Psychopharmacology Flashcards
1
Q
____ (____) ____ are chemicals that interact with the central nervous system in a way that produces a change in mood, consciousness, perception, and/or behavior. These drugs exert their effects in a number of ways — i.e., by _________________________________________.
A
Psychoactive (Psychotropic) Drugs; increasing or decreasing the production or reuptake of neurotransmitters. by increasing or preventing the release of neurotransmitters, or by facilitating, mimicking, or blocking the effects of neurotransmitters at receptor sites.
2
Q
____ ____: The following terms are used to describe the ____ of the ____ ____: Agonists; Inverse Agonists; Partial Agonists; Antagonists.
A
Drug Effects; Effects of the Psychoactive Drugs
3
Q
____ produce effects similar to those produced by a neurotransmitter. ____ ____ exert their effects by mimicking the effect of a neurotransmitter at a receptor site, while ____ ____ attach to a binding site on a receptor cell (a site other than the one used by the neurotransmitter) and facilitate the action of the neurotransmitter.
A
Agonists; Direct Agonists; Indirect Agonists
4
Q
____ ____ produce an effect opposite the effect produced by a neurotransmitter or an agonist.
A
Inverse Agonists
5
Q
____ ____ produce effects that are similar to (but less than) the effects produced by a neurotransmitter or an agonist.
A
Partial Agonists
6
Q
____ produce no activity in the cell on their own but, instead, reduce or block the effects of a neurotransmitter or agonist. ____ ____ exert their effects by attaching to a neurotransmitter’s receptor site, while ____ ____ attach to a binding site on a receptor cell (a site other than the one used by the neurotransmitter) and interfere with the action of the neurotransmitter.
A
Antagonists; Direct Antagonists; Indirect Antagonists
7
Q
____ and ____ ____: ____ -____ ____ are a common cause of hospital admissions for people over the age of 65. Factors that contribute to these problems include the use of ____ ____, noncompliance with ____ ____, and ____ or ____ ____ to ____ ____. Changes in sensitivity are due to several factors including ____ -____ ____ in ____ ____, ____, ____, and ____.
A
Drugs and Older Adults; Medication-Related Problems; Multiple Medications, Noncompliance with Medication Regimens, and Decreased or Increased Sensitivity to Drug Effects; Age-Related Changes in Drug Absorption, Distribution, Metabolism, and Excretion
8
Q
An age-related decrease in ____ or reduction in renal functioning may extend the half-life of some drugs (e.g., benzodiazepines), resulting in an increased risk for ____. (____ -____ refers to the time it takes for the plasma concentration of the drug to drop by 50%.) Because of the increased risk for adverse drug effects, a general rule when prescribing drugs for older adults is to “____ ____ and ____ ____ “ — i.e., begin with a low initial dose and, if necessary, increase the dose gradually.
A
Metabolism; Toxicity; Half-Life; Start Low and Go Slow
9
Q
____ and ____ /____: Research has identified some cross-ethnic differences in responses to ____ ____ and has related these differences to a number of ____, ____, and ____ factors.
A
Drugs and Race/Ethnicity; Psychotropic Medications; Pharmacokinetic, Pharmacogenetic, and Pharmacodynamic
10
Q
Regarding ____, some ethnic dissimilarities in drug response have been linked to differences in ____. For example, in comparison to Caucasians, higher proportions of Asians and, to a somewhat lesser degree, African-Americans are slower or poorer metabolizers of specific ____, which explains why they are more sensitive to the therapeutic and side effects of certain drugs such as neuroleptics, benzodiazepines, lithium, and some antidepressants.
A
Pharmacokinetics; Metabolism; Isoenzymes
11
Q
Because of the ethnic differences, the experts propose that the best approach when prescribing a new drug for an Asian or African-American patient is to be4n with a ____ ____ and ____ ____ ____ until the ____ ____ ____ ____.
A
Low Dose and Gradually Titrate Upward; Desired Effects are Achieved
12
Q
Chlorpromazine, Fluphenazine, Thiothixene, Haloperidol
A
Conventional Antipsychotics
13
Q
Clozapine, Resperidone, Olanzapine, Quetiapine
A
Atypical Antipsychotics
14
Q
Amitriptyline, Doxepin, Imipramine, Clomipramine, Nortriptyline
A
TCAs
15
Q
Fluoxetine, Fluvoxamine, Paroxetine, Sertraline
A
SSRIs
16
Q
Isocarboxazid, Phenelzine, Tranylcypromine
A
MAOIs
17
Q
Diazepam, Alprazolam, Alprazolam, Oxazepam, Triazolam, Chlordiazepoxide, Lorazepam
A
Anxiolytics (Benzodiazepines)
18
Q
____ of ____ ____: Data on ambulatory medical care visits in the United States is collected regularly by the ____ ____ on ____ ____ (___). As denned by the NCHS, ____ ____ ____ include primary care offices, surgical specialty offices. medical specialty offices, hospital outpatient departments, and hospital emergency departments.
A
Prescribers of Psychotropic Drugs; National Center on Health Statistics (NCHS); Ambulatory Care Settings
19
Q
Data has shown that, with some exceptions, ____ (____ ____ ____) ____ are most frequently provided, prescribed, or continued at ____ ____ ____ in ____ ____ ____ followed by ____ ____ ____ (e.g., the offices of psychiatrists and neurologists). The exceptions include ____ and ____, which are most often provided, prescribed, or continued in ____ ____ ____.
A
Psychotropic (Central Nervous System) Drugs; Ambulatory Care Visits in Primary Care Offices; Medical Specialty Offices; Antipsychotics and Antimanics; Medical Specialty Offices
20
Q
The antipsychotic drugs are also known as major ____ and ____. Included in this category are the ____ and ____ ____.
A
Tranquilizers and Neuroleptics; Traditional and Atypical Antipsychotics
21
Q
____ (____) ____ ____: The ____ ____ include phenothiazine (chlorpromazine, fluphenazine), thioxanthene (thiothixene), and butyrophenone (haloperidol).
A
Traditional (Conventional) Antipsychotic Drugs; Traditional Antipsychotics
22
Q
Use: The traditional antipsychotics are effective for alleviating ____ ____ and are most often prescribed as a treatment for ____. They are also used to treat ____ ____, ____ and ____ associated with ____ ____ ____, and ____ ____. While the traditional antipsychotic drugs alleviate hallucinations, delusions, agitation and other positive symptoms of Schizophrenia, they are much less effective for its ____ ____.
A
Psychotic Symptoms; Schizophrenia; Acute Mania; Delusions and Hallucinations; Major Depressive Disorder; Organic Psychoses; Negative Symptoms
23
Q
____ of ____: The traditional antipsychotic drugs exert their effects by blocking ____ ____ in the brain (especially D2 receptors). This finding led to the development of the ____ ____, which proposes that Schizophrenia is related to overactivity at dopamine receptors either as the result of oversensitivity of the receptors or excessive dopamine levels.
A
Mode of Action; Dopamine Receptors; Dopamine Hypothesis
24
Q
____ ____ of the ____ ____ include ____ ____, extrapyramidal effects, and neuroleptic malignant syndrome. ____ ____ include dry mouth, blurred vision, urinary retention, constipation, tachycardia, and delayed ejaculation. These effects appear ____, and tolerance ordinarily develops within a ____ ____ or ____.
A
Side Effects; Traditional Antipsychotics; Anticholinergic Effects; Early; Few Weeks or Months
25
____ ____ ____ are believed to be caused by the effects of the drugs on dopamine receptors, especially in the ____ ____. Parkinsonism, akathisia (extreme motor restlessness), and acute dystonia (muscle spasms in the mouth, face, and neck) are the most ____ ____ ____.
Extrapyramidal Side Effects; Caudate Nucleus; Common Extrapyramidal Effects
26
____ ____, the most serious of the extrapyramidal effects, is ____ -____ and is more common in ____ and ____ ____. Its symptoms are similar to those of Huntington's disease and include ____ ____ ____ of the Jaw, lips, tongue, and extremities.
Tardive Dyskinesia; Late-Occurring; Females and Older Patients; Involuntary Rhythmic Movements
27
Although tardive dyskinesia has traditionally been viewed as ____, recent studies indicate this is not true for ____ ____. For many, symptoms eventually improve when the drug is gradually ____ (although there may be an initial worsening of symptoms). In addition, tardive dyskinesia may be alleviated to some degree by administering a ____ or other ____ ____. ____, the most potent of the antipsychotics, is associated with the most ____ ____ ____.
Irreversible; All Patients; Withdrawn; Benzodiazepine; GABA Agonist; Haloperidol; Severe Extrapyramidal Effects
28
Finally, a rare, but potentially fatal side effect of the antipsychotic drugs is ____ ____ ____ (___). NMS is characterized by a ____ ____ of ____, ____, and ____ ____ including muscle rigidity, tachycardia, hyperthermia, and altered consciousness. To avoid a potentially fatal outcome, the drug must be ____ as soon as symptoms of NMS develop.
Neuroleptic Malignant Syndrome (NMS); Rapid Onset of Motor, Mental, and Autonomic Symptoms; Stopped
29
____ (____) ____ ____: The ____ ____ include dibenzodiazepine (____), benzisoxazole (resperidone), thienobenzodiazepine (olanzapine), and dibenzothiazepine (quetiapine).
Atypical (Novel) Antipsychotic Drugs; Atypical Antipsychotics; Clozapine
30
____: The atypical antipsychotics are used to treat ____ and other disorders with ____ ____. In addition, ____ has been found useful for treating Bipolar Disorder that has not responded to a mood stabilizer, depression and suicidality, alcohol and drug addiction, hostility, and the motor symptoms of Huntington's disease, Parkinson's disease, and other movement disorders.
Use; Schizophrenia; Psychotic Symptoms; Clozapine
31
An advantage of the atypical drugs is that they alleviate both the ____ and ____ ____ of ____, and they are often effective when ____ ____ drugs have ____. One disadvantage is that these drugs may have a ____ ____ of ____ ____ than the ____ ____ do.
Positive and Negative Symptoms of Schizophrenia; Traditional Antipsychotic; Failed; Slower Onset of Therapeutic Effects; Traditional Antipsychotics
32
____ of ____: The atypical antipsychotic drugs act on ___ and other ____ ____ as well as receptors for other neurotransmitters including ____ and ____.
Mode of Action; D4; Dopamine Receptors; Serotonin and Glutamate
33
Common ____ ____ of the atypical antipsychotics include ____ ____ (e.g., blurred vision, dry eyes, constipation, and urinary retention), lowered ____ ____, and ____. Extrapyramidal side effects are much ____ ____ (except for ____); and an important advantage of the atypical drugs is that they are less likely to cause ____ ____.
Side Effects; Anticholinergic Effects; Seizure Threshold; Sedation; Less Common; Akathisia; Tardive Dyskinesia
34
Atypical antipsychotics can produce ____ (a marked decrease in a certain type of white blood cell) and other blood ____, and, consequently, their use requires careful ____ ____. Also, like the traditional antipsychotics, they may cause ____ ____ ____.
Agranulocytosis; Dyscrasias; Blood Monitoring; Neuroleptic Malignant Syndrome
35
Several terms are used to describe the effects of the psychoactive drugs: For example, (1) ____ produce effects similar to those produced by a neurotransmitter, while (2) ____ produce no activity on their own but reduce or block the effects of a neurotransmitter. Because of the increased risk for adverse side effects, a general rule when prescribing drugs for older adults and members of some ethnic minority groups is to (3) ____.
(1) agonists; (2) antagonists; (3) start low and go slow
36
The traditional antipsychotic drugs are used primarily as a treatment for (4) ____ and are especially effective for alleviating its (5) ____ symptoms such as delusions and hallucinations. Research on the effects of the traditional antipsychotic drugs provides support for the dopamine hypothesis, which attributes Schizophrenia to (6) ____ to dopamine or excessive dopamine levels.
(4) Schizophrenia; (5) positive; (6) oversensitivity
37
These drugs are associated with several undesirable side effects including (7) ____ effects (e.g., dry mouth, constipation, blurred vision) and extrapyramidal symptoms. Of the latter, (8) ____ is the most serious side effect, but its symptoms may eventually decrease if the drug is (9) ____. Neuroleptic (10) ____ is characterized by a rapid onset of muscle rigidity, tachycardia, hyperthermia, and altered consciousness.
(7) anticholinergic; (8) tardive dyskinesia; (9) gradually withdrawn; (10) malignant syndrome
38
The atypical antipsychotic drugs (e.g., clozapine) are associated with several advantages. They alleviate both the (11) ____ symptoms of Schizophrenia and are often effective when traditional drugs have failed. In addition, they are less likely to produce (12) ____ and other extrapyramidal side effects (except akathisia). However, they can cause (13) ____ or other blood dyscrasias.
(11) positive and negative; (12) tardive dyskinesia; (13) agranulocytosis
39
The antidepressant drugs include the ____, the ____, and the ____. In addition. several other antidepressants have been introduced in recent years including ____ ____ ____ ____ and ____ ____ ____ ____.
Tricyclics; SSRIs; MAOIs; Norepinephrine Dopamine Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors
40
____: The ____ (___) include amitriptyline, nortriptyline, doxepin, ____, and ____.
Tricyclics; Tricyclics (TCAs); Imipramine; Clomipramine
41
____: The ___ are ____ ____ for depressions that involve decreased appetite and weight loss, early morning awakening and other sleep disturbances, psychomotor retardation, and anhedonia. They are particularly useful for alleviating the ____, ____ ____ of depression. Because it takes ____ to ____ ____ for these drugs to exert their therapeutic effects, ___ (which has a more immediate impact) is sometimes preferred for patients with ____ ____ and a ____ ____ for ____.
Use; TCAs; Most Effective; Vegetative, Somatic Symptoms; Two to Four; ECT; Severe Depression; High Risk for Suicide
42
The ___ are also ____ for Panic Disorder, Agoraphobia, Bulimia, Obsessive-Compulsive Disorder (especially clomipramine), enuresis in children and adolescents (especially imipramine), and neuropathic pain (especially amitriptyline and nortriptyline).
TCAs; Used
43
____ of ____: The TCAs ____ the ____ of ____, ____, and/or ____ at ____ ____. The effects of the tricyclic drugs on norepinephrine support the ____ ____, which proposes that depression is caused by a deficiency of this neurotransmitter.
Mode of Action; Block the Reuptake of Norepinephrine, Serotonin, and/or Dopamine at Nerve Synapses; Catecholamine Hypothesis
44
The primary ____ ____ of the TCAs are summarized in Table 6. The most serious problem is that the TCAs are ____, producing such cardiovascular symptoms as tachycardia, palpitations, hypertension, severe hypotension (drop in blood pressure), and cardiac arrhythmia. For this reason, they must be used with ____ with people suffering from ____ ____.
Side Effects; Cardiotoxic; Caution; Heart Disease
45
Many of the adverse effects of the TCAs are more common in ____ ____, and most can be alleviated by lowering the ____ ____. ____ of ____ ____ include ataxia, impaired concentration, agitation, severe hypotension, fever, cardiac arrhythmia, delirium, seizures, and coma. Because an overdose can be ____, the tricyclics should be prescribed in ____ ____ for patients at ____ ____ for ____.
Older Patients; Dosage Level; Symptoms of Tricyclic Overdose; Lethal; Small Quantities; High Risk for Suicide
46
____ ____ ____ of ___ include cardiovascular symptoms; anticholinergic effects (e.g., dry mouth, blurred vision, urinary retention, constipation, sexual dysfunction); confusion; drowsiness; fatigue; weight gain; fine tremor; paresthesia; blood dyscrasia.
Adverse Side Effects of TCAs
47
____ ____ ____ of ___ include gastrointestinal disturbances (e.g., nausea, appetite loss, constipation or diarrhea); insomnia; anxiety; headache; dizziness; anorexia; tremor; frequent urination; sexual dysfunction.
Adverse side Effects of SSRIs
48
____ ____ ____ of ___ include anticholinergic effects (e.g., dry mouth, blurred vision, nausea, constipation, sexual dysfunction); insomnia; agitation; confusion; skin rash; weight gain; edema; headache; dizziness; tremor; blood dyscrasia; hypertensive crisis
Adverse side Effects of MAOIs
49
____: The ____ (____ ____ ____ ____) include ____, fluvoxamine, paroxetine, and sertraline.
SSRIs; SSRIs (Selective Serotonin Reuptake Inhibitors; Fluoxetine
50
____: The SSRIs are used to treat ____ and are particularly effective for ____ ____. Several of the ____ are also prescribed for obsessive-compulsive symptoms, Bulimia, Panic Disorder, and PTSD.
Use; Depression; Melancholic Depression; SSRIs
51
____ of ____: The SSRIs ____ the ____ of ____.
Mode of Action; Block the Reuptake of Serotonin
52
The ____ ____ of the SSRIs include those listed in Table 6. As with most medications, many of these effects are ____ but others may require a ____ in ____ or ____. In comparison to the tricyclic antidepressants, the SSRIs are associated with several ____: They are ____ ____, ____ in ____, and are less likely to produce ____ ____.
Side Effects; Temporary; Change in Dosage or Drug; Advantages; Less Cardiotoxic; Safer in Overdose; Cognitive Impairment
53
SSRIs have a fairly ____ ____ of therapeutic effects: Most individuals experience a substantial improvement in ____ ____ within ____ to ____ ____, although some may not experience the full therapeutic effects for ____ to ____ ____.
Rapid Onset; Depressive Symptoms; Two to Four Weeks; Six to Eight Weeks
54
Since its introduction in the United States in 1987, ____ (____) has become the most ____ -____ antidepressant, and it has been surrounded by controversy because Of anecdotal and empirical evidence linking it with acts of ____ and ____. The FDA, however. has concluded that the risks associated with Prozac are no greater than those associated with ____ ____.
Prozac (Fluoxetine); Widely-Prescribed; Violence and Suicide; Other Antidepressants
55
Administration of an SSRI in conjunction with an ____ or ____ ____ ____ may result in ____ ____ Symptoms include ____ ____ (headache, nystagmus, tremor, dizziness, unsteady gait), changes in ____ ____ (irritability, confusion, delirium), and cardiac arrhythmia and can progress to ____ and ____.
MAOI or other Serotonergic Agent; Serotonin Syndrome; Neurological Effects; Mental State; Cardiac Arrhythmia; Coma and Death
56
____: Commonly-prescribed ____ (monoamine oxidase inhibitors) include isocarboxazid, phenelzine, and tranylcypromine.
MAOIs; MAOIs
57
____: The MAOIs are most effective for treating ____ -____ and ____ ____ that involve ____, reversed ____ ____ (e.g., hypersomnia, hyperphagia), and ____ ____.
Use; Non-Endogenous and Atypical Depressions; Anxiety; Vegetative Symptoms; Interpersonal Sensitivity
58
____ of ____: The MAOIs inhibit the ____ ____ ____, which is involved in ____ dopamine, norepinephrine, and serotonin.
Mode of Action; Enzyme Monoamine Oxidase; Deactivating
59
The most dangerous ____ ____ of MAOIs is ____ ____, which can occur when an MAOI is taken in conjunction with barbiturates, amphetamines, antihistamines, or certain other drugs or with foods containing the amino acid tyramine (e.g., aged cheeses and meats, beer, red wine, chicken liver, avocados, bananas, fava beans, soy sauce).
Side Effect; Hypertensive Crisis
60
Symptoms of a ____ -____ ____ ____ include a severe headache, stiff neck, rapid heart rate, nausea, vomiting, sweating, and sensitivity to light. A person experiencing these symptoms should seek ____ ____.
Tyramine-Induced Hypertensive Crisis; Emergency Treatment
61
____ ____: Several other antidepressants have been introduced in recent years, including the ____ and ____.
Newer Antidepressants; NDRIs and SNRIs
62
____: ____ (Wellbutrin) is a norepinephrine dopamine reuptake inhibitor (NDRI) and is used to treat Major Depressive Disorder and the depressive phase of Bipolar Disorder. (Under the name Zyban, this medication is also used to facilitate smoking cessation.)
NDRIs; Bupropion
63
Bupropion has fewer ____ ____ ____ and is less ____ than the TCAs, and it does not cause ____ ____. However, it may aggravate pre-existing ____ and ____. It is often effective for individuals who have not responded to other ____.
Anticholinergic Side Effects; Cardiotoxic; Sexual Dysfunction; Psychosis and Seizures; Antidepressants
64
____: ____ (____) is a serotonin norepinephrine reuptake inhibitor (SNRI) and is prescribed for Major Depressive Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, and OCD. It has also been identified as an effective drug for certain ____ ____ including fibromyalgia, mixed headaches, back pain, and peripheral neuropathic pain.
SNRIs; Venlafaxine (Effexor); Pain Syndromes
65
Venlafaxine is less dangerous in ____ than the TCAs, and may have a ____ ____ of ____ ____. Because it can increase ____ ____, ____ ____ is required. ____ (____) is similar to venlafaxine and is prescribed for Major Depressive Disorder and Generalized Anxiety Disorder.
Overdose; Faster Onset of Therapeutic Effects; Blood Pressure, Frequent Monitoring; Duloxetine (Cymbalta)
66
The ____ ____ ____ include ____ and ____.
Mood Stabilizing Drugs; Lithium and Carbamazepine
67
____: In the past 100 years, ____ ____ have been used to treat a variety of disorders including gout, diabetes, epilepsy, and mania.
Lithium; Lithium Salts
68
____: ____ is considered the drug-treatment-of-choice for Bipolar Disorder, especially "____ " ____ ____ involving ____ ____ with elevated (as opposed to irritable or dysphoric) mood and without a rapid cycling of moods. It not only reduces or eliminates manic symptoms but also ____ ____ ____.
Use; Lithium; “Classic” Bipolar Disorder; Manic Episodes; Suppresses Mood Swings
69
____ of ____: The effects of lithium on mood are not ____ ____ but appear to be related to the ____ of ____ and ____.
Mode of Action; Well Understood; Reuptake of Serotonin and Norepinephrine
70
The ____ ____ ____ of ____ usually subside within a few weeks and include nausea. vomiting. diarrhea. a metallic taste, and weight gain. ____ ____ ____ include fine hand tremor and shakiness. fatigue, restlessness, polyuria, and polydipsia.
Gastrointestinal Side Effects of Lithium; Other Side Effects
71
The major danger of lithium use is ____, which results when the dose is ____ ____. ____ ____ of ____ are diarrhea, ataxia. drowsiness, slurred speech, confusion, and coarse tremor. Because ____ ____ can result in seizures, coma, and death, serum levels of lithium must be ____ ____.
Toxicity; Too Hight; Initial Signs of Toxicity; Severe Toxicity; Regularly Monitored
72
The retention of lithium is affected by the body's ____ ____, and people taking this drug must be careful to avoid ____ in their ____ ____ and avoid caffeine, alcohol, and other diuretics. Lithium is ____ for people with cardiovascular, kidney, liver, thyroid, or gastrointestinal problems.
Sodium Levels; Fluctuations; Salt Intake; Contraindicated
73
____: ____ (____) was initially used as an ____ ____ but has also been found effective for ____. Other anticonvulsant drugs that are useful as mood stabilizers include ____ ____ (____) and ____ (____).
Carbamazepine; Carbamazepine (Tegretol); Anticonvulsant Drug; Mania; Valproic Acid (Depakote) and Clonazepam (Klonopin)
74
____: Carbamazepine is an effective treatment for ____ ____, especially for people who have not responded to ____. There is some evidence that it is more beneficial than lithium for those who experience frequent ____ ____ ("____ ____ ") and those with ____ ____.
Use; Bipolar Disorder; Lithium; Mood Swings (“Rapid Cyclers”); Dysphoric Mania
75
____ of ____: The mood-stabilizing effects of carbamazepine and other anticonvulsants are not ____ ____, but they are believed to affect ____ ____.
Mode of Action; Well Understood; Serotonin Levels
76
____ ____: ____ ____ of ____ include dizziness, ataxia, visual disturbances, anorexia. nausea, and rash, but tolerance for many of these symptoms develops ____ ____. Because of its potential effects on ____ ____, carbamazepine is contraindicated for people with ____ in ____ ____. In addition, there is a slight risk for ____ and ____ ____, and careful ____ ____ is ____.
Side Effects; Adverse Effects of Carbamazepine; Fairly Quickly; Cardiovascular Functioning; Abnormalities in Cardiac Conduction; Agranulocytosis and Aplastic Anemia; Blood Monitoring is Required
77
The antidepressants include the TCAs, SSRIs, and MAOIs. The TCAs exert their effects by blocking the reuptake of (1) ____, serotonin, and/or dopamine. Their effects on the former support the (2) ____ hypothesis. Undesirable side effects include (3) ____ effects (e.g., blurred vision, dry mouth, constipation), weight gain, drowsiness. and confusion. These drugs are also (4) ____ and can cause hypertension. extreme hypotension, and tachycardia.
(1) norepinephrine; (2) catecholamine; (3) anticholinergic; (4) cardiotoxic
78
The SSRIs are particularly effective for (5) ____ depression. They are less cardiotoxic than the TCAs. are safer in (6) ____ and are less likely to produce (7) ____ impairments. The SSRIs exert their effects by blocking the reuptake of (8) ____. The MAOIs are most effective for (9) ____ depressions. The most dangerous side effect is hypertensive crisis, which can occur when an MAOI is taken in conjunction with certain drugs or foods containing (10) ____.
(6) overdose; (7) cognitive; (8) serotonin; (9) non-endogenous and atypical; (10) tyramine
79
Lithium is the drug-treatment-of-choice for "classic" (11) ____. To avoid toxicity when taking this drug, patients must be careful to avoid fluctuations in their (12) ____ intake and to avoid caffeine, alcohol, and other diuretics. Carbamazepine is an (13) ____ drug that has been found to have similar effects on manic symptoms as lithium and may be more beneficial than lithium for people who experience (14) ____ or who have dysphoric mania.
(11) Bipolar Disorder; (12) salt (sodium); (13) anticonvulsant; (14) frequent mood swings
80
The ____ -____ include the barbiturates, anxiolytics, and alcohol. These drugs are generalized ___ ____, and their effects, for the most part, are ____ ____: At low doses, these drugs reduce ____ and ____ ____; at moderate doses, they induce ____ and ____; and at high doses, they can produce ____, ____, and ____.
Sedative-Hypnotics; CNS Depressants; Dose Dependent; Arousal and Motor Activity; Sedation and Sleep; Anesthesia, Coma, and Death
81
The initial increase in activity and feelings of ____ produced by sedative-hypnotics are due to their ____ of ____ ____ in the ____, while their subsequent ____ and ____ ____ result from ____ of ____ ____.
Elation; Suppression of Inhibitory Mechanisms; Brain; Sedating and Hypnotic Effects; Suppression of Excitatory Mechanisms
82
Chronic use of a ____ -____ produces ____ and ____ and ____ ____, and abrupt cessation causes a ____ ____ that is characterized by tremors, anxiety, nausea, vomiting, paranoia, and, in extreme cases, hallucinations, delirium, and life-threatening convulsive seizures.
Sedative-Hypnotic; Tolerance and Psychological and Physical Dependence; Withdrawal Syndrome
83
The effects of the sedative-hypnotics are ____: Combining an ____ with a ____ or ____ can have ____ ____ because of the ____ nature of their actions on the brain structures that control ____. The sedative-hypnotics also produce ____ -____, which means that, when tolerance develops to one sedative-hypnotic, it is likely to be shown for other ____ ____ as well.
Synergistic; Anxiolytic; Barbiturate or Alcohol; Lethal Consequences; Superadditive; Respiration; Cross-Tolerance; Sedative Hypnotics
84
____: The ____ include amobarbital, pentobarbital, secobarbital, and phenobarbital.
Barbiturates; Barbiturates
85
____: In the past, barbiturates were frequently used as ____ and ____ ____ but, due to recognition of their lethal effects and the development of safer and more effective drugs, they are now ____ ____. The effects of the barbiturates range from ____ ____ to ____, ____, and ____. In young children, older adults, and people experiencing pain, the barbiturates sometimes produce ____ ____.
Use; Sedatives and Anesthetic Agents; Infrequently Prescribed; Mild Sedation to Anesthesia, Coma, and Death; Paradoxical Excitement
86
____ of ____: Barbiturates exert their effects by ____ ____ to the ____ ____ ____.
Mode of Action; Interrupting Impulses; Reticular Activating System
87
The ____ ____ ____ of the ____ include slurred speech, nystagmus, dizziness, irritability, and impaired motor and cognitive performance. An ____ can produce ataxia, confusion, agitation, respiratory depression, and death.
Adverse Side Effects; Barbiturates; Overdose
88
When used to alleviate insomnia, the ____ (____ -____) ____ of the barbiturates generally last for only a ____ ____; after that, total sleep time may actually fall below the ____ -____ ____. Barbiturate use causes a ____ in ___ ____, and abrupt cessation can produce an ___ ____ and ____.
Soporific (Sleep-Inducing) Effects; Few Weeks; Pre-Drug Level; Decrease in REM Sleep; REM Rebound and Nightmares
89
Chronic use of a barbiturate results in ____ and ____ and ____ ____. Tolerance is not equal for all ____ ____. For example, a barbiturate user will develop tolerance to the sleep-inducing actions of the drug, but his/her respiratory centers will not adapt to the drug's effects.
Tolerance and Psychological and Physical Dependence; Affected Systems
90
Consequently, increasing the dose of a barbiturate to maintain its ____ ____ can have ____ ____. Withdrawal symptoms are generally ____ and, without ____ ____. can be ____-____. The barbiturates are a ____-____ class of drugs. and they are frequently involved in ____ and ____ ____.
Soporific Effects; Lethal Results; Severe; Medical Supervision; Life-Threatening; Much-Abused; Suicides and Accidental Deaths
91
____: The ____ (which are also called minor tranquilizers and anti-anxiety drugs) are the most widely-used ____ ____. Of the anxiolytics, the ____ are the most ____ ____. The ____ include diazepam, alprazolam, oxazepam, triazolam, chlordiazepoxide, and lorazepam.
Benzodiazepines; Anxiolytics; Psychiatric Medication; Benzodiazepines; Commonly Prescribed; Benzodiazepines
92
____: The benzodiazepines are prescribed primarily to relieve ____ but are also used to treat sleep disturbances. seizures, cerebral palsy and other disorders involving muscle spasms, and alcohol withdrawal.
Use; Anxiety
93
____ of ____: The benzodiazepines stimulate the ____ ____ of the ____ ___.
Mode of Action; Inhibitory Action; Neurotransmitter GABA
94
The ____ ____ ____ ____ of the ____ and similar anxiolytics are drowsiness. dizziness, lethargy, slurred speech, ataxia, and impaired psychomotor ability; ____ ____ include irritability, hostility, paradoxical excitation or agitation, increased appetite and weight gain, skin rash, blood dyscrasias, impaired sexual functioning, disorientation and confusion, sleep disturbances (e.g., reduced REM sleep), amnesia, and depression. Less severe effects are often alleviated by ____ the ____ ____.
Most Common Side Effects; Benzodiazepines; Other Effects; Lowering the Dosage Level
95
The relaxation. euphoria, and sense of well-being produced by the benzodiazepines and similar anxiolytics promote ____ ____, and chronic use results in ____ and ____ ____. Withdrawal symptoms can be ____, and abrupt cessation may induce ____ ____, which can be accompanied by seizures, depersonalization, panic, and stroke.
Psychological Dependence; Tolerance and Physical Dependence; Severe; Rebound Hyperexcitability
96
____: ____ (____) is the first anxiolytic that reduces ____ without ____. It appears to be ____-____, ____-____-____, and not subject to abuse. Unlike the benzodiazepines and similar anxiolytics, which have ____ ____ ____, buspirone must be taken for ____ ____ before it is ____.
Azapirone; Azapirone (Buspirone); Anxiety; Sedation; Non-Addictive; Non-Habit-Forming; Abuse; Immediate Therapeutic Effects; Several Weeks; Effective
97
Included in the Beta-Blocker category is ____ (Inderal).
Propranolol
98
____: ____ -____ are used to treat high blood pressure, angina, and other cardiovascular disorders; tremors; migraine headache; and glaucoma. They have also been found useful for reducing the palpitations. tremor, excessive sweating, and other physical symptoms associated with ____.
Use; Beta-Blockers; Anxiety
99
____ of ____: ____-____ block ____-____ ____, which respond to ____ and ____.
Mode of Action; Beta-Adrenergic Receptors; Epinephrine and Norepinephrine
100
____ ____ of ____ include bradycardia, shortness of breath, arterial insufficiency (usually of the Raynaud's type), nausea, diarrhea, depression, dizziness, sexual dysfunction, trouble sleeping, and numbness or tingling in the fingers and toes.
Side Effects of Propranolol
101
Propranolol is potentially ____ for people with certain ____ ____ and should not be prescribed for those with ____ ____ ____. In addition, propranolol and other beta-blockers should not be ____ ____ because doing so can cause sweating, palpitations, headache, tremulousness, and cardiac arrhythmia.
Lethal; Respiratory Problems; Obstructive Pulmonary Disease; Discontinued Abruptly
102
The drugs classified as ____-____ (____) have both ____ and ____ ____. Included in this class are the ____ ____ (opium, morphine, and codeine), the ____-____ ____ of ____ (heroin, Percodan, Dilaudid), and the pure ____ (Demerol, Darvon, methadone).
Synthetic Derivatives of Morphine; Synthetics
103
____: Medically, the narcotic-analgesics are used for the same reasons they were used centuries ago — i.e., as analgesics, treatments for ____, and ____ ____.
Use; Diarrhea; Cough Suppressants
104
The immediate effect of the narcotic-analgesics is a ____ -____ "____ " or sense of ____. This effect is usually followed by a feeling of ____, drowsiness, apathy, decreased physical activity, and impaired ____ and ____.
Short-Lived “Rush”; Euphoria; Tranquility; Attention and Memory
105
____ of ____: Research conducted in the 1960s and 1970s to investigate the mechanism of action of the narcotic-analgesics identified ____ ____ in the ____ ____ and various regions of the ____ including the ____, ____, and ____.
Mode of Action; Opioid Receptors; Spinal Cord; Brain; Amygdala, Thalamus, and Hypothalamus
106
Identification of opioid receptors led to the hypothesis that the body produces its own ____-____ ____; and support for this hypothesis was provided by the discovery of the ____ and ____, which appear to be involved in reducing ____ ____, especially ____ ____ to ____.
Opioid-Like Substances; Endorphins and Enkephalins; Pain Perception; Emotional Responsivity to Pain
107
____ ____: ____ ____ ____ of ____ -____ use include constricted pupils. decreased visual acuity, increased perspiration, constipation, nausea, vomiting, and respiratory depression. ____ (____) can produce slow and shallow breathing, muscle rigidity, catalepsy, clammy skin, decreased blood pressure and pulse rate, convulsions, coma, and death.
Side Effects; Common Physical Signs of Narcotic-Analgesic; Overdose (Toxicity)
108
Chronic use of a narcotic-analgesic results in ____ and ____ and ____ ____. Users of these drugs often develop ____ ____ ____ as a result of the ____ produced by the drug. By the time this effect has diminished, ____ ____ has developed, and users continue taking the drug to avoid ____. Withdrawal symptoms resemble those associated with a bad case of the ____ and include stomach cramps, nausea, vomiting, weakness, fever, muscle and joint pain, sweating, and insomnia.
Tolerance and Psychological and Physical Dependence; Psychological Dependence First; Euphoria; Physical Dependence; Withdrawal; Flu
109
The ____ ____-____, ____, is often used in ____ ____ programs. Methadone provides a heroin user with a means of satisfying his or her physical dependence without providing ____ -____ ____ ____.
Synthetic Narcotic-Analgesic, Methadone; Heroin Detoxification Programs; Physical Dependence; Psychologically-Reinforcing Positive Feelings
110
Although methadone is nearly as addictive as heroin, its withdrawal symptoms are ____ and the duration of its effects is ____. It is also effective when administered ____, thereby eliminating the hazards associated with ____ ____.
Milder; Longer; Orally; Intravenous Injections
111
Included in the psychostimulants category are the ____ and ____.
Amphetamines and Methylphenidate
112
____: ____ (e.g., dexamphetamine sulphate) are used to treat narcolepsy and Attention-Dencit Hyperactivity Disorder (ADHD); and ____ (Ritalin. Concerta, Metadate) is used to treat ADHD in children and adults.
Use; Amphetamines; Methylphenidate
113
____ of ____: The psychostimulant drugs potentiate the release of ____ and ____ and ____ their ____.
Mode of Action; Norepinephrine and Dopamine; Block their Reuptake
114
____ ____ ____ of the ____ include restlessness, insomnia, poor appetite. tremor, palpitations, and cardiac arrhythmia.
Common Side Effects; Amphetamines
115
Repeated use produces ____ and ____ and can also result in ____, which is basically the opposite of tolerance and involves a greater behavioral response to the drug that occurs when it is used intermittently. Prolonged use of an amphetamine can lead to a ____ ____ that resembles ____ ____.
Tolerance and Dependence; Sensitization; Psychotic State; Paranoid Schizophrenia
116
The side effects of ____ include decreased appetite, insomnia, dysphoria (amnesty, irritability, depression, euphoria, sadness), abdominal pain, and tachycardia. Higher doses of the drug may cause ____ ____, although the research has found that this effect is temporary and adult height and weight are usually unaffected (Taylor, 1994). Occasional “____ ____ " (e.g.. during summer and end-of-year vacations) can be used to minimize growth suppression and other adverse side effects and confirm that the drug is still needed.
Methylphenidate; Growth Suppression; Drug Holidays
117
An important limitation of methylphenidate is that symptoms quickly return when the drug is ____. Methylphenidate is ____ for individuals with anxiety and tension, anorexia, severe hypertension or angina pectoris, a history of functional psychosis, a recent history of drug or alcohol abuse or pre-existing motor tics, or a family history of Tourette's Disorder.
Discontinued; Contraindicated
118
Included in the anti-alcohol drugs category are disulfiram (Antabuse) and ____ (ReVia, Vivitrol).
Naltrexone
119
____: These drugs are used to prevent ____ ____ in individuals with Alcohol Use Disorder.
Use; Alcohol Use
120
____ of ____: Disulfiram inhibits ____ ____, causing an accumulation of ____ and ____ ____ (e.g., severe nausea, vomiting, sweating, headache, tachycardia, and hypotension) that deter the individual from ____ ____. ____ is an opioid receptor antagonist. It blocks the ____ for and ____ ____ of ____.
Mode of Action; Alcohol Metabolism; Acetaldehyde and Unpleasant Reactions; Drinking Alcohol; Naltrexone; Craving; Reinforcing Efforts of Alcohol
121
____ ____ of ____ include drowsiness, depression, disorientation, headache, restlessness, impotence, and blood dyscrasias. ____ ____ of ____ include abdominal cramping, nausea, vomiting, insomnia, nervousness, headache, and joint and muscle pain.
Side Effects of Disulfiram; Side Effects of Naltrexone
122
Agranulocytosis is a potential side effect of ____; eating foods containing tyramine when taking an MAOI can produce a ____ ____; propranolol is used to control the physical symptoms associated with ____.
Clozapine; Hypertensive Crisis; Anxiety
123
The sedative-hypnotics are generalized (1) ____ depressants and include the barbiturates and anxiolytics. The effects of the sedative-hypnotics are synergistic, and they also produce cross-(2) ____. The barbiturates are now rarely prescribed because of their adverse effects. Their use causes a decrease in REM sleep, and abrupt cessation can produce an REM (3) ____ and nightmares.
(1) CNS; (2) tolerance; (3) rebound
124
The benzodiazepines are the most commonly-prescribed anxiolytic. They are associated with several adverse side effects including drowsiness, lethargy, slurred speech, and (4) ____ (lack of muscle coordination). The euphoric feelings produced by the benzodiazepines results in psychological dependence, and chronic use can result in the development of (5) ____ and physical dependence. Withdrawal can produce rebound (6) ____.
(4) ataxia; (5) tolerance; (6) hyperexcitability
125
Propranolol and other beta-blockers are used to treat cardiovascular disease, tremor, and migraine headache and have been found useful for reducing the (7) ____ symptoms of anxiety. Propranolol and other beta blockers should not be discontinued (8) ____ because doing so can cause sweating, headache, tremulousness, and cardiac arrhythmia.
(7) physical; (8) abruptly
126
The narcotic-analgesics have both sedative and analgesic effects. Research on the effects of these drugs led to the discovery of natural (9) ____ receptors in the spinal cord and brain. Chronic use results in tolerance and (10) ____ dependence. Amphetamines are currently used to treat (11) ____ and ADHD, while methylphenidate is used to treat the latter disorder.
(9) opioid; (10) psychological and physical; (11) narcolepsy
127
Common side effects of methylphenidate include decreased (12) ____, insomnia, and dysphoria. Higher doses of methylphenidate may cause (13) ____ suppression, but occasional (14) ____ can help minimize this effect. Methylphenidate is contraindicated for people with pre-existing motor tics or a family history of (15) ____. Disulfiram and naltrexone are both used to prevent alcohol use.
(12)appetite; (13) growth; (14) drug holidays; (15) Tourette's Disorder
128
Disulfiram does so by causing (16) ____ that deter the individual from drinking, while naltrexone blocks the (17) ____ and reinforcing effects of alcohol.
(16) unpleasant reactions (symptoms); (17) craving for
129
____ (or ____) ____ ____ (___) are randomized studies conducted in practice settings to evaluate the effects of interventions delivered under typical community conditions. PCTs complement and increase the information provided by ____ ____ ____, which evaluate interventions under ____ ____ ____. This is done by carefully selecting ____ ____, adopting a ____ ____, and utilizing ____ ____ batteries to detect ____ ____ ____.
Practical (or Pragmatic) Clinical Trials (PCTs); Efficacy Clinical Trials; Ideal Experimental Conditions; Suitable Patients; Placebo Control; Intensive Assessment Batteries; Statistically Meaningful Variations
130
"____ _" ____ ____ have a key role in demonstrating the intrinsic pharmacological effects of ____, thus providing the data necessary for their potential ____ and ____ ____. Clinical practice guidelines considered, PCTs are meant to ____ ____-____ in ____ ____ by addressing the ____ that ____ ____ at ____ ____ ____ ____.
“Phase III” Efficacy Trials; Medications; Cataloging and Marketing Authorization; Notify Decision-Makers in Clinical Care; Uncertainty that Clinicians Face at Critically Imperative Decision Points
131
The key features of a PCT include: a ____ ____ for which there is ____ ____ on the ____ ____ of ____; a precisely formulated ____ ____ that directly addresses a ____ ____ ____; an easily ____ ____ of ____ ____ (e.g., functional recovery. hospitalization, death. suicide attempt); ____ ____; broad entry criteria to capture the ____ ____ ____ likely to receive the ____ in ____ ____; ____ ____; minimal clinician and patient ____ ____; and lastly, a sample size ____ ____ to account for the ____ of the ____.
Clinical Dilemma; Genuine Uncertainty; Best Course of Action; Research Hypothesis; Practical Medical Decision; Measurable Outcome of Clinical Significance; Randomized Design; Mainstream Clinical Population; Intervention in Standard Care; Practice Setting; Research Burden; Large Enough; Heterogeneity; Participants
132
A PCT is intended to answer a ____, ____ ____ ____ ____ by concentrating on a ____ ____ of ____ ____ ____. On average, successful PCTs tend to be "____ ____ ____ ". a concept that applies to studies with many hundreds, if not thousands, of patients.
Single, Clearly Formulated Research Question; Major Outcome of Direct Clinical Significance; Large Simple Trials
133
PCTs frequently provide ____ ____ on ____ ____, such as depression or the availability of a ____ of ____, both ____ and ____.
Relevant Information on Common Conditions; Variety of Treatments; Pharmacological and Psychosocial
134
____ ____ ____ (___) is the clinical practice of optimizing medication regimens by measuring specific drugs at designated intervals to maintain a constant concentration in a patient's bloodstream.
Therapeutic Drug Monitoring (TDM)
135
Typically, it is unnecessary to employ TDM for ____ ____. It is used most frequently for monitoring drugs with ____ ____ ____, drugs with ____ ____ ____, medications for which target concentrations are ____ to ____, and drugs known to cause ____ and ____ ____.
Most Medications; Limited Therapeutic Ranges; Pronounced Pharmacokinetic Variability; Challenging to Oversee; Therapeutic and Adverse Effects
136
The process of TDM is based on the assumption that there is a definable connection between ____ and ____ or ____ ____ ____, and between ____ and ____ ____.
Dose and Plasma or Blood Drug Concentration; Concentration and Therapeutic Effects
137
TDM begins when the drug is ____ ____, and involves determining an ____ ____ ____ appropriate for the patient's ____ ____, age, weight, organ function, and concomitant drug therapy. When interpreting concentration measurements, factors that need to be considered include the ____ ____ in relation to ____ ____, dosage history, patient response, and the desired medicinal targets. The goal of TDM is to use ____ ____ of ____ -__ -____ ____ to optimize ____ ____ in patients in various ____ ____.
First Prescribed; Initial Dosage Regimen; Clinical Condition; Sampling Time; Drug Dose; Appropriate Concentrations of Difficult-to-Manage Medications; Clinical Outcomes; Clinical Situations
138
In general, there are approximately three main types of ____ ____ currently available, although the type of test utilized will depend on what is ____ ____. In general, three categories of genetic testing are available to detect abnormalities in ____ ____, ____ ____ and ___ ____: cytogenetic testing, biochemical testing, and molecular testing. ____ involves the examination of chromosomes and their abnormalities.
Genetic Testing; Being Measured; Chromosome Structure, Protein Function and DNA Sequence; Cytogenetics
139
Chromosomes of a dividing human cell can be clearly analyzed in ____ ____ ____, specifically _ ____, which are easily collected from ____. Clinical testing for a ____ ____ utilizes techniques that examine the ____ instead of the ____.
White Blood Cells; T Lymphocytes; Blood; Biochemical Disease; Protein; Gene
140
Many biochemical genetic diseases are known as ____ ____ of ____ because they are existent at ____ and disrupt a key ____ ____. ____ ___ ____ is possible only when the gene sequence of interest is known.
Inborn Errors of Metabolism; Birth; Metabolic Pathways; Direct DNA Analysis
141
For small DNA mutations, ____ ___ ____ tends to be the most effective methodology, particularly if the function of the ____ is not known and a ____ ____ cannot be developed. For some genetic diseases, many different ____ can occur in the ____ ____ and result in the same disease, making ____ ____ very difficult.
Direct DNA Testing; Protein; Biochemical Test; Mutations; Same Gene; Molecular Testing
142
PCTs are conducted to determine the effectiveness of interventions in typical (1) ____. They tend to be large, (2) ____ trials with hundreds, if not thousands, of participants. TDM is used in clinical practice to optimize medication regimens by maintaining a specific (3) ____ level in the bloodstream. Three main types of genetic screening techniques are utilized to identify any abnormalities in chromosome structure, protein sequences, or DNA structure: cytogenetic, biochemical, and (4) ____.
(1) community settings; (2) simple; (3) concentration; (4) molecular
