Psychopharmacology Flashcards
Data collected in a survey of 242 million adults in the United States indicated that about ____ in ____ adults had filled one or more prescriptions for psychiatric drugs in 2013 (Moore & Mattison, 2016). In terms of type of drug, the largest number of adults reported filling prescriptions for ________ (12%), followed by ________ (8.3%) and ________ (1.6 percent).
- 1 in 6
- antidepressants
- anxiolytics, sedatives, and hypnotics
- antipsychotics
The first-generation antipsychotics (FGAs) are also known as traditional and conventional antipsychotics and include:
- chlorpromazine (Thorazine)
- haloperidol (Haldol)
- thioridazine (Mellaril)
- fluphenizine (Prolixin)
FGAs are used to treat ________ and other disorders with psychotic symptoms and are more effective for treating ________ than ________.
- schizophrenia
- positive symptoms
- negative symptoms
The FGAs exert their therapeutic effects primarily by:
blocking dopamine (especially D2) receptors
The major side effects of the FGAs fall into three categories:
1) Anitcholinergic sides effects: (e.g., chlorpromazine and thioridazine)
2) Extrapyramidal side effects
3) Neuroleptic malignant syndrome (NMS)
Anticholinergic side effects are most likely with ________ (e.g., chlorpromazine and thioridazine) and include ________, ________, ________, ________, and ________.
- low potency FGAs
- dry mouth
- blurred vision
- urinary retention
- constipation
- tachycardia
Extrapyramidal side effects are most likely with ________ (e.g., haloperidol and fluphenizine) and include ________, ________, ________, and ________.
- high-potency FGAs
- parkinsonism (resting tremor, muscle rigidity, slowed movement)
- dystonia (uncontrollable muscle contractions)
- akathisia (a sense of inner restlessness)
- tardive dyskinesia (involuntary, rhythmic movements of the tongue, face, and jaw and, over time, may also affect the limbs and trunk)
Tardive dyskinesia is:
- potentially life threatening
- begins after long-term drug use
- more common in women and older adults
- irreversible
- treated by gradually withdrawing the drug, administering a benzodiazepine, or switching to a second-generation antipsychotic
Neuroleptic malignant syndrome (NMS) is a rare life-threatening side effect from FGA use. Its symptoms include ________, ________, ________, and ________.
- muscle rigidity
- a high fever
- autonomic dysfunction (e.g., unstable blood pressure, tachycardia, excessive sweating)
- an altered mental state (e.g., confusion, combativeness)
Treatment for neuroleptic malignant syndrome (NMS) involves:
having the person stop taking the drug at the first sign of symptoms and providing him/her with supportive therapy (e.g., hydration, cooling).
The second-generation antipsychotics (SGAs) are also known as atypical antipsychotics and include:
- clozapine (Clozaril)
- risperidone (Risperdal)
- olanzapine (Zyprexa)
- quetiapine (Seroquel)
- aripiprazole (Abilify)
Like the FGAs, SGAs are used to treat ________ and other disorders with ________ symptoms, and some are FDA-approved as an adjunctive treatment for ________.
schizophrenia
psychotic
major depressive disorder
SGAs are as effective as or more effective than the FGAs for treating the ________ of schizophrenia and more effective than the FGAs for treating the ________, although this may be true for only some SGAs. In addition, an SGA (especially ________) may be effective when ________.
positive symptoms
negative symptoms
clozapine
FGAs have been ineffective
SGAs alleviate positive symptoms primarily by ________ and alleviate negative and cognitive symptoms primarily by ________.
- blocking dopamine (especially D3 and D4) receptors
- blocking serotonin receptors
The SGAs are ________ than the FGAs to cause ________; however, they can cause anticholinergic effects, neuroleptic malignant syndrome, and metabolic syndrome
less likely
extrapyramidal side effects
Metabolic syndrome from SGA use involves:
- substantial weight gain
- high blood pressure
- insulin resistance
- hyperglycemia
- increased risk for diabetes mellitus and heart disease
Clozapine and, to a lesser extent, other SGAs can cause agranulocytosis, which is:
- a potentially life-threatening condition that involves a dangerously low white blood cell count
- requires regular white blood cell monitoring
The major antidepressants include:
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin and norepinephrine reuptake inhibitors (SNRIs)
- norepinephrine dopamine reuptake inhibitors (NDRIs)
- tricyclic antidepressants (TCAs)
- monoamine oxidase inhibitors (MAOIs)
The SSRIs include:
- fluoxetine (Prozac, Sarafem)
- fluvoxamine (Luvox)
- paroxetine (Paxil)
- sertraline (Zoloft),
- citalopram (Celexa)
The SSRIs are the ________ prescribed antidepressants and are generally considered to be the first-line pharmacological treatment for________ and ________. Some are also used to treat other disorders including ________, ________, ________, ________, ________, ________, and ________.
- most frequently
- major depressive disorder
- persistent depressive disorder
- premenstrual dysphoric disorder
- OCD
- panic disorder
- generalized anxiety disorder
- PTSD
- bulimia nervosa
- premature ejaculation
The SSRIs exert their therapeutic effects primarily by ________, thereby increasing its availability in the synaptic cleft. Because they increase the ________, the SSRIs are classified as ________ or ________.
- blocking the presynaptic reuptake of serotonin
- availability of serotonin
- serotonin agonists
- indirect agonists
Compared to TCAs, the SSRIs are; ________ in terms of efficacy, have ________ side effects, are ________ (e.g., are less cardiotoxic), and are safer for ________.
- comparable
- fewer
- safer in overdose
- older adults
Side effects for SSRIs include:
- mild anticholinergic effects
- gastrointestinal disturbances
- insomnia
- anxiety
- sexual dysfunction
Abrupt cessation of an SSRI can cause ________, which involves headaches, dizziness, mood lability, impaired concentration, sleep disturbances, and flu-like symptoms
discontinuation syndrome
Combining an SSRI with an MAOI, lithium, or other serotonergic drug can cause ________, which is potentially fatal and involves ________, ________, ________, ________, ________, ________, and ________.
serotonin syndrome
extreme agitation
confusion
autonomic instability
hyperthermia
tremor
seizures
delirium
Treatment for serotonin syndrome requires ________ of the serotonergic drugs and providing appropriate medical interventions for its symptoms.
immediate withdrawal
The SSRIs have a ________ of therapeutic effects on depressive symptoms of about ________ weeks.
- delayed onset
- two to four
The SNRIs include:
- venlafaxine (Effexor)
- duloxetine (Cymbalta)
- desvenlafaxine (Pristiq)
SNRIs used to treat ________, ________, ________ and other ________.
- major depressive disorder
- social anxiety disorder
- neuropathic pain
- pain disorders
The SNRIs are ________ to the SSRIs in terms of efficacy, although there’s some evidence they may be more effective for ________.
- similar
- severe depression
The therapeutic effects of SNRIs are due to:
the inhibition of the reuptake of serotonin and norepinephrine at synapses.
The side effects of the SNRIs are ________ to those of the SSRIs and, like the SSRIs, they can cause ________ when abruptly stopped and ________ when combined with other serotonergic drugs. Because of their effects on norepinephrine, they can ________ and may be contraindicated for patients with ________.
- similar
- discontinuation syndrome
- serotonin syndrome
- elevate blood pressure
- hypertension or heart problems
The NDRIs include ________, which is used to treat ________ and assist with ________ and exerts its therapeutic effects by ________ at synapses.
- bupropion (Wellbutrin, Zyban)
- major depressive disorder
- smoking cessation
- inhibiting the reuptake of norepinephrine and dopamine
The side effects of NDRIs include:
- skin rash
- decreased appetite and weight loss
- agitation
- insomnia
- dizziness
- seizures
Advantages of bupropion are that it causes few ________, does not cause ________, and is not ________.
- anticholinergic effects
- sexual dysfunction
- cardiotoxic
Bupropion and other antidepressants that increase levels of norepinephrine and dopamine have an ________, which means they’re useful for patients who have ________ but not for those who have ________.
- energizing effect
- low energy and motivation
- insomnia or are very anxious
Of the TCAs, the tertiary amines include:
- amitriptyline (Elavil)
- imipramine (Tofranil)
- clomipramine (Anafranil)
- doxepin (Sinequan)
Of the TCAs, the tertiary amines exert their effects by ________, with some having a stronger effect on ________.
- inhibiting the reuptake of both serotonin and norepinephrine
- serotonin
Of the TCAs, secondary amines include ________ and ________ and are more potent at ________.
- nortriptyline (Pamelor)
- desipramine (Norpramin)
- inhibiting the reuptake of norepinephrine than serotonin
The TCAs are used to treat ________, ________, ________, and ________.
- major depressive disorder
- panic disorder
- obsessive-compulsive disorder (especially clomipramine)
- neuropathic pain (especially nortriptyline and amitriptyline).
The side effects of the TCAs include ________, ________, ________, ________, and ________.
- cardiovascular effects (e.g., hypertension, tachycardia, orthostatic hypotension)
- anticholinergic effects
- sedation
- weight gain
- sexual dysfunction
The secondary amines have ________ side effects than the tertiary amines (e.g., they are ________ to cause sedation and anticholinergic effects).
- fewer
- less likely
Because the TCAs are ________ and ________, they must be prescribed with caution for patients who have heart disease or are ________.
- cardiotoxic
- lethal in overdose
- suicidal
The MAOIs include:
- phenelzine (Nardil)
- isocarboxazid (Marplan)
- tranylcypromine (Parnate)
The MAOs are useful for patients with ________ or ________, which involves reversed vegetative symptoms such as hypersomnia, increased appetite, and reactive dysphoria.
- treatment-resistant depression
- atypical depression
The enzyme monoamine oxidase ________ norepinephrine, serotonin, and dopamine, and the MAOIs increase the levels of these neurotransmitters by ________ of this enzyme.
- deactivates
- inhibiting the activity
The side effects of MAOs include:
- anticholinergic effects
- orthostatic hypotension
- sedation
- sexual dysfunction
MOAs may produce a ________ when taken in conjunction with certain drugs (e.g., amphetamines, antihistamines) or food containing ________ (e.g., aged cheese and meat, soy products, beer, red wine, sauerkraut, fava beans, ripe bananas).
- hypertensive crisis
- tyramine
Symptoms of a hypertensive crisis include:
- a severe throbbing headache
- neck pain or stiffness
- rapid heart rate
- nausea and vomiting
- sweating
- sensitivity to light
- confusion
- delirium
