Key areas 2

Question 1

Agonist

Answer 1

molecule that binds to a receptor and activates it

Question 2

agonists and GPCRs

Answer 2

agonists bind to GPCRs and induce conformational change that fully activates the receptor, leading to a robust signaling response.
ie) morphine is a full agonist at opioid receptors

Question 3

partial agonist

Answer 3

binds to a receptor but activates it less effectively than a full agonist, resulting in weaker response

Question 4

partial agonists and GPCRs

Answer 4

when bound to GPCRs, partial agonists activate the receptor but produce a lower level of signaling compared to full agonists

Question 5

Spectrum: no agonist

Answer 5

constitutive activity; baseline

Question 6

Spectrum: full agonist

Answer 6

maximum signal transduction

Question 7

Spectrum: silent antagonist

Answer 7

back to baseline, constitutive activity only, same as no agonist

Question 8

Spectrum: partial agonist

Answer 8

partially enhanced signal transduction

Question 9

Spectrum: inverse agonist

Answer 9

beyond antagonism; even constitutive activity is blocked

Question 10

Where is serotonin produced

Answer 10

primarily in raphe nuclei of brainstem

Question 11

what is the primary effect of serotonin

Answer 11

regulates mood, appetite, sleep, cognition. Involved in feelings of well-being and happiness

Question 12

disorders linked to serotonin

Answer 12

depression (low levels), anxiety (dysregulation), OCD (implicated)

Question 13

Where is NorE produced?

Answer 13

locus coeruleus in brainstem and adrenal glands

Question 14

what is the primary effect of NorE?

Answer 14

plays a role in arousal, attn, stress response, and mood regulation

Question 15

disorders linked to NorE?

Answer 15

depression (dysregulation), anxiety (overactivity), PTSD (implicated in hyperarousal and stress response)

Question 16

Where is dopamine produced

Answer 16

several areas including substantia nigra and ventral tegmental area

Question 17

what is the primary effect of dopamine

Answer 17

regulates mood, motivation, reward, and motor control

Question 18

what disorders are linked to dopamine

Answer 18

parkinson’s disease, schizophrenia, addiction

Question 19

where is GABA produced

Answer 19

synthesized throughout the brain, particularly in interneurons

Question 20

what is the primary effect of GABA

Answer 20

acts as the main inhibitory neurotransmitter, reducing neuronal excitability and promoting relaxation and calmness

Question 21

what disorders are linked to GABA

Answer 21

anxiety disorders (low gaba=anxiety), epilepsy (dysregulation leads to seizures d/t excessive neuronal activity), and mood disorders (imbalances may contribute to depression and bipolar)

Question 22

where is glutamate produced?

Answer 22

found throughout the brain, synthesized in neurons from glucose and other precursors

Question 23

what is the primary effect of glutamate?

Answer 23

primary excitatory neurotransmitter, essential for synaptic plasticity, learning, memory

Question 24

disorders associated w/ glutamate

Answer 24

alzheimer’s (excessive leads to neurotoxicity and cognitive decline), schizophrenia (imbalances in glutamate signaling), autism (dysregulation may affect synaptic development and function)

Question 25

spectrum of mood disorders

Answer 25

MDD, dysthymia, bipolar disorders, cyclothymia, SAD, DMDD. Brain areas responsible for controlling feelings are amygdala and orbirofrontal cortex

Question 26

key neurotransmitters in mood disorders

Answer 26

serotonin, norepinephrine, dopamine

Question 27

what is the monoamine hypothesis?

Answer 27

theorizes imbalances in certain neurotransmitters, specifically monoamines, play a critical role in development of mood disorders, especially depression and anxiety

Question 28

Key monoamine: serotonin

Answer 28

influences mood, emotion, sleep, appetite; low levels or dysreg L/T depression and anxiety d/os

Question 29

key monoamine: norepinephrine

Answer 29

affects arousal, attn, stress response; decrease NorE assoc w/ depressive s/s

Question 30

key monoamine: dopamine

Answer 30

involved in reward, motivation, mood regulation; low levels can contribute to anhedonia. Dysregulation r/t bipolar and certain anxiety d/os

Question 31

Unipolar depression

Answer 31

aka MDD. Persistent depressive episodes w/o hx of manic or hypomanic episodes

Question 32

bipolar depression

Answer 32

episodes of depression that alternate with episodes of mania or hypomania

Question 33

bipolar I

Answer 33

at least one manic episode which may be preceded or followed by depressive episodes

Question 34

bipolar II

Answer 34

at least 1 major depressive episode and at least one hypomanic episode, but no full manic episodes

Question 35

Duration dx criteria for manic episode

Answer 35

distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 wk (or any duration if hospitalization is necessary)

Question 36

dx criteria for manic episode: mood changes

Answer 36

during period of mood disturbance, 3 or more of the following s/s have persisted (4 if mood is only irritable) and represent a noticeable change in bx
1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. hyperverbal or rapid pressured speech
4. flight of ideas or racing thoughts
5. increase in goal directed activities
6. easily distracted
7. engaging in risky bx

Question 37

manic episode: functional impairment dx criteria

Answer 37

the mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features

Question 38

characteristics of med-induced hypomanic episode

Answer 38

1. elevated or irritable mood
2. increased energy
3. decreased need for sleep
4. more talkative
   5 racing thoughts
5. impulsivity
   -onset occurs shortly after starting or increasing certain meds like antidepressants, stimulants, steroids

Question 39

management of med-induced hypomania

Answer 39

1) assessment to confirm med-induced and not part of underlying mood d/o
2) med review: figure out what started it
3) dose adjustment/discontinuation
4) monitor for changes in mood or bx during withdrawal or adjustment period
5) supportive care: provide supportive interventions, therapy
6) meds for symptoms: use mood stabilizers or antipsychotics to manage hypomanic s/s esp if causing impairment
7) schedule follow ups to assess stability and adjust as needed

Question 40

What is NMS

Answer 40

neuroleptic malignant syndrome: potentially life-threatening rxn to antipsychotic meds (neuroleptics). Manifests as a combination of severe s/s like muscle rigidity, fever, altered mental status, autonomic dysregulation, elevated CK

Question 41

S/s of NMS

Answer 41

-severe muscle rigidity
-high fever
-altered mental status
-autonomic dysreg: increased HR, labile BP, sweating, tachypnea
-elevated CK (indicative of muscle breakdown)

Question 42

How to manage NMS in OP setting

Answer 42

immediately assess for s/s like muscle rigidity, fever, and altered mental status. obtain detailed med hx, focusing on recent changes in antipsychotic meds or dosages. Contact emergency services. Ensure they are hydrated and in safe environment while waiting for help. Document all findings including s/s, vitals, med hx, condition during visit. Plan for f/u, re-eval need for antipsychotics, consider alt tx w/ lower NMS risk, monitor for s/s recurrence if meds are resumed. Educate pt on warning signs and reporting s/s.

Question 43

what is tardive dyskinesia

Answer 43

movement disorder caused by long-term use of antipsychotics, particularly typical antipsychotics. Characterized by involuntary repetitive movements, primarily affecting face, tongue, and limbs

Question 44

common s/s of TD

Answer 44

oral-facial movements: lip smacking, tongue protrusion, facial grimacing. Limb movements: involuntary arm or leg movements like twitching or writhing. Postural changes: abnormal posture or body movements

Question 45

how to assess for TD?

Answer 45

ask about involuntary movements, when they started, if they’ve worsened. Abnormal involuntary movement scale (AIMS) standardized tool to assess presence and severity of TD; includes questions and observation checklist to rate movements in different body parts.

Question 46

what is akathisia

Answer 46

inner sense of restlessness and an uncontrollable need to be in constant motion. can occur as side effect of antipsychotic meds, particularly during early tx phases

Question 47

s/s of akathisia

Answer 47

restlessness, pacing, fidgeting, shifting positions; anxiety and feeling tense or agitated; inability to sit still, may express discomfort when seated for long periods

Question 48

how do you assess for akathisia

Answer 48

ask about feelings of restlessness, inability to remain still, and any associated anxiety. Rating scales: barnes akathisia rating scale is used to assess severity, includes items to evaluate motor restlessness and subjective feelings of inner restlessness. Observe for fidgeting or restlessness during appt.

Question 49

Dx criteria for MDD: s/s

Answer 49

5 or more of the following s/s must be present during same 2-wk period and represent change from previous functioning, and at least one of the symptoms must be depressed mood or loss of interest/pleasure
1. depressed mood
2. loss of interest/pleasure
3. significant weight change (5% in 1mos w/o effort)
4. sleep disturbances
5. psychomotor agitation or retardation
6. fatigue or loss of energy
7. feelings of worthlessness or excessive guilt
8. difficulty concentrating
9. recurrent thoughts of death or SI
-functional impairment & not better explained by another mental disorder, and no hx mania or hypomania

Question 50

Dx criteria for PTSD

Answer 50

1) exposure to trauma
2) re-experienced via nightmares, flashbacks, intrusive thoughts
3) avoidance of certain things, feelings, people, or activities
4) unable to function
5) month (at least)
6) arousal increased, startles easily

Question 51

OCD dx criteria

Answer 51

presence of obsessions, compulsions, or both which are time-consuming and impair functioning

Question 52

dx criteria: GAD

Answer 52

excessive worry and anxiety for more days than not for at least 6mos.
Anxiety and worry are associated w/ 3 or more of the following s/s: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance

Question 53

dx criteria: schizophrenia

Answer 53

2 or more of the following s/s must be present for a significant portion of 1mos, at least one of them must be one of the first 3 symptoms listed:
1) delusions
2) hallucinations
3) disorganized thinking
4) grossly disorganized or abnormal motor bx
5) negative s/s
-level of functioning is impaired, continuous signs of disturbance persist x6mos, and this 6mos perion must include at least 1mos of symptoms that meet the above s/s characteristics

Question 54

positive s/s in schizophrenia

Answer 54

hallucinations, delusions, disorganized thinking, disorganized/abnormal motor bx

Question 55

negative s/s of schizophrenia

Answer 55

blunted affect, avolition, anhedonia, alogia, social withdrawal

Question 56

differences b/t pos and neg s/s

Answer 56

pos = bx or experiences not typically present in healthy individuals. neg = reduction or absence of normal emotional and bx functions

Question 57

therapeutic drug monitoring (TDM) for antipsychotics

Answer 57

1) baseline med hx, MH hx, current meds, wt, ht, vitals, labs (CBC, LFTs, kidney function, bmp)
2) regular monitoring: regularly assess s/s, s/e, functioning. vitals–monitor bp, hr, wt, esp for metabolic s/e
3) blood levels: clozapine monitor for agranulocytosis, monitor weekly x 1st 6mos, then q2wks if stable. can monitor for risperidone and abilify if needed.
4) metabolic monitoring: wt, fasting glucose, lipids. metabolic syndrome.
5) neurological monitoring: monitor for s/s EPS or TD
6) adherence monitoring: assess through self-report or pill counts or electronic monitoring devices
7) adjustment based on results

Question 58

antipsychotic key teaching points: understanding the med

Answer 58

explain purpose: used to tx psychosis s/s like delusions, hallucinations, disorganized thinking. Discuss specific med prescribed, class, how it works.

Question 59

antipsychotic key teaching points: expected benefits

Answer 59

highlight potential benefits like reduced s/s, improved functioning, enhanced quality of life. Set realistic expectations about timeline, may need weeks to work.

Question 60

antipsychotic key teaching points: common s/e

Answer 60

drowsiness or sedation, wt gain, metabolic changes (increased BG, cholesterol), EPS (tremors, rigidity), TD (long-term risk). Emphasize importance of reporting s/e to provider

Question 61

antipsychotic key teaching points: importance of adherence

Answer 61

stress importance of taking med as prescribed, even if s/s improve or if there are side effects. discuss risks of stopping meds suddenly, including potential relapse or worsening of s/s

Question 62

antipsychotic key teaching points: monitoring & f/u

Answer 62

need for regular f/u appts to monitor effectiveness and s/e. Discuss lab work which may be needed, like blood tests for clozapine

Question 63

antipsychotic key teaching points: lifestyle considerations

Answer 63

healthy lifestyle choices! regular exercise, healthy eating to manage wt, avoiding alc and rec drugs. Discuss strats to manage potential st gain and metabolic changes

Question 64

antipsychotic key teaching points: emergency situations

Answer 64

educate about NMS s/s, severe allergic rxns, significant changes in mental status or bx

Question 65

antipsychotic key teaching points: support systems

Answer 65

encourage involvement of family members in tx process to provide support. Discuss resources for support like therapy, groups, educational materials

Question 66

antipsychotic key teaching points: coping strategies

Answer 66

provide info on coping and resources for managing stress and anxiety which may be comorbid.

Question 67

general guidelines for switching antipsychotics

Answer 67

-assess need for switching
-choose new med
-plan transition
-taper old med
-initiate and titrate new med
-monitor closely
-document
-keep pt involved
-crisis management

Question 68

powerpoint guidelines for switching antipsychotics

Answer 68

-switching b/t 2 agents w/ similar pharmacology is usually fast, easy, and w/ few complications (ie quetiapine to olanzapine)
-same class of drug can be done over 7 days
-switching from one class to another can take longer (pine to a done or done to a pine)

Question 69

why does switching classes take longer?

Answer 69

-binding characteristics are different
-pines have more anticholinergic and antihistamine actions
-pines have more alpha1 antagonist properties