Psychopharmacology

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Lengthening

TCAs cause _______ (lengthening/narrowing) of the QRS complex as a side effect.

Sodium bicarbonate

Mainstay of treatment in TCA overdose.

Nortriptyline

TCA that is least likely to cause orthostatic hypotension.

Desipramine

TCA that is least sedating and least likely to cause anticholinergic side effects.

Clomipramine

TCA that is most specific for reuptake inhibition of serotonin.

TCA

Amitriptyline is a _______.

TCA

Nortriptyline is a _______.

TCA

Imipramine is a _______.

TCA

Doxepin is a _______.

MAOI

Phenelzine is a _______.

MAOI

Tranylcypromine is a _______.

MAOI

Isocarboxazid is a _______.

Serotonin syndrome

Involves constellation of symptoms including lethargy, restlessness, confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicity, rhabdomyolysis, convulsions, coma, and death.

2 weeks

One should wait a period of at least _______ before switching from a SSRI to a MAOI due to concern for serotonin syndrome.

SSRIs

Serotonin syndrome can result if MAOIs are taken together with _______.

Tyramine

Hypertensive crisis can result if MAOIs are taken together with foods high in _______.

SSRIs

Class of drugs that inhibit serotonin pumps on the presynaptic cell membrane.

Fluoxetine

SSRI with the longest half-life.

Sertraline

SSRI with the highest risk for GI disturbances.

Paroxetine

Most serotonin-specific and most activating SSRI.

SSRI

Fluvoxamine is a _______ only approved for use in OCD.

Venlafaxine

Atypical antidepressant that can increase BP and cause withdrawal effects (flu-like symptoms or electric-like shocks and zaps).

Bupropion

Atypical antidepressant useful in seasonal affective disorder, ADHD, and smoking cessation.

Bupropion

Atypical antidepressant whose main advantage is its lack of sexual side effects.

Bupropion

Lowers the seizure threshold, especially in patients with electrolyte imbalances due to eating disorders.

Bupropion

Atypical antidepressant that may precipitate psychosis due to inhibition of dopamine reuptake.

Trazodone

Atypical antidepressant whose most famous side effects are sedation and priapism.

Mirtazapine

Atypical antidepressant that causes increased appetite, weight gain, and agranulocytosis.

Mirtazapine

Antidepressant whose sedative side effect is maximal at doses of 15 mg or less.

Low; traditional

Chlorpromazine is a _______ (high/low) potency _______ (traditional/atypical) antipsychotic.

Low; traditional

Thioridazine is a _______ (high/low) potency _______ (traditional/atypical) antipsychotic.

High; traditional

Haloperidol is a _______ (high/low) potency _______ (traditional/atypical) antipsychotic.

High; traditional

Fluphenazine is a _______ (high/low) potency _______ (traditional/atypical) antipsychotic.

High; traditional

Trifluoperazine is a _______ (high/low) potency _______ (traditional/atypical) antipsychotic.

High; traditional

Perphenazine is a _______ (high/low) potency _______ (traditional/atypical) antipsychotic.

High; traditional

Pimozide is a _______ (high/low) potency _______ (traditional/atypical) antipsychotic.

Fluphenazine; haloperidol

Traditional antipsychotics for which IM form is available.

Atypical

_______ antipsychotics are more effective in treating negative symptoms of schizophrenia.

Akathisia; dystonia; parkinsonism

Three different syndromes classified as extrapyramidal side effects of antipsychotics.

Benztropine

Anticholinergic used to treat extrapyramidal side effects of antipsychotics.

Diphenhydramine

Antihistamine used to treat extrapyramidal side effects of antipsychotics.

Amantadine

Anti-parkinsonian medications that may be used to treat extrapyramidal side effects of antipsychotics.

Akathisia

Subjective anxiety and restlessness; objective fidgeting. A side of effect of antipsychotic medication.

Dystonia

Painful, sustained contraction of muscles of neck, tongue, and eyes.

Tardive dyskinesia

Choreoathetoid movements of mouth and tongue, resulting from long-term neuroleptic use and more common in women.

Chlorpromazine

Antipsychotic whose side effects include deposition in lens and cornea, blue-gray skin discoloration.

Thioridazine

Antipsychotic that might cause irreversible retinal pigmentation as a side effect.

Low

_______(Low/High)-potency antipsychotics are more likely to lower the seizure threshold and cause seizures.

Neuroleptic malignant syndrome

Preceded by catatonic state. Progresses to constellation of symptoms including fever, tachycardia, labile hypertension, diaphoresis, leukocytosis, tremor, elevated creatine phosphokinase, and lead pipe rigidity.

20

Neuroleptic malignant syndrome carries a ___% mortality rate.

Dantrolene

Muscle relaxant that abolishes excitation-contraction coupling in muscle cells by acting on the ryanodine receptor. Used in treatment of NMS.

Bromocriptine

Dopamine agonist used in treatment of NMS.

Amantadine

Anti-parkinsonian medication with unknown mechanism of action. Used in treatment of NMS.

Risperidone

Atypical antipsychotic that gives the strongest dopamine-blocking effects.

Quetiapine; ziprasidone

Two atypical antipsychotics approved for use in treatment of mania.

Clozapine

Atypical antipsychotic with 1% incidence of agranulocytosis and 2-5% incidence of seizures.

Olanzapine

Atypical antipsychotic with the highest chance of causing hyperlipidemia, glucose intolerance, weight gain, and liver toxicity.

Quetiapine

Atypical antipsychotic that may cause cataracts and thus requires slit lamp exams every 6 months.

1.5; 2.0

Lithium is toxic with a blood level above ___, and lethal with a blood level above ___.

Lithium

Renally-excreted mood stabilizer. Levels are elevated by NSAID use, diuretic use, dehydration, salt wasting, and impaired renal function.

Lithium

Side effects include tremor, sedation, ataxia, metallic taste, polyuria, edema, weight gain, benign leukocytosis, hypothyroidism, and nephrogenic DI.

Lithium

Toxic levels cause altered mental status, coarse tremors, convulsions, and death.

Carbamazepine; valproic acid

Two medications useful for treatment of mixed manic episodes and rapid-cycling bipolar disorder.

Carbamazepine

Mood stabilizer that acts by blocking sodium channels and inhibiting action potentials.

Carbamazepine

Side effects include skin rash, drowsiness, ataxia, leukopenia, hyponatremia, aplastic anemia, agranulocytosis, elevated liver enzymes, and neural tube defects in pregnancy.

Valproic acid

Side effects include sedation, weight gain, alopecia, hemorrhagic pancreatitis, hepatotoxicity, thrombocytopenia, and neural tube defects in pregnancy.

Tardive dyskinesia

Treatment entails stopping offending drug if possible, administration of anxiolytics or cholinomimetics if needed.

Long; benzodiazepine

Chlordiazepoxide is a _______ (long/intermediate/short)-acting _______.

Long; benzodiazepine

Diazepam is a _______ (long/intermediate/short)-acting _______.

Long; benzodiazepine

Flurazepam is a _______ (long/intermediate/short)-acting _______.

Intermediate; benzodiazepine

Alprazolam is a _______ (long/intermediate/short)-acting _______.

Intermediate; benzodiazepine

Clonazepam is a _______ (long/intermediate/short)-acting _______.

Intermediate; benzodiazepine

Lorazepam is a _______ (long/intermediate/short)-acting _______.

Intermediate; benzodiazepine

Temazepam is a _______ (long/intermediate/short)-acting _______.

Short; benzodiazepine

Oxazepam is a _______ (long/intermediate/short)-acting _______.

Short; benzodiazepine

Triazolam is a _______ (long/intermediate/short)-acting _______.

Zaleplon; zolpidem

Two compounds that bind to benzodiazepine binding site on GABA receptor, but arenot benzodiazepines.

Zaleplon; zolpidem

Two anxiolytics that affect GABA receptor, but have no withdrawal effects and no tolerance/dependence with prolonged use.

Buspirone

Anxiolytic that is a partial agonist of 5HT-1a receptors.

Buspirone

Anxiolytic that affects serotonin receptors. Low potential for abuse/addiction. Does not potentiate effects of alcohol.

Propranolol

Useful in treating panic attacks, performance anxiety, and akathisia.

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