Source / episode info

• **Episode:**349
• **Title:**Divine Intervention Episode 349 – The Clutch Psych Pharm Review (for the psych shelf, Step 2CK, and Step 3).
• **Published:**2021-11-11
• Source:Episode page

One-liner

This episode provides a comprehensive review of psychopharmacology, covering the mechanisms, side effects, toxicities, and clinical applications of major drug classes including SSRIs, SNRIs, TCAs, MAOIs, antipsychotics (1st/2nd gen), mood stabilizers, and agents for sleep disorders.

High-yield summary

• Antidepressant Classes: SSRIs are first-line for most indications but carry risks of sexual dysfunction and SIADH. SNRIs can treat pain syndromes (diabetic neuropathy, fibromyalgia) but raise blood pressure.
• TCA Toxicity: TCAs are cardiotoxic sodium channel blockers; QRS widening is the hallmark toxicity, treated with Sodium Bicarbonate. They also cause anticholinergic effects (_1 blockade).
• Antipsychotic Spectrum: First-generation agents are potent for positive symptoms but carry high EPS risk. Second-generation (atypical) agents improve negative symptom management and have a lower D2 receptor affinity.
• Critical Monitoring: Clozapine requires monitoring for agranulocytosis, while Lithium has narrow therapeutic index risks (nephrogenic DI).
• Opioid/Benzodiazepine Overdose: Naloxone reverses opioids; Flumazenil reverses benzodiazepines.
• Neurodegenerative Agents: AChE inhibitors (Donepezil, Rivastigmine) boost acetylcholine levels for Alzheimer's disease.

Learning objectives

• Differentiate the mechanisms and clinical uses of major antidepressant classes (SSRIs, SNRIs, TCAs, MAOIs).
• Recognize the specific toxicities and antidotes for common drug overdoses (opioids, benzodiazepines, TCAs).
• Compare first-generation vs. second-generation antipsychotics regarding positive/negative symptom efficacy and side effect profiles.
• Understand the management principles of mood disorders, including initial treatment for acute mania and monitoring requirements for Lithium.
• Identify agents used to treat specific neurodegenerative or sleep disorders (e.g., AChE inhibitors for AD; stimulants for Narcolepsy).