Antipsychotics and Antidepressants

Question 1

How many adults filled out one or more prescriptions for psychiatric drugs in 2013?

Answer 1

Data collected in a survey of 242 million adults in the United States indicated that about 1 in 6 adults had filled one or more prescriptions for psychiatric drugs in 2013 (Moore & Mattison, 2016).

Question 2

List the order of filled psychiatric prescriptions in order.

Answer 2

In terms of type of drug, the largest number of adults reported filling prescriptions for antidepressants (12%), followed by anxiolytics, sedatives, and hypnotics (8.3%) and antipsychotics (1.6 percent). Of the leading ten prescribed drugs, antidepressants accounted for six, with SSRIs being four of the leading ten and an SARI and an SNRI each being one of the top ten. The remaining four drugs were benzodiazepines.

Hypnotics-Drugs used for sleep such as Ambien
SARI-Seratonin Antagonist Reuptake Inhibitors-they act by antagonizing Seratonin receptors and inhibiting the reuptake of Seratonin, norepinephrine and dopamine.

Question 3

What is another name for Antipsychotics? How are they classified?

Answer 3

The antipsychotic drugs are also known as neuroleptics and are categorized as first generation or second generation.

Question 4

What are First-Generation Antipsychotics known as?

Answer 4

The first-generation antipsychotics (FGAs) are also known as traditional and conventional antipsychotics

Question 5

Name the First-Generation Antipsychotics?

Answer 5

Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Ghioridazine (Mellaril)
Fluphenizine (Prolixin)

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Question 6

What are First-Generation Antipsychotics? How effective are they in treating sxs?

Answer 6

These drugs are used to treat schizophrenia and other disorders with psychotic symptoms and are more effective for treating positive symptoms than negative symptoms

Negative-affect symptoms

Question 7

How do First-Generation Antipsychotics work?

Answer 7

The FGAs exert their therapeutic effects primarily by blocking dopamine (especially D2) receptors.

Question 8

What are the major side effects of the FGA’s?

Answer 8

The major side effects of the FGAs fall into three categories:
Anticholinergic side effects
Extrapyramidal side effects
Neuroleptic malignant syndrome (NMS)

Question 9

Anticholinergic side effects are most likely with what drugs? What are the side effect symptoms?

Answer 9

(a) Anticholinergic side effects are most likely with low potency FGAs (e.g., chlorpromazine and thioridazine) and include dry mouth, blurred vision, urinary retention, constipation, and tachycardia.

Question 10

Extrapyramidal side effects are most likely with what drugs? Name are the side effect symptoms?

Answer 10

(b) Extrapyramidal side effects are most likely with high-potency FGAs (e.g., haloperidol and fluphenizine) and include parkinsonism (resting tremor, muscle rigidity, slowed movement), dystonia (uncontrollable muscle contractions), akathisia (a sense of inner restlessness), and tardive dyskinesia.

Question 11

What is Tardive dyskinesia? What is it associated with?

Answer 11

It is associated with Extrapyramidal side effects when taking FGAS.
Tardive dyskinesia is potentially life threatening, begins after long-term drug use, and is more common in women and older adults. It starts with involuntary, rhythmic movements of the tongue, face, and jaw and, over time, may also affect the limbs and trunk. Tardive dyskinesia is irreversible for some patients and is treated by gradually withdrawing the drug, administering a benzodiazepine, or switching to a second-generation antipsychotic.

Question 12

What side effect is (Neuroleptic malignant syndrome) associated with? How is this side effect treated?

Answer 12

Neuroleptic malignant syndrome (NMS) is a rare life-threatening side effect. Its symptoms include muscle rigidity, a high fever, autonomic dysfunction (e.g., unstable blood pressure, tachycardia, excessive sweating), and an altered mental state (e.g., confusion, combativeness). Treatment involves having the person stop taking the drug at the first sign of symptoms and providing him/her with supportive therapy (e.g., hydration, cooling).

Question 13

What are second-generation antipsychotics also known as?

Answer 13

The second-generation antipsychotics (SGAs) are also known as atypical antipsychotics

Question 14

Name the SGA drugs

Answer 14

Clozapine (Clozaril)
Fisperidone (Risperdal), Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Aripiprazole (Abilify).

Like the FGAs, they’re used to treat schizophrenia and other disorders with psychotic symptoms, and some are FDA-approved as an adjunctive treatment for major depressive disorder

Remember -pine.

Question 15

What is the evidence of the SGAs?

Answer 15

There’s evidence that the SGAs are as effective as or more effective than the FGAs for treating the positive symptoms of schizophrenia and more effective than the FGAs for treating the negative symptoms, although this may be true for only some SGAs (e.g., Leucht et al., 2009). In addition, an SGA (especially clozapine) may be effective when FGAs have been ineffective.

Question 16

How do SGA’s alleviate symptoms?

Answer 16

These drugs alleviate positive symptoms primarily by blocking dopamine (especially D3 and D4) receptors and alleviate negative and cognitive symptoms primarily by blocking serotonin receptors (e.g., Stepnicki, Kondej, & Kaczor, 2018).

Question 17

SGA’s are less likely than FGA’s to cause __________side effects

Answer 17

The SGAs are less likely than the FGAs to cause extrapyramidal side effects.

Question 18

What side effects can SGA’s cause?

Answer 18

They can cause anticholinergic effects, neuroleptic malignant syndrome, and metabolic syndrome. Metabolic syndrome involves substantial weight gain, high blood pressure, insulin resistance, hyperglycemia, and increased risk for diabetes mellitus and heart disease. In addition, clozapine and, to a lesser extent, other SGAs can cause agranulocytosis, which is a potentially life-threatening condition that involves a dangerously low white blood cell count and requires regular white blood cell monitoring.

Question 19

Name the major antidepressants

Answer 19

The major antidepressants include the
selective serotonin reuptake inhibitors (SSRIs),
serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine dopamine reuptake inhibitors (NDRIs),
tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs).

Question 20

Name the SSRIs

Answer 20

The SSRIs include
fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox),
paroxetine (Paxil),
sertraline (Zoloft), and
citalopram (Celexa).

Question 21

How frequently are SSRI’s prescribed? How are they prescribed? For what disorder?

Answer 21

The SSRIs are the most frequently prescribed antidepressants and are generally considered to be the first-line pharmacological treatment for major depressive disorder and persistent depressive disorder. Some are also used to treat other disorders including premenstrual dysphoric disorder, OCD, panic disorder, generalized anxiety disorder, PTSD, bulimia nervosa, and premature ejaculation.

Question 22

How do SSRI’s work?

Answer 22

The SSRIs exert their therapeutic effects primarily by blocking the presynaptic reuptake of serotonin, thereby increasing its availability in the synaptic cleft. Because they increase the availability of serotonin, the SSRIs are classified as serotonin agonists or indirect agonists (Freberg, 2019; American Psychological Association, n.d.).

Question 23

How do SSRI’s compare with the TCAs?

Answer 23

The SSRIs are comparable to the TCAs in terms of efficacy and have several advantages: The SSRIs have fewer side effects, are safer in overdose (e.g., are less cardiotoxic), and are safer for older adults.

Question 24

What are side effects of SSRI’s?

Answer 24

Side effects include mild anticholinergic effects, gastrointestinal disturbances, insomnia, anxiety, and sexual dysfunction

Question 25

What happens with abrupt cessation of an SSRI?

Answer 25

Abrupt cessation of an SSRI can cause discontinuation syndrome, which involves headaches, dizziness, mood lability, impaired concentration, sleep disturbances, serotonin syndrome and flu-like symptoms.

Question 26

What can cause seratonin syndrome? What are the symptoms and treatment?

Answer 26

Also, combining an SSRI with an MAOI, lithium, or other serotonergic drug can cause serotonin syndrome, which is potentially fatal and involves extreme agitation, confusion, autonomic instability, hyperthermia, tremor, seizures, and delirium. Treatment for serotonin syndrome requires immediate withdrawal of the serotonergic drugs and providing appropriate medical interventions for its symptoms.

Question 27

When do the SSRI’s take effect?

Answer 27

Like other antidepressants, the SSRIs have a delayed onset of therapeutic effects on depressive symptoms of about two to four weeks (Antidepressant Medication, 2017).

Question 28

List the SNRIs and what do they treat?

Answer 28

The SNRIs include venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq). They’re used to treat major depressive disorder, social anxiety disorder, and neuropathic pain and other pain disorders.

Question 29

How are SNRIs and SSRIs similar? How do they work?

Answer 29

The SNRIs are similar to the SSRIs in terms of efficacy, although there’s some evidence they may be more effective for severe depression (e.g., Thronson & Pagalilauan, 2014). Their therapeutic effects are due to inhibition of the reuptake of serotonin and norepinephrine at synapses.

Question 30

What are the side effects fo SNRIs similar to? What are the side effects?

Answer 30

The side effects of the SNRIs are similar to those of the SSRIs and, like the SSRIs, they can cause discontinuation syndrome when abruptly stopped and serotonin syndrome when combined with other serotonergic drugs. Because of their effects on norepinephrine, they can elevate blood pressure and may be contraindicated for patients with hypertension or heart problems.

Question 31

Name on NDRI and what they treat?

Answer 31

The NDRIs include bupropion (Wellbutrin, Zyban), which is used to treat major depressive disorder and assist with smoking cessation and exerts its therapeutic effects by inhibiting the reuptake of norepinephrine and dopamine at synapses.

Question 32

What are the side effects of NDRIs?

Answer 32

Side effects include skin rash, decreased appetite and weight loss, agitation, insomnia, dizziness, and seizures.

Question 33

What are the advantages of bupropion?

Answer 33

Advantages of bupropion are that it causes few anticholinergic effects, does not cause sexual dysfunction, and is not cardiotoxic. Note that bupropion and other antidepressants that increase levels of norepinephrine and dopamine have an energizing effect, which means they’re useful for patients who have low energy and motivation but not for those who have insomnia or are very anxious.

Question 34

How are TCAs categorized?

Answer 34

They are categorized as tertiary or secondary amines based on their chemical structure.

Question 35

Name the TCAs.

Answer 35

The tertiary amines include amitriptyline (Elavil), imipramine (Tofranil), clomipramine (Anafranil), and doxepin (Sinequan) Remember the ils

Question 36

How do TCA’s work?

Answer 36

They exert their effects by inhibiting the reuptake of both serotonin and norepinephrine, with some having a stronger effect on serotonin. Secondary amines include nortriptyline (Pamelor) and desipramine (Norpramin) and are more potent at inhibiting the reuptake of norepinephrine than serotonin.

Question 37

What do the TCAs treat?

Answer 37

The TCAs are used to treat major depressive disorder, panic disorder, obsessive-compulsive disorder (especially clomipramine), and neuropathic pain (especially nortriptyline and amitriptyline).

Question 38

What are the side effects of the TCAs?

Answer 38

The side effects of the TCAs include cardiovascular effects (e.g., hypertension, tachycardia, orthostatic hypotension), anticholinergic effects, sedation, weight gain, and sexual dysfunction. The secondary amines have fewer side effects than the tertiary amines (e.g., they are less likely to cause sedation and anticholinergic effects).

Question 39

TCAs must be prescribed with caution for which type of patients? Why?

Answer 39

TCAs are cardiotoxic and lethal in overdose, they must be prescribed with caution for patients who have heart disease or are suicidal.

Question 40

Name the MAOIs.

Answer 40

Phenelzine (Nardil), isocarboxazid (Marplan), and tranylcypromine (Parnate).

Question 41

What are MAOIs useful for?

Answer 41

These drugs are useful for patients with treatment-resistant depression or atypical depression, which involves reversed vegetative symptoms such as hypersomnia, increased appetite, and reactive dysphoria. Reactive dysphoria-extreme emotional sensitivity to perception of rejection by important ppl in one's life.

Question 42

How does the enzyme monoamine oxidase work?

Answer 42

The enzyme monoamine oxidase deactivates norepinephrine, serotonin, and dopamine, and the MAOIs increase the levels of these neurotransmitters by inhibiting the activity of this enzyme.

Question 43

What are the side effects of MAOI’s?

Answer 43

Side effects include anticholinergic effects, orthostatic hypotension, sedation, and sexual dysfunction. They may also produce a hypertensive crisis when taken in conjunction with certain drugs (e.g., amphetamines, antihistamines) or food containing tyramine (e.g., aged cheese and meat, soy products, beer, red wine, sauerkraut, fava beans, ripe bananas).

Question 44

What are the symptoms of a hypertensive crisis?

Answer 44

Symptoms include a severe throbbing headache, neck pain or stiffness, rapid heart rate, nausea and vomiting, sweating, sensitivity to light, confusion, and delirium.