Exam 1

Question 1

Know the limits and the basics of the hold described in California’s Welfare and Institution Code section 5150 (How long can it last? Who can it legally be applied to? Who can write this hold in Humboldt county? How can it be rescinded?).

Answer 1

72 hour involuntary hold Person is danger to self/others or gravely disabled Written by peace officer, ER docs, clinicians who work at county Psychiatrist can rescind- others???

Question 2

Know the major differences between LPS and Probate conservatorship.

Answer 2

LPS- temporary, reviewed every year, used for mental illness Probate- more permanent injuries/illnesses

Question 3

Know the 5 elements of decisional capacity discussed in class.

Answer 3

Understanding and Appreciation of Reason to Communicate their Values (CAURV) 1. Understanding of mental illness. 2. Appreciation of implications of illness 3. Reasoning the risks/benefits of treatment 4. Communicate decisions about their Tx. 5. Values- tx congruent with patient values

Question 4

What is the purpose of a Riese hearing? How does it relate to informed consent?

Answer 4

1) Determines whether someone can give IC to treatment (5 elements of decisional capacity)

Question 5

What is Laura’s Law?

Answer 5

court-ordered assisted outpatient treatment

Question 6

Know the meaning of the term “off-label” in reference to a medication prescription

Answer 6

Prescription of a med for condition other than what it has been approved for

Question 7

What is the blood-brain barrier?

Answer 7

Capillary cells that surround the central nervous system and brain. These capillaries are bound tightly together with astrocytes (glial cell) that make a somewhat impenetrable barrier between the nervous system/ brain and the rest of the body

Question 8

What is lipophilicity? How does it relate to medications?

Answer 8

fat-soluble; most meds are fat soluble- easiest way to pass through BBB

Question 9

What is the primary excitatory neurotransmitter in the brain?

Answer 9

Glutamate

Question 10

What is the primary inhibitory neurotransmitter in the brain?

Answer 10

GABA

Question 11

Which neurotransmitter is highly implicated in cognition in the brain? What is this same neurotransmitter’s role in the autonomic nervous system? Can you name any other roles for this neurotransmitter elsewhere in the body?

Answer 11

1) Acetylcholine 2) primary PNS NT (calm down) 3) responsible for moving muscles in peripheral ns

Question 12

What is the primary neurotransmitter in the sympathetic nervous system? What is this same neurotransmitter’s role in the brain?

Answer 12

Norepinephrine In SNS controls bp, hr, bronchial dilation In brain controls reward, pain relief, mood, memory, hormonal functioning

Question 13

Which neurotransmitter is involved in regulating pleasure and reward in the brain?

Answer 13

Dopamine

Question 14

Which neurotransmitter is involved in regulating worry vs. a sense of wellbeing in the brain?

Answer 14

serotonin

Question 15

What is an agonist?

Answer 15

Assists cell doing what it would normally do (NT or drug)

Question 16

What is an antagonist?

Answer 16

Prevents cell from firing- stop message or blocks receptor

Question 17

What is a receptor?

Answer 17

Protein, binding site for certain NT’s to enter neuron from synapse, tell neuron to excite/calm action potential

Question 18

What is a transporter? Understand how transporters play a role in regulating the amount of neurotransmitter in the synaptic cleft.

Answer 18

Protein that floats around in the synapse, cleans up extra NT’s so they can be reused or broken down and recycled

Question 19

How can enzymes affect neurotransmitters in the synaptic cleft? Give an example of how a medication can target an enzyme to alter the amount of neurotransmitter in the synaptic cleft.

Answer 19

Enzymes break down nt’s left in synaptic cleft Meds can affect level of NT’s by blocking enzymes from cleaning up NT’s

Question 20

Know the basic differences between first messenger and second messenger effects

Answer 20

1st: fast/simple- drug tells cell to fire or not, basically imitates NT 2nd: slower/complex, changes shape of receptor, activates G protein, changes the way cell functions

Question 21

What do the Cytochrome P450 enzymes do and where are they located?

Answer 21

principally in the hepatic system, its purpose is to metabolize potentially toxic compounds

Question 22

Be able to describe first-pass metabolism…and two methods of drug administration which allow bypass of first-pass metabolism.

Answer 22

*reduces the bioavailability of a drug, this occurs with oral administration of medication. *Once the drug is absorbed through the GI tract, the drug compounds move through the portal vein to the liver where they are subject to breakdown before hitting the bloodstream. *bypass: inhalation, transdermal, mucus membrane, injection

Question 23

What is the portal vein (aka. the hepatic portal vein) and why does it matter in a psychopharmacology class?

Answer 23

The portal vein is a blood vessel that moves blood from the GI tract to the liver system without going into the systemic blood supply first. The purpose is to move drugs (or toxins) from the GI tract to the liver to be metabolized before reaching the systemic blood supply.

Question 24

Describe cross-tolerance and give an example.

Answer 24

Drugs that work with similar mechanisms- if you build tolerance for one, you build tolerance for all (i.e. alcohol & xanax)

Question 25

What is metabolic tolerance? Where in the body do changes typically occur to bring about this type of tolerance? Is this synonymous with pharmacokinetic or pharmacodynamic tolerance? Be able to give an example of metabolic tolerance.

Answer 25

*Increase in enzymes that metabolize a drug caused by presence of drug *Liver *pdynamics= effect of drugs on body, pkinetics= effect of body on drugs. Metabolic tolerance is pkinetic tolerance Tolerance to LSD builds quickly- the more you take, the more efficient your body becomes at eliminating it

Question 26

What is cellular tolerance? Where do changes typically occur to cause this type of tolerance? Is this pharmacokinetic or phramacodynamic tolerance?

Answer 26

*Receptors in brain adapt to continued presence of a drug (up/downregulation) *Occurs in postsynaptic membrane *Pdynamic tolerance (effect of drug on body)

Question 27

What kind of genetic testing (related to psychiatric medications, as discussed in class) is available in clinical practice now? Describe what is actually being tested and briefly describe the meaning of the results.

Answer 27

*Test for # of genes for certain enzymes that metabolize antidepressants (2D6, 2C19, 3A4) gene differences make you a slower/faster metabolizer *Faster metabolizers need larger/more frequent dosages, slow metabolizers less (greater risk of side effects) *Genetic tests predict side effects ⅔ of the time

Question 28

Give an example of the influence of ethopsychopharmacology in prescription practice.

Answer 28

Ethiopians more likely to be rapid or ultra rapid metabolizers of 2D6 (prozac)- max safe doses may not be strong enough to provide therapeutic relief

Question 29

What is a prodrug?

Answer 29

form of a drug that it inactive when administered but becomes active once metabolized

Question 30

Define the following in the context of medication research trials: double blinded, single blinded & randomization

Answer 30

DB- neither the experimenters nor the participants know who is receiving a particular treatment SB- experimenters know who is getting what treatment, but the participants do not. Randomization- people are chosen at random to receive one of several clinical interventions, including a control group

Question 31

What medical illness (discussed in class) can cause congestion/increased blood pressure in the portal vein? What’s a common cause of this illness? What are a few of the physical results of the congestion in the portal?

Answer 31

Cirrhosis of liver, scarring/hardening keeps blood from passing through- backs up into portal vein. Comes from drinking. May cause hemorrhoids, intestinal bloating, jaundice, vomiting blood

Question 32

What is the classic example of a water-soluble drug? (Richard correctly gave this example in class).

Answer 32

Lithium

Question 33

What is the classic example of a fat-soluble (lipophilic) drug? (The one I’m thinking of is listed as a Schedule 1 substance by the DEA).

Answer 33

Marijuana

Question 34

Give an example of pharmacodynamic tolerance with descriptions of the actual changes that occur.

Answer 34

Cellular tolerance- receptors in the brain get used to the presence of a drug (i.e. alcohol) and down regulate by decreasing the number or sensitivity of receptors on postsynaptic neuron. Over time, person needs more and more to get the same results.