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Psychopharmacology and Mood Stabilizers
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Psychopharmacology and Mood Stabilizers
Psychopharmacology and Mood Stabilizers
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1
Question
How do monoamine oxidase inhibitors (MAOIs) increase neurotransmitter levels?
Answer
MAOIs inhibit the enzyme monoamine oxidase, preventing the breakdown of serotonin, norepinephrine, and dopamine, thereby increasing their synaptic concentrations.
2
Question
For which condition are monoamine oxidase inhibitors primarily indicated?
Answer
MAOIs are used for depression, particularly atypical or treatment-resistant depression.
3
Question
Why must patients on MAOIs avoid aged cheese and red wine?
Answer
These foods contain tyramine, which can cause a hypertensive crisis (tyramine crisis) when combined with MAOIs due to reduced tyramine metabolism.
4
Question
What is the antidote for hypertensive crisis caused by MAOIs?
Answer
Phentolamine Mesylate (Regitine), an alpha-adrenergic antagonist.
5
Question
What is the mechanism of action of tricyclic antidepressants (TCAs)?
Answer
TCAs block the reuptake of norepinephrine and serotonin, increasing their synaptic availability.
6
Question
What are the three C's of tricyclic antidepressant overdose?
Answer
Cardiotoxicity, convulsions, and coma. Cardiotoxicity is the most severe, requiring ECG monitoring; antidote is sodium bicarbonate.
7
Question
What anticholinergic side effects are associated with tricyclic antidepressants?
Answer
Increased blood pressure, increased heart rate, pupil dilation, decreased GI and urine output, and sedation (often given at bedtime).
8
Question
Selective serotonin reuptake inhibitors (SSRIs) are the drug of choice for which disorder?
Answer
Major Depressive Disorder (MDD).
9
Question
Name five SSRI medications using the mnemonic LINE, PRAM, TINE.
Answer
Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline, and Fluvoxamine (six drugs).
10
Question
What are the four S side effects of SSRIs?
Answer
Suicidal ideation (especially under 25, except with Fluoxetine), stomach upset, sexual dysfunction (decreased orgasm), and serotonin syndrome.
11
Question
What does the mnemonic D-MOSSSAM represent in serotonin syndrome causes?
Answer
Dextromethorphan, MAOIs, Opioids (tramadol, morphine, oxycodone, fentanyl), SSRIs, SNRIs, Saint John's wort, and Anticonvulsants/Anxiolytics/Antibiotics (valproic acid, phenytoin, carbamazepine, buspirone, linezolid).
12
Question
What are the signs of serotonin syndrome as summarized by the mnemonic FAAT CHD?
Answer
Fever, Agitation/Altered mental status, Autonomic dysregulation, Tremors, Clonus, Hyperreflexia, and Diaphoresis.
13
Question
What is the antidote for serotonin syndrome?
Answer
Cyproheptadine, a serotonin (5-HT2) antagonist.
14
Question
How do SNRIs differ from SSRIs in mechanism, and which SNRI is specifically indicated for neuropathic pain?
Answer
SNRIs block the reuptake of both serotonin and norepinephrine (not just serotonin). Duloxetine is specifically used for neuropathic pain and fibromyalgia.
15
Question
What is the 5 S mnemonic for SNRI side effects?
Answer
Suicidal ideation, Sexual dysfunction, Stomach upset, Serotonin syndrome, plus Sweating/Hypertension.
16
Question
What are the primary uses of Bupropion among atypical antidepressants?
Answer
Smoking cessation and treatment of Seasonal Affective Disorder (SAD).
17
Question
What does the mnemonic AABE represent for Bupropion contraindications?
Answer
Alcohol withdrawal, Anorexia, Bulimia, and Epilepsy (seizure disorders).
18
Question
What are the characteristic side effects of Mirtazapine?
Answer
Weight gain and sedation (the mnemonics are 'Mataba' for weight gain and 'Makakatulog' for sleepiness).
19
Question
What serious side effect is associated with Trazodone?
Answer
Priapism (prolonged erection), which is the basis for the mnemonic 'Trazo-bone'.
20
Question
How does the mechanism of SNRIs differ from SSRIs in treating depression?
Answer
SSRIs selectively block serotonin reuptake only; SNRIs block both serotonin and norepinephrine reuptake, providing additional noradrenergic effects.
21
Question
What is the LAA mnemonic for bipolar disorder management?
Answer
Lithium, Anticonvulsants, and Atypical antipsychotics.
22
Question
During which phase of bipolar disorder is lithium primarily given?
Answer
The manic/hypomanic phase.
23
Question
What are the mild, moderate, and severe signs of lithium toxicity?
Answer
Mild: GI disturbances, lack of coordination, coarse tremors. Moderate: delirium, blurred vision, hyperreflexia. Severe: renal failure, oliguria, seizure, coma.
24
Question
Which drug classes are contraindicated with lithium?
Answer
NSAIDs, ACE inhibitors, ARBs, and diuretics.
25
Question
What are the antidotes for lithium toxicity, and when is hemodialysis indicated?
Answer
Mannitol and Acetazolamide (Diamox) promote lithium excretion. Hemodialysis is indicated for severe toxicity with levels > 3 mEq/L.
26
Question
Which anticonvulsant is not teratogenic, unlike others used in mood stabilization?
Answer
Lamotrigine. The others (valproic acid, carbamazepine, etc.) are teratogenic.
27
Question
What adverse effects require CBC monitoring when using Valproic Acid?
Answer
Liver toxicity and blood dyscrasias (such as thrombocytopenia).
28
Question
Carbamazepine is the drug of choice for which condition besides bipolar disorder?
Answer
Trigeminal neuralgia.
29
Question
What two major side effects are associated with Carbamazepine?
Answer
Blood dyscrasias and hyponatremia.
30
Question
Which seizure type is Phenytoin ineffective against?
Answer
Absence seizures.