Drugs for Psychiatric Disorders

Question 1

Prototype Drugs (Antipsychotics)

Answer 1

Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Clozapine (Clozaril)
Aripiprazole (Abilify)

Question 2

Antidepressant Drugs

Answer 2

Imipramine (Tofranil)
Fluoxetine (Prozac)
Phenelzine (Nardil)
Tranylcypromine (Parnate)

Question 3

Antimanic and Mood Stabilizing Drugs

Answer 3

Lithium

Carbamazepine

Question 4

Psychosis

Answer 4

General term for any major mental disorder of organic and/or emotional origin, characterized by derangement of personality and loss of contact with reality.

Question 5

Schizophrenia

Answer 5

Major psychotic disorder characterized by disturbed thought processes, delusions, or hallucinations, in the absence of a full affective syndrome or organic mental disorder.

Question 6

Affective Disorders

Answer 6

A disturbance of mood accompanied by related symptoms, and generally involves depression and/or elation.

Question 7

Manic Disorder

Answer 7

The predominant mood is elevated, expansive or irritable, and is associated with other symptoms, such as hyperactivity, flight of ideas, inflated self-esteem, accelerated speech, and distractibility.

Question 8

Major Depressive Disorder

Answer 8

Emotional state of dejection, usually associated with loss of interest in pleasure, sleep disturbances, and feelings of worthlessness or guilt, which is not a reaction to a particular environmental event.

Question 9

3 Categories of Schizophrenia symptoms

Answer 9

Positive symptoms: Unusual thoughts or perceptions
Negative symptoms: Loss or decrease of normal functions
Cognitive symptoms: degraded ability to understand information and use it to make decisions

Question 10

Effects of behavior with Schizophrenia

Answer 10

Neuroleptic syndrome: psychomotor slowing, emotional quieting, affective indifference. (Acute)

Decrease in disturbed thought patterns and psychotic ideation with chronic treatment.

Question 11

Common theme of all anti psych drugs of different classes

Answer 11

They all work to block Dopamine receptors

Question 12

Dopamine “D1 - like” family

Answer 12

D1 and D5, when activated increases the amount of cAMP in the cell (excitatory gene expression)

Question 13

D2 - like family

Answer 13

D2, D3, and D4, when activated decreases the amount of cAMP in the cell (inhibitory gene expression)

Question 14

Most anti-psych drugs block what?

Answer 14

alpha-1 receptors, causing orthostatic hypotension

Question 15

Side effects of anti-psych drugs (D2 receptors)

Answer 15

Drug induced Parkinsonism

Extrapyramidal motor side effects: acute and tardive dyskinesias, tremors, spasticity (most common)

Question 16

Typical vs. A-typical Antipsychotics

Answer 16

Typical: Antipsychotics that produce motor side effects
Haloperidol
Chlorpromazine

A-Typical: Drugs that do not produce motor side effects, do not increase prolactin levels, and can reduce negative and positive symptoms
Clozapine

Question 17

Aripiprazole (Abilify)

Answer 17

An A-Typical antipsychotic
Not at dopamine receptor antagonist
Partial agonist at other receptors
FDA approved for treatment of schizophrenia and bipolar disorder

Question 18

Antidepressant Drugs

Answer 18

Tricyclic Antidepressants
SSRIs
MAOIs

Question 19

Tricyclic Antidepressants (prototype: imipramine)

Answer 19

Inhibits Monoamine Transporters: NE, 5HT
Not euphoric – Dulls depressive ideation
When given to non-depressed individuals: sedation/sleepiness, blurred vision unpleasant
Therapeutic latency of 2-6 weeks; cannot be given PRN – patient compliance problems

Question 20

Tricyclic Antidepressants: Side-effects

Answer 20

Sedation
Anticholinergic
Orthostatic hypotension
Arrhythmias
Tachycardia
Tremor
Transition to hypomanic or manic excitement

Question 21

Tricyclic Antidepressants: Acute Overdose

Answer 21

Initially, hypertension, hyperpyrexia, myoclonus, seizure, followed by coma, hypotension, shock sometimes with metabolic acidosis, hypothermia, respiratory depression, cardiac conduction defects and arrhythmias, especially with drugs with strong antimuscarinic properties

Question 22

Selective Serotonin Uptake Inhibitors (SSRI’s)

prototype: fluoxetine

Answer 22

Work by blocking reuptake transporters leaving high levels of 5HT in synaptic cleft
Behavioral Effect:
Similar to tricyclic antidepressants – dulling of depressive ideation
Therapeutic latency reported to be slightly shorter than with tricyclics, but difficult to prove

Question 23

Side effects

Answer 23

Less antimuscarinic activity than tricyclics

Since fluoxetine is selective for 5HT uptake and has little anticholinergic activity, there are fewer cardiovascular problems (ie., tachycardia), less problem with patient compliance

Question 24

Monoamine Oxidase Inhibitors (MAOIs): Drugs

Answer 24

Hydrazines: Phenelzine (Nardil)

Non-hydrazines: Tranylcypromine (Parnate)

Question 25

MAOIs: Behavioral effect

Answer 25

Psychomotor stimulant, especially tranylcypromine

Therapeutic latency of 2-3 weeks; behavioral stimulant effects of tranylcypromine observed earlier

Question 26

MAOI mechanism of action

Answer 26

Irreversible inhibition of MAO, leading to increased levels of NE, 5HT, and DA; maximal inhibition of MAO

Seen within a few a days, but the antidepressant effect takes longer to develop

Inhibition of DA uptake with tranylcypromine

Question 27

MAOI Side Effects, Overdose, and Drug Interactions

Answer 27

Side Effects:
Orthostatic hypotension
Excessive CNS stimulation resulting in tremors and insomnia

Overdose:
Agitation, hallucinations, hyperreflexia, hyperpyrexia, and convulsions; both hypotension and hypertension may occur

Drug interactions:
L-DOPA: agitation and hypertension
Tyramine (cheese/ wine/ beer): hypertensive crisis