Exam 1 - Psychopharmacology

Question 1

The use of psychotropic medications in the treatment of psychiatric disorders.

Answer 1

Psychopharmacology

Question 2

Study of what the body does to drugs (i.e. absorption, distribution, metabolism and excretion)

Answer 2

Pharmacokinetics

Question 3

Process by which the drug is metabolized by the cytochrome P450 enzymes (CYP 450) in the intestines and liver prior to going into the systemic circulation.

Answer 3

First pass metabolism:

Question 4

Increase serum levels of other drugs that are substrates of that enzyme= cause toxic levels(SLOW METABOLISM)

e.g. Bupropion, Clomipramine, SSRIs, Ketoconazole, Grapefruit juice, Clarithromycin

Answer 4

Enzyme Inhibitors:

Question 5

Decrease serum levels of other drugs that are substrates of that enzyme= can cause subtherapeutic drug levels (FAST METABOLISM).
e.g. Carbamazepine, St. John’s Wort, Tobacco, Phenobarbital, Phenytoin

Answer 5

Enzyme Inducers:

Question 6

Study of what the drugs do to the body (i.e. target sites for drugs- receptors, ion channels, enzymes(MAOIs) and carrier proteins/reuptake pumps)

Answer 6

Pharmacodynamics:

Question 7

Drug binds to receptors and activates a biological response

Answer 7

Agonist effect:

Question 8

Drug causes the opposite effect of agonist

Answer 8

Inverse agonist effect:

Question 9

Drug does not fully activate the receptors

Answer 9

Partial agonist effect:

Question 10

Drug binds to the receptor but does not activate a biological response.

Answer 10

Antagonist effect:

Question 11

Excitatory response:
Depolarization= The opening of Na+ and Ca+ channels so these ions go into the cell

Answer 11

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Question 12

Inhibitory response: Repolarization= The opening of Cl- channels so that Cl- goes into the cell, K+ leaves or both

Answer 12

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Question 15

-Nonmedicinal substances
-High abuse potential
-Not legally available by prescription

e.g. Heroin, Marijuana

Answer 15

Schedule 1

Question 16

Medicinal drugs
High potential for abuse and dependency
Written prescription only
No telephone orders
No refills

e.g. Morphine sulfate, Methadone, Fentanyl, Oxycodone, Dilaudid

Answer 16

Schedule 2

Question 17

-Medicinal drugs
Abuse potential
Refills limited to 5

e.g. testosterone, suboxone, appetite suppressants

Answer 17

Scheule 3

Question 18

Medicinal drugs
Lesser abuse potential

e.g. Xanax, Librium, Klonopin, Ativan, Restoril,

Answer 18

Schedule 4

Question 19

-Medicinal drugs
-Lowest abuse potential
-Handles like noncontrolled drugs

e.g. Lomotil

Answer 19

Schedule 5

Question 20

___: Controlled studies show no risk
___: No evidence of risk in humans
___: Risk cannot be rule out
___: Positive evidence of risk
___: Absolutely contraindicated in pregnancy

A, B, C, D, X

Answer 20

A: Controlled studies show no risk

B: No evidence of risk in humans

C: Risk cannot be rule out

D: Positive evidence of risk

X: Absolutely contraindicated in pregnancy

Question 21

Teratogenic risks common with psychiatric medications:

Benzodiazepines: Floppy baby syndrome, cleft palate

Carbamazepine (Tegretol): Neural tube defects

Lithium(Eskalith): Epstein anomaly

Divalproex sodium (Depakote): Neural tube deficits- specifically spina bifida, atrial septal defects, cleft palate and possible long-term developmental deficits

Question 22

Locus Cerelus: Key center of NE production

Ralphe Nuclei: Key center for 5HT production

Answer 22

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Question 23

Key center of NE production

Answer 23

Locus Cerelus:

Question 24

Key center for 5HT production

Answer 24

Ralphe Nuclei:

Question 25

Essential for maintaining homeostasis; controls basic needs (eating, drinking, temperature regulation, sleep-wake cycles Impairment: Disturbed sleep, eating, changes in body temperature, emotional instability.

Answer 25

Hypothalamus

Question 26

Relay station for sensory information, Impairment: Sensory processing issues

Answer 26

Thalamus

Question 27

Memory, converting STM to LTM, learning Impairment: Impaired memory and attention

Answer 27

Hippocampus

Question 28

Regulates powerful emotions (fear, rage, sexual desires” Impairment: Irritability, anger, aggression

Answer 28

Amygdala

Question 29

Serotonin (5HT) "Calming NT) Derived from Tryptophan Made in the Ralphe Nuclei Precursor of melatonin Affects sleep, mood and behavior 7- 5HT receptor families w/ 15+ subfamilies NOTE: 90% of serotonin in found in the GI tract

Answer 29

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Question 30

Norepinephrine (NE) Made in the Locus Cerulus Key player in mediating the sympathetic nervous system (i.e. Fight or Flight) Implicated in mood disorders, GAD, ADHD, PTSD etc. Noradrenergic pathways - NE neurons innervates the amygdala and prefrontal cortex = areas important for anxiety and worry

Answer 30

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Question 31

Dopamine (DA) Produced in the Ventra Tegmental Area(Reward Pathway) Associated with reward and pleasure Involves 4 major pathways: Mesolimbic Pathway - - Associated with positive symptoms of schizophrenia (i.e. hallucinations, delusions etc) Mesocortical Pathway - - Associated with the negative symptoms of Schizophrenia (i.e. cognition, affect, apathy, behavior etc.) Tuberoinfundibular Pathway - - Note: Dopamine inhibits prolactin Therefore ↓DA= ↑ Prolactin Nigrostriatal Pathway - - Low levels of DA in this pathway produces increased motor movements e.g. EPS (Pseudo parkinsonism, Akathisia, dystonia & TD)

Answer 31

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Question 32

Gamma-aminobutytric Acid (GABA) = "off" Inhibitory at the postsynaptic neuron Induces calmness and relaxation Plays a role in anxiety disorders e.g. Benzodiazepines & Barbiturates GABA-a and GABA-b

Answer 32

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Question 33

Glutamate = "on" Excitatory at the post-synaptic neuron Pre-cursory of GABA Involved in learning, memory, thought processing, sensory inputs.

Answer 33

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Question 34

Acetylcholine (ACh) Neurotransmitter of the parasympathetic autonomic nervous system and the sympathetic ganglia Acts at the neuromuscular junctions Involved in learning and memory (brain’s cholinergic neurons play a critical role in dementias)

Answer 34

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Question 35

Antidepressants Mood stabilizers Antipsychotics Anxiolytics Psychostimulants Benzodiazepines and Z-meds Cognitive enhancers Medications for Substance-related and addictive disorders

Answer 35

Medication Classe

Question 36

- Patient symptoms - Previous treatment responses by the patient or a family member to a particular med - Side effect profile - Comorbid(medical and psychiatric) conditions - Risk of suicide via overdose on the medication - Cost (newer meds may be prohibitively expensive)

Answer 36

Determinants of choice of medications

Question 37

Movement of drug from site of administration to the blood

Answer 37

Absorption

Question 38

Movement of drug from blood to rest of body

Answer 38

Distribution

Question 39

Breakdown of drug

Answer 39

Metabolism

Question 40

Removal of drug’s metabolic waste products from the body

Answer 40

Elimination

Question 41

Before the blood goes to the rest of the body from the GI tract, it passes through the liver The liver is the major organ that breaks down drugs Therefore, a certain amount of the drug will be inactivated or metabolized as it goes through the liver Other routes may not be subject to this “first pass” effect (IV, IM, inhalation, subq)

Answer 41

First-Pass Metabolism

Question 42

CYP450 Inducer: leads to increased level of that enzyme Inhibitor: leads to decreased level of that enzyme Substrate: the enzyme works on the substrate to make the "product" - E.g. Venlafaxine is a substrate of CYP450 2D6 which converts it to desvenlafaxine - E.g. 1A2 can be induced by smoking: this means increased levels of 1A2, therefore any substrate of 1A2 will decrease in level - Major types affecting psych drugs: 1A2, 2D6, 3A4, - Many “newer” medications circumvent CYP450 issues - Genetic testing is often comprised largely of understanding the metabolism of this pathway for the individual

Answer 42

CYP450

Question 43

reduces the enzyme activity due to direct interaction with a drug=decreased metabolism of meds= increased Med levels 

Answer 43

Inhibition

Question 44

increases the enzyme activity due to direct interaction with a drug =increased metabolism of meds= decreased Med level 

Answer 44

Induction

Question 45

Major Inducers of CYP450 "COPS" Carbamazepine (aut0inducer) Oxcarbazepine Phenytoin/phenobarbital Smoking/St. John's Wort

Answer 45

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Question 46

Major Inhibitors of CYP450 Enzymes "G-PACMAN" Grapefruit Protease Inhibitors Antifungals Cyclosporine/Cimetidine Macrolides Amiodarone (and dronederone) Non-DHP CCBs (diltiazem & verapamil)

Answer 46

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Question 47

What the drug does to the body Drug-receptor interactions Dose-response relationships Potency and efficacy Effects: Side effects/Adverse effects

Answer 47

Pharmacodynamics

Question 48

Polypharmacy - Combining medications to improve therapeutic outcome - Also called “targeted drug combinations”

Answer 48

Drug Interactions

Question 49

Principles regarding drug interactions Pharmacodynamic interactions: two drugs have the same or overlapping mechanism of action Pharmacokinetic interactions: one drug affects the other's absorption, distribution, metabolism, or excretion Inadequate dosing: doses are too low because of side effects Clinical evaluation and oversight: should be ongoing

Answer 49

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Question 50

What is the Therapeutic Index?

Answer 50

Find and fill in data.