Pharm Psych PEARLS

What is the function of an inverse agonist?

Blocks agonists at receptor site and reduces activity below baseline activity

EPS result from antagonism of which receptor?

D2

Which form of EPS causes primarily orofacial dyskinesias?

Tardive dyskinesia

What are the clinical features of serotonin syndrome?

Akathisia, muscle twitching, hyperreflexia, penile erection, seizures, and coma

What are the clinical features of neuroleptic malignant syndrome?

Muscle rigidity, fever, unstable BP, myoglobinemia

What disorders have psychosis as a defining feature?

Schizophrenia, substance-induced psychotic d/o, schizoaffective d/o, delusional d/o

What disorders have psychosis as an associated feature?

Mania, depression, Alzheimer's, cognitive d/o

Are FGAs or SGAs more commonly associated with EPS/tardive dyskinesia?

FGA

Are FGAs or SGAs more commonly associated with elevated prolactin levels and galactorrhea/amenorrhea?

FGA

What is the prototype FGA and what admin forms is it available in?

Haloperidol; PO and IM depot

What receptors do FGAs vs. SGAs generally work on?

FGA - D2 antagonism

SGA - combo of D2 antagonism and 5-HT2A antagonism/inverse agonism

Do FGAs or SGAs more commonly cause weight gain, dyslipidemia, diabetes, and accelerated CVD?

SGAs

Which SGA has multiple indications including Bipolar d/o, schizophrenia, and adjunct in MDD tx whose effects are dose-dependent?

Quetiapine (50mg hypnotic, 300mg antidepressant, 400-800mg antipsychotic)

Which SGA is not recommended for PG or lactation, but is the DoC if a breastfeeding pt must use an antipsychotic?

Olanzapine

Which SGA is indicated for treatment resistant schizophrenia and has a major SE of severe neutropenia?

Clozapine

Which two SGAs are similar to the 3rd gen antipsychotics due to their MoA of partial D2 & 5-HT1A agonist and 5-HT2A antagonist activity?

Aripiprazole and brexipiprazole

Which two SGAs should be taken with decently large amounts of calories?

- Lurasidone: >350 Kcal

- Ziprasidone: >500 Kcal

Which SGA is indicated for psychosis in Parkinson's disease only?

Pimvanserin

Which drug is a 3rd gen antipsychotic? What is its 1/2 life?

Cariprazine; 1-3 weeks

Which drug is indicated for tx of tardive dyskinesia?

Valbenazine

What % of symptom reduction is the tx goal with antidepressants?

50% or more

How long does it take to see improvement in emotions with antidepressants? How long for full impact?

Improvement: 2-4 weeks

Full impact: 6-8 weeks

How long after initiating antidepressants should you follow-up for suicidiality/SEs?

2 weeks

What drug can you combo with SSRIs to keep the SSRI dose as low as possible? This drug is also contraindicated with seizure d/o.

Bupropion

Is bupropion associated with more or less sexual dysfunction compared to other antidepressants?

Less

Which drug should be avoided with high tyramine foods?

Phenelzine (MAOI)

How long after stopping fluoxetine should you wait to prescribe phenelzine? How about other SSRIs and tricyclics?

Fluoxetine: 5 weeks

Other SSRIs and tricyclics: 2 weeks

Which drug is a tetracyclic antidepressant with a SE of significant sedation?

Mirtazapine

At wha dosage does trazadone act as a hypnotic and at what dose does it act as an antidepressant?

Hypnotic: 25-150mg

Antidepressant: 150-600mg

Which antidepressant has a very long half life of ~10 days?

Fluoxetine

Which antidepressant has two enantiomers, of which the S enantiomer is the active form? What is the name of the active form on the market?

Citalopram; Escitalopram

Which antidepressant recruits more NET inhibition as the dose is increased and therefore increases DA in the PFC?

Venlafaxine

Which antidepressant is the only one with an approved indication for chronic pain?

Duloxetine

Which antidepressant is a serotonin partial agonist reuptake inhibitor (SPARI) with little to no effect on NE, DA?

Vilazodone

Does vilazodone alleviate or worsen sexual dysfunction SEs seen with antidepressants?

Alleviate

Which psych medication is contraindicated in diabetes insipidis due to its tendency to reduce renal concentrating ability?

Lithium

Tremor development is one of the first signs of OD of which psych med?

Valproate

Which anxiolytic is contraindicated in patients with urinary retention due to its anticholinergic effects?

Hydroxyzine

Is propranolol used at relative high or low doses for tx of tremors and anxiety?

Low

Which benzodiazepine used for bridge therapy in anxiety d/o has a SE of anterograde amnesia?

Diazepam

Which BZD has a 1/2 life of 20-50 hours in adults and ~90 hours in elderly pts?

Diazepam

Which BZD exhibits its anxiolytic effects with no active metabolite?

Oxazepam

Whiich drug is used for the reversal of BZD impact in the case of BZD OD?

Flumazenil

How long does it take to see the full impact of buspirone?

2 weeks

Sedatives and hypnotics both work on BZD, alpha1, and H1 receptors. Which other receptors do sedatives vs hypnotics work on specifically?

Sedatives - M1

Hypnotics - Orexin

Which non-BZD hypnotic used for insomnia may cause next day carryover (grogginess in the morning)?

Esopiclone

Which non-BZD hypnotic used for insomnia may cause increased wakefulness during the latter part of the night (wearing off)?

Zaleplon

How much greater is the affinity of ramelteon for MT1 compared to endogenous/OTC melatonin?

6x

Which BZD hypnotic used to tx insomnia may cause a paradoxical rxn (activation)?

Temazepam

Which drug is an orexin receptor antagonist used to tx insomnia and what is one major SE of concern?

Suvorexant; can cause cataplexy and leg weakness during the day or night

Which drug used to tx ADHD has an off-label indication of depression in terminally ill pts?

Methylphenidate

Which drug used to tx ADHD can cause priapism?

Methylphenidate

Which drug is a nonstimulant, NERI used to tx ADHD? Is it more or less eeffective than stimulant drugs?

atomoxetine; less effective

Which drug used off-label to tx PTSD has the SE of floppy iris syndrome?

Prazosin

What are the timing considerations to initiate acamprosate, disulfram, and naltrexone with regards to abstinence from alcohol/opioids?

Acamprosate - "once abstinent"

Disulfram - at least 12 hr

Naltrexone - at least 7-10 days

Which opioid analgesic used to tx opoid addiction has an analgesia duration shorter than its half-life and should therefore be administered cautiously to avoid OD?

Methadone

How long does it take to achieve steady state with methadone?

3-5 days

What forms of admin are available for suboxone (buprenorphine + naloxone)?

Buccal and SL films and tablets (not all strengths are bioequivalent to one another)

Which 2 drugs used to tx opioid addiction require specific trainings?

Methadone - CSAT training

Buprenorphine - FDA training

What % of primary care pts have a substance use problem?

20-25%

Are psychosocial or medication interventions more important for OUD tx?

Psychosocial

Does fluoxetine cause hypersomnia or insomnia?

Insomnia

What is the DoC for depression with mixed features?

Lorasidone

What is the baseline suicide rate in adolescents to young adults? What is the rate with antidepressant use?

Baseline - 2%

With meds - 4%

Why don't we give psych meds rectally?

Hard to know the concentration of drug in the pt's system (I think??)