Psychiatry-Pharmacology (USMLE)
Drug of choice for management of chronic generalized anxiety disorder –
antidepressants
<i>velaxafine and SSRIs preferred over TCAs
What drugs can be used for acute treatment of generalized anxiety disorder or as
adjuncts during initiation of antidepressant therapy? –
benzodiazepines
Name a second-line agent for generalized anxiety disorder. –
buspirone
<i>alternative agents: hydroxyzine and pregabalin
Drug of choice for panic disorder –
SSRIs
List 2 adverse effects of alprazolam that do not make it an ideal choice for treatment of
panic disorder. –
rebound anxiety between doses
withdrawal syndromes, including seizures
Drug of choice for social anxiety disorder –
SSRIs
List 3/5 FDA-approved drugs for the treatment of obsessive-compulsive disorder. -
clomipramine
fluoxetine
fluvoxamine
paroxetine
sertraline
<i>benzodiazepines or antipsychotic drugs can be added for highly anxious
patients
Drug of choice for PTSD –
SSRIs
,List 2 SSRIs approved for the <i>ACUTE</i> treatment of PTSD. Which is indicated for
long-term management as well? –
sertraline: long-term management as well
paroxetine
Drug of choice for performance anxiety –
propranolol <i>and other beta-blockers
What amino acid precursor gives rise to dopamine? –
tyrosine
<i>must be transported across the blood-brain barrier into the dopamine neuron
What transporter allows for tyrosine uptake in the presynaptic neuron? –
system L
<i>Na+-independent manner
What is the rate-limiting enzyme in dopamine synthesis? –
tyrosine hydroxylase
<i>tetrahydrobiopterin cofactor required
What enzyme converts DOPA to dopamine? –
DOPA decarboxylase
<i>so rapid that DOPA levels in brain negligible
How do D1 and D2 receptors affect adenylyl cyclase activity? –
D1: ↑ adenylyl cyclase
D2: ↓ adenylyl cyclase, ↑ K+ conductance, ↓ Ca2+ conductance
How do dopaminergic neurons from the substantia nigra affect GABAergic output from
the striatum? –
normally inhibit the GABAergic output
Destruction of neurons of which dopamine pathway cause Parkinson's disease? –
nigrostriatal
<i>70% of neurons destroyed at time symptoms first appear
In regards to dopaminergic and cholinergic neurons, what is the strategy of treatment
for Parkinson's disease? –
,restore dopamine in basal ganglia
antagonize excitatory effect of cholinergic neurons
What enzyme converts levodopa to dopamine? –
DOPA decarboxylase (in CNS)
Why does levodopa cause nausea, vomiting, cardiac arrhythmias, and hypotension? –
much of the drug is decarboxylated to dopamine in the periphery
Name a DOPA decarboxylase inhibitor. –
carbidopa
<i>does not cross the blood-brain barrier
What drug contains carbidopa and levodopa in fixed proportions? –
sinemet
How does food intake affect the appearance of levodopa in the plasma? –
delays appearance of levodopa in plasma
METABOLISM OF LEVODOPA -
Why does responsiveness to levodopa eventually decrease in Parkinson's disease
patients? –
disappearance of dopaminergic nigrostriatal neurons
What vitamin is contraindicated with levodopa? –
vitamin B6
<i>increases peripheral metabolism of levodopa
What emergency can occur with concomitant administration of nonspecific MAO
inhibitors and levodopa? –
hypertensive crisis
Why are antipsychotics contraindicated in Parkinson's disease? –
may produce a parkinsonian syndrome
Why is levodopa contraindicated in angle-closure glaucoma? - ...
Name an ergo dopamine agonist.
Which dopamine receptor subtype is acted upon by this drug? –
bromocriptine
, D2 receptor
<i>used alongside levodopa
Bromocriptine adverse effects (3/5) -
Name 2 nonergot dopamine agonists used in younger patients. –
pramipexole
ropinirole
What nonergot dopamine agonist was available in a transdermal formulation? –
rotigotine
<i>recalled due to formation of rotigone crystals
What nonergot dopamine agonist is used for rescue therapy for treatment of "off"
episodes of akinisia in patients on dopaminergic therapy? –
apomorphine
<i>pretreatment with antiemetic <b>trimethobenzamide</b>
Apomorphine adverse effects (3/6) –
QT prolongation
dyskinesias
drowsiness
sweating
hypotension
bruising at the injection site
Name 2 MAOIs that selectively and <b>IRREVERSIBLY</b> inhibit MAO-B. –
deprenyl (selegiline)
<i>mainly used as adjunct to levodopa; allows dose of levodopa to be reduced
rasagiline
Inhibition of DOPA decarboxylase by carbidopa increases what peripheral metabolite? –
3-o-methylDOPA
What COMT inhibitor is associated with fulminating hepatic necrosis? –
tolcapone
Drug of choice for management of chronic generalized anxiety disorder –
antidepressants
<i>velaxafine and SSRIs preferred over TCAs
What drugs can be used for acute treatment of generalized anxiety disorder or as
adjuncts during initiation of antidepressant therapy? –
benzodiazepines
Name a second-line agent for generalized anxiety disorder. –
buspirone
<i>alternative agents: hydroxyzine and pregabalin
Drug of choice for panic disorder –
SSRIs
List 2 adverse effects of alprazolam that do not make it an ideal choice for treatment of
panic disorder. –
rebound anxiety between doses
withdrawal syndromes, including seizures
Drug of choice for social anxiety disorder –
SSRIs
List 3/5 FDA-approved drugs for the treatment of obsessive-compulsive disorder. -
clomipramine
fluoxetine
fluvoxamine
paroxetine
sertraline
<i>benzodiazepines or antipsychotic drugs can be added for highly anxious
patients
Drug of choice for PTSD –
SSRIs
,List 2 SSRIs approved for the <i>ACUTE</i> treatment of PTSD. Which is indicated for
long-term management as well? –
sertraline: long-term management as well
paroxetine
Drug of choice for performance anxiety –
propranolol <i>and other beta-blockers
What amino acid precursor gives rise to dopamine? –
tyrosine
<i>must be transported across the blood-brain barrier into the dopamine neuron
What transporter allows for tyrosine uptake in the presynaptic neuron? –
system L
<i>Na+-independent manner
What is the rate-limiting enzyme in dopamine synthesis? –
tyrosine hydroxylase
<i>tetrahydrobiopterin cofactor required
What enzyme converts DOPA to dopamine? –
DOPA decarboxylase
<i>so rapid that DOPA levels in brain negligible
How do D1 and D2 receptors affect adenylyl cyclase activity? –
D1: ↑ adenylyl cyclase
D2: ↓ adenylyl cyclase, ↑ K+ conductance, ↓ Ca2+ conductance
How do dopaminergic neurons from the substantia nigra affect GABAergic output from
the striatum? –
normally inhibit the GABAergic output
Destruction of neurons of which dopamine pathway cause Parkinson's disease? –
nigrostriatal
<i>70% of neurons destroyed at time symptoms first appear
In regards to dopaminergic and cholinergic neurons, what is the strategy of treatment
for Parkinson's disease? –
,restore dopamine in basal ganglia
antagonize excitatory effect of cholinergic neurons
What enzyme converts levodopa to dopamine? –
DOPA decarboxylase (in CNS)
Why does levodopa cause nausea, vomiting, cardiac arrhythmias, and hypotension? –
much of the drug is decarboxylated to dopamine in the periphery
Name a DOPA decarboxylase inhibitor. –
carbidopa
<i>does not cross the blood-brain barrier
What drug contains carbidopa and levodopa in fixed proportions? –
sinemet
How does food intake affect the appearance of levodopa in the plasma? –
delays appearance of levodopa in plasma
METABOLISM OF LEVODOPA -
Why does responsiveness to levodopa eventually decrease in Parkinson's disease
patients? –
disappearance of dopaminergic nigrostriatal neurons
What vitamin is contraindicated with levodopa? –
vitamin B6
<i>increases peripheral metabolism of levodopa
What emergency can occur with concomitant administration of nonspecific MAO
inhibitors and levodopa? –
hypertensive crisis
Why are antipsychotics contraindicated in Parkinson's disease? –
may produce a parkinsonian syndrome
Why is levodopa contraindicated in angle-closure glaucoma? - ...
Name an ergo dopamine agonist.
Which dopamine receptor subtype is acted upon by this drug? –
bromocriptine
, D2 receptor
<i>used alongside levodopa
Bromocriptine adverse effects (3/5) -
Name 2 nonergot dopamine agonists used in younger patients. –
pramipexole
ropinirole
What nonergot dopamine agonist was available in a transdermal formulation? –
rotigotine
<i>recalled due to formation of rotigone crystals
What nonergot dopamine agonist is used for rescue therapy for treatment of "off"
episodes of akinisia in patients on dopaminergic therapy? –
apomorphine
<i>pretreatment with antiemetic <b>trimethobenzamide</b>
Apomorphine adverse effects (3/6) –
QT prolongation
dyskinesias
drowsiness
sweating
hypotension
bruising at the injection site
Name 2 MAOIs that selectively and <b>IRREVERSIBLY</b> inhibit MAO-B. –
deprenyl (selegiline)
<i>mainly used as adjunct to levodopa; allows dose of levodopa to be reduced
rasagiline
Inhibition of DOPA decarboxylase by carbidopa increases what peripheral metabolite? –
3-o-methylDOPA
What COMT inhibitor is associated with fulminating hepatic necrosis? –
tolcapone
