1.3.1 Psychopharmacology General Concepts Flashcards
Which one of the following is the first antidepressant to be introduced? MAO inhibitors SNRIs SSRIs Tetracyclics Tricyclics
Iproniazid is a monoamine oxidase inhibitor. This was the first antidepressant developed in 1952. Iproniazid was being used in treating tuberculosis discovery of mood lifting properties. But hypertensive reactions precluded large scale use. Imipramine manufactured as chlorpromazine derivative came to market soon.
Which of the following can be called as a major tranquilliser? Chlordiazepoxide Chlorpromazine Propofol Risperidone Secobarbital
Chlorpromazine.
Antipsychotics came to be known as major tranquilizers, while barbiturates and benzodiazepines were called minor tranquilizers. 1950-52, Presurgical antihistamine chlorpromazine was shown to have antipsychotic effects independently by Delay and Deniker’s team, and Charpentier from France
Zimeldine caused demyelination disorder on introduction, leading to its withdrawal. Which of the following class does it belong to? Antipsychotics Benzodiazepines MAO inhibitors SSRIs Tricyclics
Zimeldine.
Carlssen synthesized purpose made SSRI Zimeldine – but withdrawn due to incidence of hypersensitivity syndrome and demyelinating disease that followed its use.
True or false
Aripiprazole = Benzisothiazole
False
Aripiprazole = arylpiperidylindole (quinolone).
True or false
Droperidol: butyrophenones
True.
Droperidol & haloperidol are classified as butyrophenones.
True or false
Flupentixol: dihydroindole
False.
Flupentixol = Thioxanthenes
True or false
Risperidone: dibenzoxapine
False.
Risperidone = Benzisoxazole derivative
True or false
Thioridazine: diphenyl butyl piperidine
False.
Thioridazine = Piperidine derivatives-
Chose a secondary amine from the below list: Amitriptyline Amoxapine Clomipramine Dothiepin Imipramine
Amoxapine.
Secondary amines = desipramine, amoxapine, nortriptyline and protriptyline also duloxetine)
[more potent mg to mg basis; less sedating; more noradrenergic, less antihistaminic or anticholinergic than tertiary].
Which of the following chemical class of drugs used as antidepressants can increase seizure risk heavily? Aminoketone Cyclopyrrolone Hydrazine derivatives SSRIs Triazolopyridine
Aminoketone (Bupropion) is contraindicated in seizure disorder.
What is an “active placebo”?
An ‘active placebo’ has some activity inherently, but not against the treated condition.
What is a “nocebo”?
A drug administered as placebo produces prominent side-effects.
What is the “placebo sag”?
Placebo sag is a term used to refer to decrease in placebo effect with repeated or chronic administration of placebo drugs.
True/False:
A group of ‘placebo reactors’ with stereotyped personality can be identified.
False.
There are no homogenous placebo reactors in the population.
True/False:
Degree of placebo response is similar irrespective of the treatment studied.
False.
Placebos work better for severe than mild pain, but mildly depressed patients respond well than severely depressed ones.
True/False:
No placebo response is seen in personality disorders.
False
True/False:
Opioids may have a role to play in placebo response.
True. Endogenous opioids (e.g. endorphins) play a significant role in mediating placebo-induced analgesia. Dopamine reward system is being increasingly implicated in placebo effects in psychotropic. .
True/False:
Placebo response to depression is gradual but persistent
False.
Placebo response to depression starts abruptly, occurs early in treatment and is less likely to persist.
Before approval of a drug molecule, mutagenicity, carcinogenicity and organ system toxicity are studied at which phase of clinical trials? Phase 1 Phase 2 Phase 3 Postmarketing surveillance Preclinical animal phase
Preclinical Animal Studies: The pathway a drug must undergo before approval and marketing starts with animal studies where the molecule is demonstrated to have specific actions. These extensive preclinical animal studies must be carried out at least on two different animal species. Mutagenicity, carcinogenicity and organ system toxicity are studies at this phase.
Which of the following ethnic differences in pharmacogenetics create natural alcohol deterrence?
High alcohol dehydrogenase High aldehyde dehydrogenase High CYP 3A4 Lack of aldehyde dehydrogenase Low cholinesterase
Lack of aldehyde dehydrogenase
Nearly 40% Asians and around 60% South American Native Indians lack Aldehyde dehydrogenase enzyme in sufficient amounts to metabolise alcohol – this serves as a natural deterrent in these communities
Ethnic differences in psychiatric drug effects are noted in which of the following pharmacological actions?
Alcohol metabolism All of the above Blood levels of haloperidol Hydroxylation of tricyclics Prolactin response to antipsychotics
All
Maximal haloperidol concentration in plasma after rapid tranquilisation is significantly high for Asians than Caucasians.
Nearly 40% Asians and around 60% South American Native Indians lack Aldehyde dehydrogenase enzyme in sufficient amounts to metabolise alcohol.
Caucasians appear to have lower plasma levels of tricyclic antidepressants and attain plasma peaks later when compared with Asians (of Far Eastern ancestry as well as those from the Indian subcontinent).
These differences have been attributed to a greater incidence of slow hydroxylation among Asians when compared with Caucasians.
On administration of antipsychotics, Asian subjects were reported to produce greater serum prolactin levels than Caucasian subjects.
Who discovered the tranquilising properties of chlorpromazine?
Dale
Chlorpromazine was synthesized on December 11, 1951 by Paul Charpentier, in the laboratories of Rhône-Poulenc, a French pharmaceutical company, and released for clinical investigation in May 1952 as a possible potentiator of general anesthesia.
Clinical investigations with CPZ began at Saint-Anne’s hospital – at Pierre Deniker’s service in Jean Delay’s department in 1952.
Who discovered psychotropic use of lithium?
Cade
Believing that mania might be caused by intoxication by normal body products, Cade’s experiments led him to focus on lithium urate. He observed that guinea pigs became very lethargic on the compound, and he subsequently conducted a clinical trial of lithium with ten manic patients.
Placebo effect is NOT mediated via
classical conditioning expectancy Natural remission Nocebo response operant conditioning
Nocebo
A placebo makes patients feel better for reasons unrelated to the specific healing properties of the treatment.
A nocebo makes patients feel worse (or does other harm) in the same way.
Which of the following psychotropic agents has the same pharmacokinetic properties in Asians and White Europeans?
Alprazolam Chlorpromazine Diazepam Haloperidol Lithium
Lithium is completely excreted renally; its excretion does not differ between Asians and Europeans.
Duloxetine and milnacipran are classified as:
Adrenergic type 2 antagonists Monoamine oxidase inhibitors Selective serotonin reuptake inhibitors Serotonergic and noradrenergic reuptake inhibitors Tricyclic antidepressants
Serotonergic and noradrenergic reuptake inhibitors
Same as Venlafaxine
Which one among the following is a butyrophenone derivative?
Chlorpromazine Flupenthixol Haloperidol Thioridazine Zuclopenthixol
Haloperidol
First-generation agents are usually classified into three groups:
1) phenothiazines (chlorpromazine, Thioridazine),
2) butyrophenones (e.g., haloperidol),
3) and several other minor chemicals (e.g., thiothixene, molindone, and loxapine), based on their structure.
Which one among the following is a benzisoxazole derivative?
Amisulpride Clozapine Risperidone Sulpiride Ziprasidone
Risperidone = benzisoxazole derivative
sulpride and amisulpride = substituted benzamides.
Ziprasidone = a Benzisothiazole
Clozapine = a Dibenzodiazepine.
Which of the following is a substituted benzamide used as an antipsychotic?
Amisulpride Benzhedrine Olanzapine Paliperidone Risperidone
Amisulpride = substituted benzamide.
Acamprosate is a
Alpha-1 agonist Long acting opiod agonist Opioid receptor antagonist Synthetic taurine analogue Type of benzodiazepine
Acamprosate = synthetic taurine analogue
It appears to act centrally on glutamate and GABA neurotransmitter systems, although the mechanism has not been fully established.
The risk factor predicting poor response to lithium prophylaxis in bipolar illness is:
Dominant personality High age of illness onset High number of previous hospitalizations High social status Social support
Predictors of poor response to lithium in bipolar prophylaxis include:
High number of prev hospitalization, stress, high expressed emotion, and high number of life events, episodic patterns of depression- mania interval, continuous cycling, and unemployment and neurotic personality.
Which drug is useful for the treatment of OCD?
Duloxetine Phenelzine Sertraline Trazadone Venlafaxine
SSRIs remain as the first line treatments of OCD.
Sertraline is SSRI drug, which is also useful for the treatment of OCD in children. (Refer - POTS study).
The minimum effective dose of Aripiprazole in treating a psychotic episode is
10mg 15mg 20mg 25mg 5mg
10mg
Aripiprazole was shown to be superior to placebo at doses of 15 mg/day, 20 mg/day, and 30 mg/day in at least two clinical trials for each dose and at 10 mg/day in another trial.
Two studies that evaluated the efficacy of aripiprazole at lower doses (2 and 5mg/day) in schizophrenia, failed to demonstrate the superiority of aripiprazole versus placebo.
The available trial evidences indicate that Aripiprazole 10 mg/day is the minimum effective dose for the treatment of patients with schizophrenia experiencing acute relapse.
Aripiprazole 5 mg/day produced improvements in some outcome measures but not in the primary efficacy measure, suggesting that it may lack efficacy for treating acute psychosis. CNS Spectr. 2006;11(9):691-702