 38

80-120

Front 39

What is the ideal blood level for Lithium?

Back 39

0.8 – 1.2

Front 40

What is the ideal blood level for Tegretol?

Back 40

8 to 12

Front 41

This mood stabilizer can cause thrombocytopenia, pancreatic troubles, and increased LFTs

Back 41

Depakote

Front 42

What is the generic name for Depakote?

Back 42

Divalproex

Front 43

What labs must you check for someone on divaloproex?

Back 43

Hematology, LFTs

Front 44

Does lithium cause hyper or hypo thyroidism?

Back 44

Hypothyroidism

Front 45

What is the generic name for Tegretol?

Back 45

Carbamazepine

Front 46

Which organ is most affected in babies born to mothers on litihium?

Back 46

Heart – Especially tricuspid

Front 47

Which mood stabilizer is associated with SJ rash?

Back 47

Tagretol (Carbamazepine)

Front 48

Which types of bipolar is Depakote (Divalproex) good at treating?

Back 48

1. Rapid cycling bipolar
2. Mixed episodes

Front 49

Which types of bipolar is Lamicatal (Lamotrigine) good at treating?

Back 49

Bipolar with depression

Front 50

What is the generic name for Lamictal?

Back 50

Lamorigine

Front 51

Rule of thumb for how long to treat with antidepressants after MDE has ended.

Back 51

6-9 months after end of symptoms (including sx of dysthymia)

Front 52

What is the rule of thumb for choosing which antidepressant to use:

Back 52

All antidepressant classes have the same efficacy, so choose based on side effect profile

Front 53

Common side effects of tricyclics:

Back 53

Sedation, weight gain, anticholinergic effects, tremor, orthostatic hypotension, sweating,impotence.

Also QT prolongation.

Front 54

Which patients should you order a EKG before starting tricyclic

Back 54

Patients with suspected cardiac disease, and all patients over 40 years old.

Front 55

Treatment for TCA overdose:

Back 55

Induce vomiting
Activated charcoal to block absorption.
Sodium Bicarbonate for metabolic acidosis
Anticonvulsants for seizures

Front 56

Which medicine should you never mix with desipramine:

Back 56

Citalopram

Front 57

Which commonly used analgesic can lose efficacy when combined with 2D6 inhibitors like fluoxetine, sertraline (zoloft) and paroxetine?

Back 57

Codeine

Front 58

Serotonin syndrome happens when mixings which two classes of drugs?

Back 58

Mixing MAOIs with SSRIs, or tryptophan, or venlafaxine, or meperidine

Front 59

What are the symptoms of serotonin syndrome:

Back 59

Mild tremor, hypertension, tachycardia, and fever.

Can lead to seizures / coma / death.

Front 60

How long should patient be off fluoxetine before starting MAOI?

Back 60

5 weeks

Front 61

What other condition is Duloxetine good at treating?

Back 61

Diabetic neuropathic pain

Front 62

What are the serious side effects of tricyclics?

Back 62

Antimuscarinic sx leading to decreased bowel motility, mydriasis, urinary retention, confusion.

Dath often occurs from arrhytmias, hypotension, or seizures.

Front 63

Which isozyme of P450 does Fluvoxamine inhibit?

Back 63

1A2.

Note that caffeine is broken down by this pathway as well.

Front 64

Which isozyme of P450 does norfluoxetine inhibit?

Back 64

3A4

Same as carbamazepine, alprazolam, triazolam, terfenadine, astemizole, and cisapride

Front 65

How long should MAOIs be out of the system before switching to an SSRI?

Back 65

About 2 weeks

Front 66

Are Venlafaxine and Buproprion activating or sedating?

Back 66

Activating

Front 67

Which isozyme of P450 is used in the metabolism fo Nefazodone?

Back 67

3A4

Front 68

Signs and symptoms of lithium toxicity:

Back 68

Coarse tremor, ataxia, slurred speech. With more drug you see dizziness, weakness, nystagmus, and constitution symptoms.

Can lead to stupor and coma, and circulatory collapse if left unsupervised.

Front 69

At what level of lithium toxicity do you dialize?

Back 69

4 mmol/L regardless of symptoms

Front 70

Treatment of mild elevation in lithium:

Back 70

Correct electrolytes, and IV hydration while ensuring urine output.

If more severe, may need dialysis

Front 71

In patients who are started on valproic acid, but develop fulminate hepatitis, what underlying abnormality should you suspect?

Back 71

Urea cycle disorders (OTC deficiency)

Front 72

Which mood stabilizers cause weight gain?

Back 72

Lithium and valproic acid

Front 73

Common side effects of valproic acid:

Back 73

Weight gain, alopecia, constitutional side effects.

Front 74

Which antipsychotics are available in depot form?

Back 74

Fluphenazine, halperidol, Risperdon

Front 75

Which atypical antipsychotic is the only medication shown to be effective in treating refractory schizophrenia?

Back 75

Clozapine

Front 76

Which receptor does clozapine strongly bind to? Which one does it weakly bind to?

Back 76

Strong D4, 5HT2, alpha-1, and histamine blockade

Weak D2 blockade.

Front 77

When to discontinue Clozapine

Back 77

If WBC drops below 2-3, or neutrophil count (absolute) is < 1,500.

Note that if you do see this, you must check WBC daily and carefully monitor for signs infection.

Front 78

Monitoring protocol for patient on Clozapine:

Back 78

Check WBC at baseline, then weekly X 6 mo, then two weeks X 6 months, then monthly.

Want WBCs above 3.5!

Front 79

Describe the neuroendocrine side effects of neuroleptics in both men and women:

Back 79

Blockage of dopamine receptors increases prolactin production.

In men this leads to gynecomastia

In women this leads to amenorrhea and glaactorrhea

Front 80

List 4 extrapyramidal side effects that you see with antipsychotics:

Back 80

Akathisia

Parkinsonism

Dystonia

NMS

Front 81

How to treat akathisia secondary to antipsychotics:

Back 81

Switch to a less potent medicine / smaller dose

Responds to benzos and betablockers.

Does not respond as well to anticholinergics

Front 82

Treatment of acute dystonic reactions secondary to antipsychotic usage:

Back 82

IV anticholinergics or benzodiazepines.

Ensure that airway is adequately maintained.

Front 83

Patient taking an antipsychotic deveops severe muscle rigidity, elevated temperature, hypertension and leucocytosis. Labs also show an elevated creatine phosphokinase.

What is the name for this syndrome

Back 83

NMS

Front 84

Treatment of NMS:

Back 84

Rapidly withdrawal antipsychotics.

Supportive treatment (fluids, electroytes, BP mgmt, antipyretics)

Front 85

Which antipsychotic is associated with a lower seizure threshold?

Back 85

Clozapine

Front 86

Which is tougher to treat with medication, delusions or psychosis?

Back 86

Delusions are harder to treat

Front 87

What is benztropine? What is it used to treat primarly? What is it used for in psychiatry?

Back 87

Cholinergic and histamine antagonist.

Used primarily for Parkinsons, but can be used for parkinsonism secondary to antipsychotic drugs.

Front 88

Are benzos good for akathisia, dystonia, or both?

Back 88

Akathisia, but not dystonia

Front 89

Which mood stabilizer should be avoided in patients with cardiac problems?

Back 89

Carbamazepine

Front 90

Which isoenzyme is used by Carbamazepine?

Back 90

P450-3A4

Review, other 3A4 drugs include triazolam, nefazodone, alprazolam,, terenadine, ketoconazole, astemizole, and birth control pills

Front 91

Effect of lithium on calcium levels:

Back 91

Lithium can lead to elevated calcium (and subsequent elevation in PTH)

Front 92

Are he EKG changes seen with lithium (T-wave flattening, inversion) worrysome?

Back 92

No

Front 93

Is Lithium better at treating manic episodes, or prophylaxis?

Back 93

Trick question - Both

Front 94

What mood stabilizer is assocated with less effectiveness after discontinuing it and starting it back up?

Back 94

Lithium

Front 95

Advantages of SSRIs over TCAs

Back 95

Minimal anticholinergic side effects

No alpha adrenergic antagonism

No antihisamine activity

Less effects on cardiovascular system

Front 96

Disadvantages of SSRIs over TCAs:

Back 96

Sexual side effects

Diarrhea

Nausea

Insomnia

Headache

Tremor

Front 97

Fluoxetine and metoprolol both inhibit which isozyme of P450?

Back 97

CYP 2D6

Front 98

Which SSRI is most associated with anti-muscarinic side effects?

Back 98

Paroxetine

Front 99

What EKG finding is a contraindication to using heterocyclic antidepressants?

Back 99

Widened QRS interval

Front 100

Which 2 TCAs can you combine with MAOIs?

Back 100

Amitriptyline and trimipramine

Front 101

Which class of antidepressants are good for treating premenstrual dysphoria?

Back 101

SSRIs

Front 102

Effect of benzos on sleep:

Back 102

They increase the total sleep time, decrease sleep latency and night time awakenings

Decrease all stages of sleep (including REM), except stage 2.

Increases the number of REM cycles (although the total time in REM sleep is still decreased)

Front 103

What is the advantage of zolpidem over benzos?

Back 103

Lack of tolerance / withdrawal

Down side is "sleep driving"

Front 104

What is yohimbine? when is it used in psychiatry?

Back 104

Alpha2 adrenergic antagonist.

Often used to counteract sexual dysfunction, especially SSRIs.

Note that phosphodiesterase type 5 inhibitors have largely replaced yohimbine in treating sexual side effects.

Front 105

Which antipsychotics are most likely to result in a rash after being in the sun?

Back 105

Low potency antipsychotics like Chlorpromazine, Mesoridazine, and

Front 106

Which carries a higher risk of EPS, low potency or high potency antipsychotics?

Back 106

High potency like Fluphrenazine and Haloperidol