Psychopharmacology

Question 1

Aricept (donepezil hydrochloride)

Answer 1

can be used in mild to moderate dementia to slow and temporarily reverse some of the cognitive decline associated with Dementia of the Alzheimer’s type

Question 2

Antipsychotics

Answer 2

typical/traditional or atypical/novel; many end in “azine”; traditional treat positive symptoms more effectively than negative symptoms; novel generally effective for both positive and negative; all are to some extent dopamine antagonists

Question 3

Neurolpetics

Answer 3

antipsychotic medications; block dopamine receptors

Question 4

Thorazine

Answer 4

Typical/traditional antipsychotic

Question 5

Chlorpromazine

Answer 5

Typical/traditional antipsychotic

Question 6

Prolixin

Answer 6

Typical/traditional antipsychotic

Question 7

Fluphenazine

Answer 7

Typical/traditional antipsychotic

Question 8

Haldol

Answer 8

Typical/traditional antipsychotic

Question 9

Haloperidol

Answer 9

Typical/traditional antipsychotic

Question 10

Clozaril

Answer 10

atypical/novel antipsychotic; increased risk of agranulocytosis; usually only administered to those who have failed trials of others

Question 11

Clozapine

Answer 11

atypical/novel antipsychotic; increased risk of agranulocytosis; usually only administered to those who have failed trials of others

Question 12

Risperdal

Answer 12

atypical/novel antipsychotic

Question 13

Risperidone

Answer 13

atypical/novel antipsychotic

Question 14

Zyprexa

Answer 14

atypical/novel antipsychotic

Question 15

Olanzapine

Answer 15

atypical/novel antipsychotic

Question 16

Positive symptoms (schizophrenia)

Answer 16

hallucination, disorganized thinking, delusions

Question 17

Negative symptoms (schizophrenia)

Answer 17

affective flattening, lack of motivation, poverty of speech

Question 18

Depot neuroleptics

Answer 18

antipsychotics administered intramuscularly in doses that last 2-4 weeks; helpful for inconsistent compliance

Question 19

Decanoate

Answer 19

added to antipsychotic name to indicate it was administered in depot form

Question 20

Schizophrenia factors that correlate with better treatment outcome

Answer 20

-later age of onset
-acute onset
-good premorbid functioning
-anxiety or other affective symptoms (as opposed to emotional blunting)
-systematized and focused delusions
-precipitating factors
-married status
-family history of affective disorders
-no family history of schizophrenia

Question 21

Other disorders antipsychotics are used to manage

Answer 21

Delusional Disorder; sometimes Delirium, Brief Psychotic Disorder, Tourette’s Disorder, and Autism/Pervasive Developmental Disabilities (to decrease oppositional behavior, emotional lability, and irritability); sometimes adjunct in PTSD or MDD; not first choice for dementia but can be used to reduce agitation, confusion, and sleep problems

Question 22

Lower potency antipsychotic side effects

Answer 22

sedation, anticholinergic effects (confusion, memory loss, worsening mental function), orthostatic hypotension, and a lowering of the seizure threshold; weight gain (increased appetite, decreased activity), sexual dysfunction

Question 23

Higher potency antipsychotic side effects

Answer 23

extrapyramidal symptoms; weight gain (increased appetite, decreased activity), sexual dysfunction

Question 24

Anticholinergic effects

Answer 24

dry mouth, constipation, urinary hesitancy or retention, blurred vision, dry eyes, photophobia (sensitivity to light), nasal congestion, and confusion and decreased memory; antipsychotic side effect, typically diminish but do not completely disappear within first month of use

Question 25

Orthostatic hypotension

Answer 25

dizziness and lightheadedness when standing up

Question 26

Extrapyramidal symptoms (EPS)

Answer 26

movement-related symptoms; potentially most damaging side effects of antipsychotics; include dystonia, parkinsonism, akathisia; some treated with anticholinergic agents (ACAs), such as Cogentin (benztropine) and Artane (trihexy - phenidyl)

Question 27

Dystonia

Answer 27

acute and painful muscle spasms of the neck, back, tongue, eyes, and/or larynx; usually pass within two weeks; extrapyramidal symptom

Question 28

Parkinsonism

Answer 28

also called pseudoparkinsonism; mask-like face, shuffling gait, drooling, resting tremor, rigidity, and akinesia; persist through treatment; treated by lowering dose, switching drugs, or using an anticholinergic agent; extrapyramidal symptom

Question 29

Akathasia

Answer 29

most prevalent side effect of antipsychotics; dysphoria as well as an internal sense of restlessness or agitation, a feeling of the “ jitters” or “fidgeting,” tapping of the feet, rocking backward or forward, and shifting weight when standing; may persist throughout treatment; helped by using propranolol (a beta-blocker), a benzodiazepine, or an anticholinergic agent

Question 30

Neuroleptic malignant syndrome (NMS)

Answer 30

affects 1% of patients treated with antipsychotics, potentially lethal; severe muscle rigidity, altered consciousness, autonomic instability (heart rate, blood pressure), high fever; requires emergency medical treatment

Question 31

Tardive dyskinesia

Answer 31

typical/traditional antipsychotics can cause; abnormal movements of the lips, tongue, jaw (e.g., frowning, blinking, rolling and protruding the tongue), limbs (rapid purposeless movements, tremors, knee tapping), and trunk (rocking, twisting, pelvic gyrations); generally arises after 6+ months, plateaus at 3-6 years; may be reversible; sometimes seen when dosage is lowered or terminated; best treated through prevention; neuroleptics most effective short-term treatment for TD; anticholinergic agents typically exacerbate; not associated with Clozaril

Question 32

Agranulocytosis

Answer 32

potentially lethal side effect of Clozaril; a sudden drop in the granulocyte count, usually occurring within hours to 12 weeks of initial administration, and manifesting as a sore throat and high fever

Question 33

Antipsychotic dependence/withdrawal/overdose

Answer 33

do not cause addiction, dependence, or tolerance; only withdrawal if immediately stop high dosage (GI distress, headaches, insomnia, nightmares); overdoses not lethal unless take 30-60 day supply at once, but more lethal in combination with other medications

Question 34

Antidepressants

Answer 34

include tricyclics (TCAs), selective serotonin reuptake inhibitors (SSRIs), monoamine-oxidase inhibitors (MAOIs), and others; primary mechanism of action usually blocking reuptake of norepinephrine and/or serotonin

Question 35

Elavil

Answer 35

tricyclic antidepressant

Question 36

Amitryptyline

Answer 36

tricyclic antidepressant

Question 37

Anafranil

Answer 37

tricyclic antidepressant

Question 38

Clomipramine

Answer 38

tricyclic antidepressant

Question 39

Tofranil

Answer 39

tricyclic antidepressant

Question 40

Imipramine

Answer 40

tricyclic antidepressant

Question 41

Prozac

Answer 41

SSRI antidepressant; fluoxetine

Question 42

fluoxetine

Answer 42

SSRI antidepressant

Question 43

Zoloft

Answer 43

SSRI antidepressant; sertraline

Question 44

sertraline

Answer 44

SSRI antidepressant

Question 45

Paxil

Answer 45

SSRI antidepressant

Question 46

Paroxetine

Answer 46

SSRI antidepressant

Question 47

Treatment for “typical depressions”

Answer 47

SSRIs typically have fewer and less distressing side effects and are first choice; all classes of antidepressants equally effective in treating “typical depressions”

Question 48

Treatment for psychotic depression

Answer 48

best treated by tricyclics (TCAs) in combination with antipsychotic

Question 49

Treatment for inpatient depression

Answer 49

severe inpatient depression usually best treated with tricyclics (TCAs)

Question 50

Treatment for melancholic depression

Answer 50

usually best treated with tricyclics (TCAs)

Question 51

Treatment for geriatric depression

Answer 51

usually best treated with tricyclics (TCAs)

Question 52

Atypical depression

Answer 52

symptoms of hypersomnia, increased appetite, rejection sensitivity, and profound lack of energy

Question 53

Treatment for atypical depression

Answer 53

usually best treated with monoamine-oxidase inhibitors (MAOIs); SSRIs may be shown to be equally effective

Question 54

Treatment for treatment-resistant depression

Answer 54

usually best treated with monoamine-oxidase inhibitors (MAOIs); SSRIs may be shown to be equally effective

Question 55

Treatment for depression with panic disorder

Answer 55

usually best treated with monoamine-oxidase inhibitors (MAOIs); SSRIs may be shown to be equally effective

Question 56

Treatment for mild depression

Answer 56

first line is psychotherapy since placebos and psychotherapy as effective as drug treatment

Question 57

Treatment for bipolar disorder

Answer 57

lithium treatment of choice; long time to take effect (1-3 weeks for mania, 6-8 for depression), so often combined with antipsychotic/antidepressant; after several months, prophylactic (preventive) effect;; must be treated carefully if using antidepressants; tricyclics induce mania in 10-15%; SSRIs also induce mania but at lower rate

Question 58

Treatment for depression with sleep problems

Answer 58

frequently helped by Desyrel (trazadone; other) or Sinequan (doxepin; TCA), both of which have hypnotic effects

Question 59

Treatment for panic disorder

Answer 59

in addition to antianxiety agents Xanax (alprazolam) and Klonopin (clonazepam), commonly treated with antidepressants: Tofranil (imipramine; TCA), Paxil (paroxetine, SSRI) or Prozac (fluoxetine, SSRI)

Question 60

Treatment for OCD

Answer 60

often responds to the TCA Anafranil (clomipramine), and appears to respond to any of the SSRIs, especially Prozac (fluoxetine)

Question 61

Chronic pain disorders

Answer 61

respond well to TCAs, particularly Elavil (amitryptiline), Norpramin (desipramine), and Sinequan (doxepin). It is less clear if the SSRIs help

Question 62

Treatment for bulimia

Answer 62

antidepressants most typical pharmacological treatment; tricyclic antidepressants frequently used, including Norpramin (desipramine) and Tofranil (imipramine); SSRIs more common now, particularly Prozac (fluoxetine)

Question 63

Treatment for premature ejaculation

Answer 63

tricyclic Anafranil (clomipramine) and the SSRI Paxil (paroxetine)

Question 64

Other antidepressant uses

Answer 64

severe bereavement, anorexia nervosa, premenstrual phase dysphoric syndrome, enuresis, childhood sleepwalking or night terrors, dysthymia, and borderline personality disorder

Question 65

Tricyclic side effects

Answer 65

can trigger manic episodes in bipolar patients; more severe anticholinergic effects than antipsychotics; sedation, orthostatic hypotension, weight gain, nausea, and sexual dysfunction; contraindicated for patients with heart conditions, high blood pressure, or seizures

Question 66

SSRI side effects

Answer 66

lower side effect profile than the TCAs (no anticholinergic effects, less sedation); headaches, nervousness, restlessness, insomnia, sedation, gastrointestinal distress, and sexual dysfunction

Question 67

MAOI side effects

Answer 67

frequently cause orthostatic hypotension, weight gain, edema, sexual dysfunction, and insomnia; most serious side effect is tyramine-induced hypertensive crisis (must be warned not to eat foods high in tyramine; symptoms include severe headache, stiff neck, palpitations, sweating, nausea, and vomiting); contraindicated for variety of medical conditions; can be dangerous in conjunction with other meds

Question 68

Antidepressant dependence/withdrawal/overdose

Answer 68

no dependence, tolerance, addiction; non-life-threatening withdrawal symptoms with abrupt stop; TCAs and MAOIs lethal, increased if combined with alcohol; SSRIs and atypical antidepressants not very lethal

Question 69

Types of anti-anxiety drugs

Answer 69

benzodiazepines (anxiolytics and sedatives/hypnotics), non-benzodiazepine sedatives/hypnotics

Question 70

Anxiolytics

Answer 70

benzodiazepines whose major function is anxiety reduction

Question 71

Sedatives/hypnotics

Answer 71

benzodiazepines whose major function is sedation and sleep improvement

Question 72

Xanax

Answer 72

anxiolytic benzodiazepine; disadvantage of triggering “mini withdrawals” between doses, may make patients feel worse and more dependent on the drug; alprazolam

Question 73

alprazolam

Answer 73

anxiolytic benzodiazepine; disadvantage of triggering “mini withdrawals” between doses, may make patients feel worse and more dependent on the drug; Xanax

Question 74

Klonopin

Answer 74

anxiolytic benzodiazepine

Question 75

Clonazepam

Answer 75

anxiolytic benzodiazepine

Question 76

Valium

Answer 76

anxiolytic benzodiazepine; daizepam

Question 77

Diazepam

Answer 77

anxiolytic benzodiazepine; Valium

Question 78

Ativan

Answer 78

anxiolytic benzodiazepine

Question 79

Lorazepam

Answer 79

anxiolytic benzodiazepine

Question 80

Restoril

Answer 80

sedative/hypnotic benzodiazepine

Question 81

Temazepam

Answer 81

sedative/hypnotic benzodiazepine

Question 82

Halcion

Answer 82

sedative/hypnotic benzodiazepine

Question 83

Triazolam

Answer 83

sedative/hypnotic benzodiazepine

Question 84

Ambien

Answer 84

non-benzodiazepine sedative/hypnotic

Question 85

Zolpidem

Answer 85

non-benzodiazepine sedative/hypnotic

Question 86

Benzodiazepine mechanism of action

Answer 86

facilitate GABA’s ability to bind to its receptor site; increasing GABA results in reduced anxiety, increased sedation, muscle relaxation, and reduction in seizures

Question 87

Benzodiazepine use

Answer 87

limited and short-term because of potential for abuse; first consider possible secondary causes of anxiety (medical illness, illicit drugs, withdrawals from CNS depressants (benzodiazepines, alcohol, opiates, and barbiturates), medications (SSRIs, tricyclics, antipsychotics, etc)

Question 88

Adjustment disorder treatment

Answer 88

benzodiazepines appropriate when response to particular stressor that meets criteria for adjustment disorder with anxiety; limited to 1-2 weeks

Question 89

Panic disorder treatment

Answer 89

symptoms sometimes helped by benzodiazepines, particularly Xanax (alprazolam) or Klonopin (clonazepam); antidepressants first choice for treating on longer-term basis

Question 90

GAD treatment

Answer 90

often treated with benzodiazepines as-needed to forestall acute anxiety or on-going while psychotherapeutic approaches are being initiated; problems: high rates of failure to respond, tolerance, dependence; Buspar and antidepressants often used instead

Question 91

Other anxiety disorder treatment

Answer 91

BZs can have a minor role in the treatment of Social and Specific Phobias, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder

Question 92

Sleep problem treatment

Answer 92

benzodiazepines best for short-term problems; problems: tolerance, dependence, rebound insomnia, disrupt sleep cycle, suppress REM sleep; when discontinued, REM rebound can cause vivid, disturbing dreams

Question 93

Other disorders treated by benzodiazepines

Answer 93

occasionally treat depression; Klonopin (clonazepam) sometimes for Acute Mania; sometimes for akathisia and Alcohol Withdrawal; occasionally play a role as anticonvulsants (particularly Klonopin), muscle relaxants, and as adjuncts in anesthesia

Question 94

Benzodiazepine side effects

Answer 94

more benign than barbiturates; most common are sedation and drowsiness; mild cognitive impairment and some amnesia; Ataxia (incoordination) and depression can occur when dosages are high; if taken with alcohol or other CNS depressants, severe drowsiness, paradoxical disinhibition, and respiratory problems that can be fatal

Question 95

Benzodiazepine dependence/withdrawal/overdose

Answer 95

both physical and psychological dependence; most addictive are those with rapid onset and short half-life; can acquire dependence requiring larger doses for similar effects; BZs and alcohol cross-tolerant; withdrawal syndrome is serious and can be fatal, need to taper; safer in overdose, rarely fatal when taken alone; can be fatal with alcohol or other CNS depressants; chronic overdose: drowsiness, ataxia, slurred speech, and vertigo; acute overdose: lethargy and confusion, coma, and on rare occasions, heart attack or death

Question 96

Benzodiazepine withdrawal symptoms

Answer 96

stage 1: tremors, sweating, agitation, and increased autonomic reactions; stage 2: hallucinations and panic; stage 3: single or multiple grand mal seizures

Question 97

Who should avoid benzodiazepines

Answer 97

elderly, those with liver problems, patients with a history of alcohol dependence or any drug dependence, and patients who do not comply well with prescription directions

Question 98

Buspar

Answer 98

non-Benzodiazepine anxiolytic; does not cause sedation, cognitive impairment, or withdrawal; low potential for abuse and dependence; may take 2-4 weeks for response, cannot be taken as needed; used primarily for GAD, not effective for panic disorder; side effects of headaches, nausea, dizziness

Question 99

Buspirone

Answer 99

non-Benzodiazepine anxiolytic; does not cause sedation, cognitive impairment, or withdrawal; low potential for abuse and dependence; may take 2-4 weeks for response, cannot be taken as needed; used primarily for GAD, not effective for panic disorder; side effects of headaches, nausea, dizziness

Question 100

Inderal

Answer 100

beta blocker

Question 101

Propanolol

Answer 101

beta blocker

Question 102

Beta blockers

Answer 102

frequently prescribed for the somatic manifestation of anxiety, especially in social and performance anxiety; sometimes prescribed for drug-induced akathisia, lithium- induced tremor, and alcohol withdrawal; prescribed for heart and blood problems; side effects: sexual dysfunction, dizziness, drowsiness, shortness of breath, angina, cold hands and feet, difficulty sleeping, and nightmares; less common side effects: depression, anxiety, sleep disturbance; non-additive, do not cause withdrawal, problematic in overdoses

Question 103

Antihistamines

Answer 103

sometimes used to treat mild insomnia and extrapyramidal symptoms; common side effects: sedation, dizziness, and low blood pressure; examples: Atarax (hydroxyzine chloride), Vistaril (hydroxyzine pamoate), and Benadryl (diphenhydramine)

Question 104

Barbiturates

Answer 104

rarely used; strong sedating effects; more likely than BZs to cause addiction and lethal in overdose; also not as good therapeutic effects

Question 105

Lithium mechanism

Answer 105

theorized that functions as cell membrane stabilizer, affects variety of neurotransmitters; largely speculative

Question 106

Other lithium uses

Answer 106

Schizoaffective Disorder, Bipolar Type; treatment-resistant depression when antidepressants alone have not been effective; sometimes combined with antipsychotics for schizophrenia; impulse disorders, such as Intermittent Explosive Disorder; occasionally part of treatment for Cyclothymia and Borderline Personality Disorder

Question 107

Lithium side effects

Answer 107

frequently causes a fine hand tremor, gastric distress, weight gain, polyuria (urine) and polydipsia (thirst), fatigue, and mild cognitive impairment; negative effects on the kidneys, thyroid, heart, and skin; lithium toxicity

Question 108

Lithium toxicity

Answer 108

potentially fatal, always medical emergency; symptoms initially mimic flu (vomiting, abdominal pain, and severe diarrhea); other symptoms severe tremor, ataxia, coma, seizures, confusion, and irregular heart beat; can occur when on stable dose and complying

Question 109

Lithium dependence/withdrawal/overdose

Answer 109

does not cause tolerance, addiction, dependence, or withdrawal; non-compliance major problem because of side effects; Contraindications for its use include pre-existing heart disease, thyroid disease, renal damage, and pregnancy; requires close medical supervision

Question 110

Zyprexa

Answer 110

mood stabilizer for maintenance treatment of bipolar disorder

Question 111

Olanzipine

Answer 111

mood stabilizer for maintenance treatment of bipolar disorder

Question 112

Klonopin

Answer 112

mood stabilizer for acute mania

Question 113

Clonazepam

Answer 113

mood stabilizer for acute mania

Question 114

Risperidal

Answer 114

mood stabilizer for acute mania

Question 115

Resperidone

Answer 115

mood stabilizer for acute mania

Question 116

Anti-convulsants

Answer 116

typically used when bipolar disorder does not respond to lithium or lithium is contra-indicated; also used to treat impulse control disorders; occasionally helpful for depression; do not cause withdrawal

Question 117

Tegretol

Answer 117

anti-convulsant; may be more effective than lithium in cases of rapid cycling or dysphoric manic episodes; drug of choice for certain neurological chronic pain disorders, such as trigeminal neuralgia; side effects mimic alcohol intoxication

Question 118

Carbamazepine

Answer 118

anti-convulsant; may be more effective than lithium in cases of rapid cycling or dysphoric manic episodes; drug of choice for certain neurological chronic pain disorders, such as trigeminal neuralgia; side effects mimic alcohol intoxication

Question 119

Depakene

Answer 119

anti-convulsant; side effects include gastrointestinal distress, sedation, and tremor

Question 120

Valproic acid

Answer 120

anti-convulsant; side effects include gastrointestinal distress, sedation, and tremor

Question 121

Ritalin

Answer 121

stimulant

Question 122

Methylphenidate

Answer 122

stimulant; Ritalin, Concerta

Question 123

Adderall

Answer 123

stimulant

Question 124

Amphetamine

Answer 124

stimulant; Adderall

Question 125

Concerta

Answer 125

stimulant

Question 126

Psychostimulant mechanism

Answer 126

increase level and effect of catecholamines

Question 127

Disorders treated with stimulants

Answer 127

primarily treat ADHD in children, response typically in the first two days; sometimes used for adult ADHD, treatment-resistant depression, treatment-resistant obesity, narcolepsy, and chronic medically debilitating conditions (e.g., AIDS, Cancer)

Question 128

Stimulant side effects

Answer 128

loss of appetite, insomnia, headaches, and gastrointestinal distress (stomach aches or nausea); may temporarily suppress growth in children, drug holidays recommended; anxiety, irritability, insomnia, and dysphoria, as well as increases in heart rate and blood pressure; occasionally bring about movement disorders; Decreased appetite, fatigue, and stomach fullness may be signs of liver damage after several months

Question 129

Stimulant dependence/withdrawal/overdose

Answer 129

can cause psychological dependence and drug abuse; physical dependence, tolerance (especially when used for Narcolepsy), addiction, and physical withdrawal; Withdrawal symptoms include increased appetite, weight gain, increased sleep, decreased energy, and, uncommonly, paranoid symptoms; overdose rarely lethal because not strong enough; overdose symptoms include agitation, suicidal ideation, chest pain, hallucinations, confusion, dysphoria, and delusions