Neuropsychopharm 1

Question 1

What is the biochemical basis of depression?

Answer 1

Imbalance in biogenic amine neurotransmitter systems

Question 2

Neurochemical effects of tricyclic antidepressants

Answer 2

Blockade of transmitter uptake – NE and 5-HT

Question 3

What are the most commonly used anti-depressants? What are the two we need to know?

Answer 3

SSRIs –Fluoxetine and Sertraline

Question 4

Common SE of SSRIs?

Answer 4

N/V, Insomnia, Nervousness, Sexual dysfunction

Question 5

What is serotonin reaction and why can it occur?

Answer 5

In the presence of MAOI’s Include hyperthermia, muscle rigidity and CV collapse

Question 6

What is SSRI Discontinuation syndrome?

Answer 6

Occurs within 1 to 7 days after stopping an SSRI; Most common with shorter acting drugs like sertraline; Symptoms include: dizziness, light-headedness, vertigo, anxiety, fatigue, h/a, tremor, visual disturbances

Question 7

Clinical uses of SSRI’s:

Answer 7

MDD, OCD, Panic disorder, social phobia, PTSD, GAD, PMS

Question 8

First SSRI on the market, Active metabolite with long half-life, Effects on drug metabolism

Answer 8

Fluoxetine

Question 9

SSRI, Similar to fluoxetine with less effects on drug metabolism, shorter half-life

Answer 9

Sertraline

Question 10

Blocks both serotonin and Norepinephrine uptake

Answer 10

SNRI

Question 11

SNRI, 12-18 hour half-life, Use with caution in patients with liver disease Approved for use with fibromyalgia, diabetic neuropathy, back pain, and osteoarthritis pain

Answer 11

Duloxetine

Question 12

Drugs without typical tricyclic structure or SSRI action; may or may not block catecholamine uptake

Answer 12

Atypical antidepressants

Question 13

Atypical antidepressant; approved for nicotine withdrawal and seasonal disorder; blocks NE and dopamine uptake

Answer 13

Bupropion

Question 14

Atypical antidepressant; blocks presynaptic alpha2 receptors in the brain; increases appetite

Answer 14

Mirtazapine

Question 15

First highly effective drugs for the treatment of depression; now used secondarily to SSRI’s and other newer cmpds

Answer 15

Tricyclic antidepressants

Question 16

Pharmacological properties of tricyclic antidepressants

Answer 16

1. produces elevation of mood in depressed patients after 2-3 weeks 2. Decreases REM and increase stage 4 sleep 3. Prominent anticholinergic effects 4. Sedation 5. Cardiac abnormalities

Question 17

Symptoms of overdose with TCA

Answer 17

hyperpyrexia, hyper/hypotension, seizures, coma, cardiac conduction defects

Question 18

Drug interactions with TCA’s

Answer 18

Guanethidine – blocks guanethidine uptake Sypathomimetic drugs – particularly indirect acting ones Effects on absorption and metabolism of other drugs

Question 19

Therapeutic uses of TCA’s

Answer 19

MDD, Enuresis in childhood; chronic pain (amitriptyline); OCD (Clomipramine)

Question 20

Two TCA’s we need to know and what they’re used for

Answer 20

Amitriptyline –> chronic pain Clomipramine –> OCD

Question 21

Block the oxidative deamination of naturally occurring biogenic amines like NE, DA and 5-HT and ingested amines

Answer 21

MAOI’s

Question 22

Irreversible inhibitor of MAO

Answer 22

Phenelzine

Question 23

What do you have to watch in your diet if you’re on MAOI’s?

Answer 23

Tyramine intake

Question 24

Major mental disorder characterized by derangement of personality and loss of contact with reality, delusions, hallucinations

Answer 24

Psychosis

Question 25

Which dopamine receptor activates adenylyl cyclase?

Answer 25

D1 type

Question 26

Which dopamine receptor inhibits adenylyl cyclase?

Answer 26

D2 type

Question 27

Which two receptors do atypical antipsychotic drugs act on?

Answer 27

DA + 5HT2 receptors

Question 28

Actions of typical antipsychotic drugs

Answer 28

Decrease psychotic behavior, sedation, extrapyramidal actions, neuroendocrine effects, orthostatic hypotension; weight gain; neuroleptic malignant syndrome

Question 29

Prototype available typical antipsychotic drugs (Class)

Answer 29

Phenothiazines– 3 subtypes based on side chain: Chlorpromazine, Thioridazine, Fluphenazine

Question 30

Compounds with aliphatic side chains; low to medium potency, sedative, pronounced anticholinergic actions

Answer 30

Chlorpromazine

Question 31

Compounds with piperidine side chains; low potency, sedative, less extrapyramidal actions, anticholinergic

Answer 31

Thioridazine

Question 32

Compounds with piperazine side chains; high potency, less sedative, less anticholinergic, more extrapyramidal reactions

Answer 32

Fluphenazine

Question 33

Butyrophenone Derivative, not chemically related to phenothiazines but pharmacologically similar to high potency piperzine derivatives

Answer 33

Haloperidol

Question 34

Atypical Antipsychotics

Answer 34

Clozapine, Olanzapine, Risperidone, Quetiapine, Aripiprazole

Question 35

Less extrapyramidal symptoms, May cause serious agranulocytosis, weight gain; Effects on negative symptoms

Answer 35

Clozapine

Question 36

More potent 5-HT2 antagonist; few extra pyramidal symptoms; no agranulocytosis; weight gain and diabetes risk

Answer 36

Olanzepine

Question 37

Combined dopamine and serotonin receptor antagonist; low incidence of extrapyramidal side effects

Answer 37

Risperidone

Question 38

Structurally related to clozapine with effects on D2 and 5-HT2 receptors; some abuse potential

Answer 38

Quetiapine

Question 39

D2 partial agonist – approved as an adjunct in the treatment of depression

Answer 39

Aripiprazole

Question 40

Uses of atypical antipsychotics

Answer 40

Acute psychotic episodes, chronic schizo, manic episodes, augmentation of antidepressant action, Tourette’s, Antiemesis