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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.