Opioids
Name an opioid that is a partial mu agonist.
Buprenorphine
What patients should avoid naltrexone?
Currently taking opioids, have active hepatitis, or liver failure
What is the black box warning for all antipsychotics?
Increased mortality in elderly patients with dementia related psychosis
Name three popular SSRIs. If you know the brand names you get double the points.
Fluoxetine (Prozac)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Citalopram (Celexa)
Give an examples of post synaptic AND pre synaptic receptors
Post synaptic = alpha 1 receptors, 5-HT2a
Pre synaptic = alpha 2 receptors, 5-HT1a
What enzyme metabolizes codeine to morphine?
CYP2D6
What are the three medications FDA approved for treatment of alcohol use disorder?
Naltrexone, Acamprosate, and Disulfiram
What are positive symptoms of schizophrenia?
Hallucinations, delusions, and disorganization
What is the washout period for SSRI/SNRIs for patients starting MAO inhibitors?
14 days
What is the relationship between serotonin and dopamine?
Inverse relationship! Decrease in 5-HT/serotonin = increase in dopamine.
Describe the differences between Methadone used for pain and Methadone used for opioid use disorder.
Methadone for pain: can be dispensed from local pharmacy, dosed 2-3 times/day, lower dose
Methadone for opioid use disorder: CANNOT be dispensed from local pharmacy, MUST be dispensed from an opioid treatment program, dosed once daily, high dose
What are some benefits of using buprenorphine over methadone?
Less restrictions since it is a C-III
Has a ceiling effect with regard to overdose
May be dispensed in pharmacy or doctor's office
Less drug interactions and cardiovascular risk
How do we know when to give a first gen antipsychotic instead of a second gen antipsychotic?
If a patient has BOTH negative and positive symptoms they may benefit more from a second gen antipsychotic.
What are four class effects of TCAs?
Anticholinergic effects: dry mouth, constipation, blurred vision, etc.
Sedation
Weight gain
Lowers seizure threshold
Which foods interact with MAO inhibitors and what is the result of the interaction?
Tyramine rich foods: aged cheese, dry meats, soy sauce, red wine, beer
Can lead to a hypertensive crisis
What are the two Alpha 2 agonists used for opioid withdrawal and how do they work?
Clonidine and Lofexidine
They reduce catecholamine release/norepinephrine in the sympathetic nervous system leading to less withdrawal symptoms.
What are ALL the signs and symptoms of opioid overdose? Hint: there are 7
Loss of consciousness, blue fingernails/lips, very slow or no breathing, pinpoint pupils, very slow or no heartbeat, vomiting/gurgling noises, chest wall rigidity
Describe all the dopaminergic pathways. Bonus points if you can say which ones are not affected by schizophrenia.
Mesolimbic: increase dopamine -> positive symptoms
Mesocortical: decrease dopamine -> negative symptoms
Nigrostriatal: improves motor control and EPS
Tuberoinfundibular: regulates prolactin
Nigrostriatal and tuberoinfundibular are not affected by schizophrenia
Inhibits 5-HT uptake and 5-HT2a receptor
Also blocks alpha 2 and H1 receptors
What are advantages of using alpha 2 agonists for withdrawal?
Does not produce opioid intoxication, detoxification without opioids, limited abuse potential, no special licensing is required for dispensing of this medication
Describe the mechanism of opioid withdrawal.
What is the brand name of the drug used monthly for opioid and alcohol use disorder?
Vivitrol
Name three second generation antipsychotics with high risk for metabolic syndrome (weight gain, dyslipidemia, and glucose abnormalities)
Clozapine, Olanzapine, Quetiapine, Risperidone, Paliperidone
What are some contraindications of Bupropion?
Seizure disorder, history of anemia/bulimia, patients undergoing abrupt discontinuation of alcohol and sedatives, patients taking MAO inhibitors, conditions that increase seizure risk
What part of the brain is responsible for body's response to stress and panic?
Locus Ceruleus