Pharm - Drug Treatment of Schizophrenia & Depression

Question 1

What are the Positive symptoms of Schizophrenia?

Answer 1

Positive symptoms - development of abnormal functions; delusions, hallucinations, disorganized speech, catatonic behaviour

Question 2

What are the Negative symptoms of Schizophrenia?

Answer 2

Reduction or loss of normal functions – affective flattening (decrease in range or intensity of emotional expression), alogia (decrease in fluency of speech), avolition (decrease in initiation of goal- directed behaviour)

Question 3

What are the Cognitive symptoms of Schizophrenia ?

Answer 3

Problems with attention, memory & executive functions that allow one to plan & organize

Question 4

Fill in the blanks. “ The Mesolimbic hyperactivity is responsible for the ____________ symptoms of Schizophrenia .”

Answer 4

Mesolimbic - POSTIVE Symptoms

Question 5

Fill in the blanks.” The Mesocortical system plays a role in the _____________ symptoms of schizophrenia .”

Answer 5

Mesocortical - NEGATIVE Symptoms

Question 6

What are the types of Typical antipsychotics?

Answer 6

Phenothiazines
Thioxanthines
Butyrophenones

Question 7

What are examples of Phenothiazines?

Answer 7

• Chlorpromazine - prototype
• Fluphenazine
• Trifluoperazine
• Thioridazine

” azines’

Question 8

What are examples of Thioxanthenes?

Answer 8

• Flupenthixol ,Flupenthixol decanoate
• Zuclopenthixol ,Zuclopenthixol decanoate
• Chlorprothixene
• Thiothixene

Question 9

What are examples of Butyrophenones?

Answer 9

Haloperidol
Droperidol

Question 10

What are examples of the Atypical antipsychotics?

Answer 10

Sulpiride
Aripiprazole
Clozapine (prototype)
Olanzapine
Quetiapine
Asenapine
Risperidone
Ziprasidone
Lurasidone
Paliperidone
Sertindole

Question 11

What is the MOA of Antipsychoics?

Answer 11

Antagonists or partial agonists at D2 dopamine receptors, but most block a variety of other receptors.

Question 12

What are the 4 tracts that are in the Central Dopamine system ?

Answer 12

• Mesolimbic
• Mesocortical
• Nigrostriatal
• Tuberoinfundibular

Question 13

A blockade of the Tuberinfundibular tract would cause?

Answer 13

Hyperprolactinemia

Question 14

A antispsychotic blockade of the Nigrostriatal tract would cause ?

Answer 14

Extrapyramidal side effects

Question 15

True or False? Atypical antipsychotics affect all 4 dopamine tracts with varying degrees of potency.

Answer 15

FALSE!!! TYPICAL Antipsychotics affect all 4 Dopamine tracts with varying degrees of Potency.

Question 16

True or False? Atypical antipsychotics primarily affect dopamine tracts in limbic system & are limbic specific.

Answer 16

TRUE!!

Question 17

Which Antipsychotic can also be used in the treatment of Tourette’s syndrome?

Answer 17

Chloropromazine & Haloperidol

Question 18

What are the adverse effects of Chlorpromazine?

Answer 18

• Cholinergic blockade → dry mouth, constipation, urinary retention, blurred vision.
• α adrenergic blockade → postural hypotension.
• Histamine blockade → sedation

Question 19

True or False? Cannabis use impacts the potency of antipsychotics .

Answer 19

TRUE!!

Question 20

True or False? Atypical antipsychotics are NOT usually associated with Extrapyramidal side effects ( EPSE)?

Answer 20

TRUE!!

Question 21

Which Atypical antipsychotic is NOT a D4 receptor antagonist?

Answer 21

Quetiapine

Question 22

Which antipsychotic Prior to initiating, obtain CBC w differential; regularly monitor ANC & WBC?

Answer 22

Clozapine

Question 23

Fill in the blanks. “ Clozapine is effective in treating the __________ symptoms of Schizophrenia .”

Answer 23

NEGATIVE

Question 24

Fill in the blanks . “ Risperidone is effective in treating the _________ symptoms.”

Answer 24

Both Positive and Negative symptoms

Question 25

Which Anticholinergic drugs are used to treat Parkinsonism & akathisia?

Answer 25

Trihexyphenidyl Benztropine Diphenhydramine " TBD- to be determined)"

Question 26

What is the Dopaminergic drug used to treat Parkinsonism & Akathisia?

Answer 26

Amantadine

Question 27

What are the GABAminergic drugs used to treat Parkinsonism & Akathisia?

Answer 27

Diazepam Clonazepam Lorazepam

Question 28

Fill in the blanks." _____________ is a noradrenergic blocker used to treat Parkinsonism and Akathisia."

Answer 28

Propanolol

Question 29

What are the symptoms of Mania?

Answer 29

Pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, elation, poor judgment, aggressiveness & possibly hostility .

Question 30

What drugs can be used to treat Bipolar affective disorder?

Answer 30

Lithium Valproic acid Carbamazepine Lamotrigine Gabapentin Topiramate

Question 31

What is the half life of Lithium?

Answer 31

20-24 hours

Question 32

Which drug is indicated for treatment of manic episodes of bipolar affective disorder?

Answer 32

Lithium Carbonate

Question 33

What are the Adverse effects of Lithium?

Answer 33

* Tremor * Hyperactivity * Seizures * @ toxic levels- confusion * Mild ↓ thyroid function (monitor for lithium induced hypothyroidism) * Teratogen * Weight gain * Vomiting * Abdominal cramps * Diarrhoea * Reversible * nephrogenic diabetes insipidus ( blocks effect of ADH on kidney ) * Leukocytosis

Question 34

Which Antipsychotic drug should be used with caution in patients w abnormal QT intervals?

Answer 34

Risperidone

Question 35

What is Depression?

Answer 35

Affective syndrome characterized by intense sadness, general loss of interest in everyday activities, insomnia, changes in appetite & low self esteem - often accompanies many ailments seen in the primary care setting.

Question 36

What are the signs of Significant depression?

Answer 36

* guilt * low self-esteem * lack of pleasure * low energy * insomnia / hypersomnia * poor hygiene * increase or decrease appetite * suicidal ideation

Question 37

A decrease in what neurotransmitters are associated with causing depression?

Answer 37

Serotonin & Nor- Epinephrine

Question 38

What are examples of Selective Serotonin Reuptake Inhibitors ( SSRI's) ?

Answer 38

Patrick - Paroxetine Fly - Fluoxetine Free - Fluvoxamine Easy - Escitalopram to South - Sertraline Carolina - Citalopram

Question 39

What is the MOA of SSRI's ?

Answer 39

Inhibition of serotonin reuptake without significant effects on norepinephrine, muscarinic, histaminic or ɑ-adrenergic receptors.

Question 40

Which SSRI's potent inhibitors of CYP2D6 isoenzyme –administration of 2D6 substrates ex. TCAs ?

Answer 40

Fluoxetine & paroxetine

Question 41

Which SSRI's are relatively free of pharmokinetics?

Answer 41

Citalopram & Escitalopram

Question 42

What are the adverse effects of SSRI's ?

Answer 42

* Anorexia, nausea, diarrhoea * Nervousness * Insomnia * Dizziness * Sexual dysfunction (erectile dysfunction, ↓libido) * ↑ risk of suicide when used in children & adolescents * Serotonin syndrome

Question 43

What is the duration in order for Antidepressants to take effect?

Answer 43

2-3 weeks to be noticeable.

Question 44

What are examples of Selective Serotonin - Noradrenergic reuptake inhibitors (SNRI's) ?

Answer 44

D- Desvenlafaxine D - Duloxetine V - Venlafaxine M - Milnacipran " Doc of Veterinary medicine'

Question 45

True or False? Venlafaxine - at higher doses ↑ risk of elevated blood pressure.

Answer 45

TRUE!!

Question 46

Which SNRI can be used to treat Fibromyalgia?

Answer 46

Duloxetine & Milnacipran

Question 47

What are other treatments the drug Duloxetine can be used for?

Answer 47

* Fibromyalgia * Chronic musculoskeletal pain - osteoarthritis . * Generalised Anxiety disorder * Chemotherapy-induced painful peripheral neuropathy * Diabetic neuropathy * Depression duh

Question 48

Which SNRI can be used to read Hot flashes flashes due to hormonal chemotherapy ?

Answer 48

Venlafaxine

Question 49

Which SNRI can be used to treat Social anxiety and Generalised anxiety disorder?

Answer 49

Venlafaxine

Question 50

Which enzyme metabolises the drug Duloxetine?

Answer 50

CYP2D6 and CYP1A2

Question 51

What are the adverse effects of Duloxetine?

Answer 51

Nausea Dry mouth Headache Somnolence Fatigue Constipation Dizziness Insomnia Diarrhea Anorexia Abdominal pain Increased sweating Agitation Nasopharyngitis Vomiting

Question 52

Which Tricyclics are Nor-Adrenergic selective?

Answer 52

Desipramine Nortriptyline Protriptyline

Question 53

What are examples of Tricyclics antidepressants?

Answer 53

Imipramine Amitriptyline DoxepinClomipramine Trimipramine Desipramine * Nortriptyline* Protriptyline*

Question 54

What are examples of Atypical antidepressants ?

Answer 54

* Bupropion * Mirtazapine * Trazodone * Amoxapine * Maprotiline * Tianepine

Question 55

What is the MOA of Bupropion?

Answer 55

* Inhibits reuptake of serotonin, NE & dopamine (possibly inhibits reuptake of DA more than NE). * Non-competitive nicotine receptor antagonist ; at high concentrations inhibits firing of noradrenergic neurons in the locus coeruleus.

Question 56

What are examples of Irreversible Monoamine Oxidase Inhibitors MAOI's ( irreversible non-competitors) ?

Answer 56

Phenelzine Tranylcypromine

Question 57

What are examples of Reversible MAO - A selective inhibitors?

Answer 57

* Moclobemide * MAO- B inhibitor * Selegiline

Question 58

What are the adverse effects of MAOI's ?

Answer 58

Orthostatic hypotension Impotence Agitation Hallucinations Seizures Hyperthermia Hepatotoxicity

Question 59

What is the active ingredient in St.Johns wort?

Answer 59

Hyperforin