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Psychopharmacology > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is transference?

A

phenomenon in which the person in treatment redirects feelings for others onto the therapist

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2
Q

What is countertransference?

A

occurs when a therapist transfers emotions to a person in therapy, is often a reaction to transference

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3
Q

Know the 5 DEA drug schedules (just the basic description of each schedule).

A

Schedule 1 - high potential for abuse, no medical use Schedule 2- high abuse potential, prescriptions not phoned in or renewed (ritalin, morphine) Schedule 3- moderate abuse potential (lower opioids/stimulants) Schedule 4- low abuse (valium, antidepressants Schedule 5 - lowest potential for abuse

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4
Q

What schedule includes most nearly all opiate pain medications?

A

Schedule 2

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5
Q

What schedule includes benzodiazepines (Valium, Xanax, Klonopin, Ativan, etc.)?

A

Schedule 4

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6
Q

What schedule includes stimulants (Adderall, Ritalin, etc.)?

A

Schedule 2

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7
Q

Is the DEA part of the US justice department or the US health/human services department?

A

Justice department

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8
Q

What is teratogenesis?

A

Development of birth defects in fetus

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9
Q

Pregnancy safety categories (A,B,C,D,X) are no longer used by the FDA, this changed in 2016, but you should still know the meaning of pregnancy category X specifically.

A

Level of risk goes from A (little or no risk), to X (unacceptable risk to fetus: i.e. Lithium)

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10
Q

Is FDA under US justice department or US Health and Human Services department?

A

Department of Health & Human Services

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11
Q

What is Equanimity?

A

Practice of approaching an interaction with respect and caring while remaining unattached to how the interaction unfolds and how you are treated

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12
Q

Know the basics of the FDA drug approval process phases (described in table 4.3 in the text).

A
  1. Preclinical R&D with animals 2. Investigational New Drug Application 3. FDA has 30 days to decide if clinical trials will be allowed 4. Phase 1: clinical trials with healthy volunteers (18 mos) 5. Phase 2: clinical trials with patients who might benefit (2yrs) 6. Phase 3: clinical trials with large number of patients where drug is tested against placebo (2 pivotal trials with statistically significant results (18 mos) 7. New Drug Application summarizing data 8. FDA has 24 mos to approve or not 9. If approved, FDA must approve label for drug 10. Drug monitored in the market for new problems/issues
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13
Q

How many placebo-controlled studies with statistically significant results are required to advance past phase 3?

A

2 ‘pivotal’ trials with statistically significant results

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14
Q

Know the basics of the 4 theories of antidepressant actions discussed in the book

A
  1. Amine- people who suffered from depression didn’t have enough amines (NTs), particularly, norepinephrine (NE), in their synapses 2. Reuptake- people lacked serotonin in their synapses; TCAs work by inhibiting reuptake; symptoms don’t abate until 2-4 weeks following- why?!? 3. Downregulation- explains delay- at first cells are starved for NT’s, have to down regulate receptors before things stabilize 4. Neurotrophic/plasticity-cell goes through many changes after an antidepressant is introduced to the system and the increase in neurotrophins (cell nutrients) is the most important change; cAMP (cyclic AMP) & BDNF increases after taking antidepressants
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15
Q

Know the medications in the SSRI class

A

Prozac, Paxil, Zoloft, Lexapro, Luvox, Celexa, Trintellix [previously known as Brintellix] and Viibryd (8)

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16
Q

Know the medications in the SNRI class

A

Pristiq, Effexor, Cymbalta

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17
Q

Mechanism of Action for TCA class

A

Inhibition of reuptake of norepinephrine and serotonin and slightly dopamine; TCAs also block receptors on acetylcholine, histamine, and epinephrine neurons

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18
Q

Be aware of the purposes for which these three TCA medications are actually prescribed in most cases (discussed in class).

A

Elavil= usually prescribed for sleep Sinequan= usually prescribed for sleep Nortriptyline= usually prescribed for pain or headaches

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19
Q

Know the most commonly prescribed MAO Inhibitor - the one that is administered via the transdermal route - and understand the mechanism of action.

A
  1. Selegiline 2. MAOIs inhibit the enzyme MAO that breaks down NTs thought to be related to depression; when drugs inhibit MAO enzyme, more NE is in synaptic cleft to bind to receptors which causes downregulation of receptors and more NE to stay in the synaptic cleft 3. Bypasses first-pass metabolism so it doesn’t activate as many MAO enzymes in the gut so people don’t have to restrict their foods
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20
Q

Which antidepressant is not prescribed for depression because it is too sedating; so is used as a treatment of insomnia (this one doesn’t fit into any of the classes above)?

A

Trazodone

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21
Q

Which class of antidepressant is most dangerous - and possibly fatal - in overdose? TCAs or SSRIs?

A

TCAs

22
Q

Which antidepressant has the most research evidence to support its use during pregnancy?

A

Zoloft (this is an SSRI)

23
Q

Name the antidepressants which have the lowest incidence of sexual side effects?

A

Wellbutrin and Remeron

24
Q

What are the most common adverse effects of SSRIs?

A

Nausea, sexual dysfunction, and suicidality were the ones mentioned in class, but in addition to these, the book lists headaches, nervousness, diarrhea, weight gain, and insomnia.

25
Q

Name the two antidepressants, which are sometimes used as monotherapy, but also sometimes used to augment SSRI treatment.

A

Wellbutrin and Remeron

26
Q

Mechanism of Action for SSRI’s

A

inhibits reuptake of serotonin so more serotonin molecules are near cell body area and over time the increase of serotonin causes autoreceptors to decrease (to downregulate) and become desensitized (autoreceptors, when triggered, signal cell to decrease production of serotonin, so when downregulated, they allow cell to produce more serotonin than normal)

27
Q

Mechanism of Action for SNRI’s

A

Potent inhibitors of the reuptake of serotonin and norepinephrine, resulting in higher concentrations in the synaptic cleft; Better tolerated than TCAs

28
Q

Be able to rate the 6 most common benzodiazepines (discussed in class) based on their duration of action.

A
  1. Librium= used a lot for alcohol withdrawal; makes GABA more effective to replace effects of alcohol; temporary suspension of alcohol withdrawal effects 2. Valium= oldest; “Mommy’s little helper”; Diazapam; even faster-acting than Xanax because it’s so lipophilic 3. Klonopin= clonazepam 4. Temazepam (Restoril)= very similar to Klonopin, they both are short-acting 5. Ativan (Lorazepam) 6. Xanax (Alprazolam); very fast-acting
29
Q

Which two benzodiazepines have the quickest onset of action? What does this mean for their abuse potential?

A

Xanax and Valium have the quickest onset of action and because of this they are widely abused and highly addictive.

30
Q

Which three substances discussed in class can lead to a potentially fatal withdrawal syndrome (if the substance is stopped abruptly)?

A

Alcohol, Opiates, and Benzos? I believe it is Alcohol, barbiturates, and benzos.

31
Q

Other than the potential lethality of the above withdrawal, describe the symptoms and physical signs you would expect to see if someone was experiencing it.

A

Emotions: Anxiety, Restlessness, Irritability, Insomnia, Headaches, Poor concentration, Depression, Social isolation Physical: Sweating, Racing heart, Palpitations, Muscle tension, Tightness in the chest, Difficulty breathing, Tremor

32
Q

Why have benzodiazepines replaced barbiturates in the US for the treatment of anxiety?

A

Benzos are less dangerous. Less abuse potential and less dependence inducing.

33
Q

Which class of medications are the treatments of choice for the LONG-TERM treatment of anxiety?

A

SSRI

34
Q

What kind of tolerance leads to the diminished subjective effect of benzodiazepines (metabolic, cellular, or both)?

A

Both

35
Q

Remember the phenomenon of cross tolerance.

A

This is resistance to effects of a substance because of exposure to a pharmacologically-similar substance. Ex. If someone takes Xanax twice a week and drinks 2-3 alcoholic drinks a day, the Xanax won’t work as well as it would if the person only drank 2-3 alcoholic drinks a week.

36
Q

How long does it take for BuSpar to start working?

A

3-4 weeks

37
Q

What is the mechanism of action of BuSpar?

A

It is a serotonin agonist and antagonist. It acts as a serotonin antagonist on 5-HT1a receptors (blocks serotonin on these receptors)

38
Q

What is the mechanism of action of Benzodiazepines?

A

Benzo’s are pure GABA agonists because they facilitate binding at GABA receptors

39
Q

What is metabolic syndrome?

A

Increased blood sugar, increased cholesterol, and weight gain

40
Q

What is akathisia? What does it look like? What medications can be used to remedy this side effect?

A
  1. Early onset side effect of neuroleptics/1st generation antipsychotics. 2. Subjective experience of motor restlessness (inability to sit still, foot tapping, pacing, shaking of the hands). 3. Benzos and beta-blockers can remedy this.
41
Q

What is tardive dyskinesia? What does it look like? What is the approximate yearly risk of this side effect for people who are taking the 1st generation antipsychotic medications (know the risks for both middle-aged and older adults)? What is the approximate yearly risk of tardive dyskinesia for people who are taking the 2nd generation antipsychotics?

A
  1. This is a late-onset side effect of neuroleptics/1st generation antipsychotics. 2. Abnormal movement of the mouth, lips, and tongue that may be accompanied by involuntary twitching and jerking of muscles. 3. Approximate yearly risk for people developing this on 1st generation antipsychotics is generally 15-20%, then for people over 40 it is 5-10% and for the elderly it is 80%. 4. Approximate yearly risk for atypical antipsychotics is 1%.
42
Q

What are the three most commonly prescribed 1st generation antipsychotics? Which one is rarely used due to anticholinergic side effects - but is powerfully sedating and can be helpful in violently aggressive patients?

A
  1. Thorazine- very anticholinergic and is powerfully sedating which is helpful to use for violent/aggressive patients 2. Halidol- commonly used; helps with positive symptoms of Schizophrenia but is known for producing side effects such as parkinsonism and tardive dyskinesia 3. Prolixen
43
Q

What are the most commonly prescribed 2nd generation (aka atypical) antipsychotics? Know how these rank in order of their likelihood to cause metabolic syndrome. What makes these medications ‘atypical’?

A
  1. Atypical because they block serotonin, not dopamine. 2. Most metabolically offensive to least: a. Clozaril= rare, compromises white blood cells. b. Zyprexa=comes in injectable form; implicated in Type 2 Diabetes c. Seroquel d. Risperdal= injectable; most likely to cause lactation e. Invega= injectable f. Geodon g. Abilify h. Latuda i. Rexulti
44
Q

What is parkinsonism?

A

A set of side effects that manifest as muscular rigidity, slowed movement, tremors, or bradykinesia (fatigue when performing repetitive motion).

45
Q

Which antipsychotic is most likely to cause lactation (in women and men)?

A

Risperdal

46
Q

Which antipsychotic is most likely to cause a potentially fatal and rapid drop in white blood cell count?

A

Clozaril

47
Q

What are anti-cholinergic side-effects?

A

Neuroleptic meds blocking acetylcholine receptors in both the peripheral and the central nervous system. The primary CNS side effect is delirium. Also includes dry mouth, constipation, urinary retention, blurred vision, and withdrawal reactions.

48
Q

The FDA has mandated a ‘black box’ warning to be attached to every second generation antipsychotic and it refers to these medications being used in older patients - what’s this about?

A

Older patients are at higher risk of having a stroke as a side effect of these meds

49
Q

What are some of the other diagnoses that are treated with 2nd generation antipsychotic medications?

A

Maintenance phase of BP1 Irritability in autism

50
Q

What is the diagnosis that can lead to 2nd generation antipsychotic medications being used to treat older people who have never wrestled with psychosis before?

A

dementia

51
Q

Which antipsychotics are available in an once-monthly injectable form?

A

1st generation= Halidol and Prolixen 2nd generation= Zyprexa, Risperdal, Invega, and Abilify

Psychopharmacology (4 decks)

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