Psych Meds Quiz 1

Hippocampus atrophies!!

Drugs for anxiety (Anxiolytic)

Benzodiazepines

  • prototypes : alprazolam (xanax), diazepam (valium)
  • CNS depressant
  • Enhance inhibitory effects of GABA
  • Use with caution in those w addictions/predispositions
  • DC slowly

Nonbenzodiazepines

  • Prototype: buspirone (buspar)
  • Doesn’t affect GABA
  • Bind to serotonin and dopamine receptors
  • Does not cause sedation, doesn’t interact with other CNS depressants, no risk for tolerance and abuse
  • Side effects: dizziness, GI effects
  • Cannot be taken w MAOI’s — severe hypertension

Drugs for depression

Tricyclic Antidepressants (TCAs)

  • prototype : amitriptyline (Elavil)
  • “Trip” , “pramine” , doxepin
  • Block reuptake of norepinephrine and serotonin
  • Can treat nerve pain
  • ORTHOSTATIC HYPOTENSION FALL RISK, anticholinergic effects
  • OVERDOSE MAY BE FATAL (cardiotoxicity)
  • Supplied limited dose at a time (week at a time)

Selective serotonin reuptake inhibitors SSRIs

  • prototype : fluoxetine (prozac)
  • Sertraline (zoloft), citalopram (celexa), paroxetine (paxil)
  • Increased energy before increased mood
  • Be aware of serotonin syndrome (fever, sweaty, restless, tachycardia)
  • Don’t mix with MAOIs or st john's wort (2 week “washout” period)
  • Sexual dysfunction in over 50% of pts, weight gain

Selective norepinephrine reuptake inhibitor SNRIs

  • prototype : venlafaxine (effexor ER)
  • Side effects: nausea, GI effects (take with food)
  • Do not mix with MAOIs (2 week “washout” period)

Monoamine oxidase inhibitors (MAOIs)

  • Prototype : phenelzine (Nardil)

  • Increase serotonin

  • Avoid tyramine containing foods – wine, aged cheese, fermented foods, processed meat

  • Causes hypertensive crisis

  • Side effects : orthostatic hypotension, GI effects

Atypical antidepressants

  • Prototype : bupropion hydrochloride (Wellbutrin)
  • Unclear MOA (dopamine?)
  • GI effects, appetite suppression

Trazodone

  • Serotonin modulator – not SSRI
  • Unclear MOA
  • Also helps insomnia
  • Only available in generic forms

Drugs for Bipolar

Lithium

  • Prototype : lithium carbonate (lithobid)
  • Unclear MOA (sodium?)
  • Narrow therapeutic range (>1.5 meq/L = side effects) 
  • GI side effects (N/V/D) – early sign of toxicity
  • Avoid dehydration, consume adequate amounts of sodium
  • Dont use NSAIDs, thiazide diuretics
  • Teratogenic (dont take while pregnant)

Antiepileptic drugs (AED)

  • Prototype : valproic acid (depakote)
  • Effects GABA

Drugs for schizophrenia

First generation/traditional

  • Prototype : chlorpromazine (thorizine)

  • Others : haloperidol (haldol), fluphenazine (prolixin)

  • Also called neuroleptics

  • Suppress release of dopamine (effects other NTs as well)

  • Side effects: EPS – movement disorders

  • Akathisia, parkinsonism, acute dystonia, tardive dyskinesia, anticholinergic effects, sexual dysfunction

  • Neuroleptic malignant syndrome (NMS) – rare but life threatening, (hyperthermia) more likely with Haldol

Second Generation antipsychotics

  • Prototype : risperidone (risperdal)
  • Introduced in 1900s
  • Equally as effective as first gen
  • Dopamine blockade, but more significant serotonin blockade, less extrapyramidal side effects
  • BUT more likely to cause metabolic side effects (weight gain, dyslipidemia, diabetes)
  • Other CNS side effects: drowsiness, insomnia, dizziness
  1. First line of treatment for anxiety disorder —- SSRIs
  2. This medication may take 3 weeks to take effect —- antidepressants
  3. Part of the cerebrum involved in decision making and social judgment — frontal lobe
  4. This is caused by excess serotonin —- serotonin syndrome
  5. This medication increases levels of serotonin and norepinephrine (brand name remeron) — mirtazapine (atypical antidepressant)
  6. Part of the brain that atrophies in chronic anxiety, depression and schizophrenia — hippocampus
  7. I would like to kill myself by taking all of my pills at once — suicidal ideation
  8. This process, if blocked will increase levels of neurotransmitters — reuptake
  9. Benzodiazepines increase transmission of this neurotransmitter —- GABA
    1. This is where neurotransmission takes place — synapse
    2. What class is phenelzine (Narzil) —- MAOIs
    3. What kind of side effects (urinary retention, constipation, blurry vision) —- anticholinergic effects (of TCAs)
    4. What can you do if you have dry mouth from anticholinergic effects — chewing gum
    5. This type of medication carries the potential for dependency and tolerance, it should not be used long term and you must taper off it — benzodiazepine
    6. Change positions slowly, this medication may cause weight changes — what is antidepressant education
    7. Part of autonomic nervous system that increases heart rate and respiratory rate — sympathetic nervous system
    8. Hypertensive crisis — happens when you eat tyramine ( cool clammy skin, high BP, dilated pupils)
    9. sweaty , high fever, confusion, agitation in patient who started prozac —- serotonin syndrome
    10. Avoid meat, cheese, wine, fermented foods when taking — MAOIs (phenelzine)
    11. States that patient is a danger to self or others — section 12, pink slip
    12. Will help your anxiety but does not have a risk for dependency — buspar
    13. Important in coordination and balance — cerebellum
    14. Associated with high levels of anxiety and depression — histamine
    15. Decreased levels can cause depression — serotonin
    16. Brain and spinal cord —CNS