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the EPPPi pen > psychopharmacology > Flashcards

psychopharmacology Flashcards

1
Q

What are psychoactive drugs also known as?

A

Psychotropic drugs

They act on the central nervous system and generate physical, cognitive, and behavioral changes.

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2
Q

What are the two categories of antipsychotic drugs?

A

First generation and second generation

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3
Q

What are first-generation antipsychotics also known as?

A

Traditional and conventional antipsychotics

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4
Q

Name two examples of first-generation antipsychotics.

A
  • Chlorpromazine (Thorazine)
  • Haloperidol (Haldol)
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5
Q

What symptoms are first-generation antipsychotics more effective in treating?

A

Positive symptoms

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6
Q

How do first-generation antipsychotics primarily exert their therapeutic effects?

A

By blocking dopamine (especially D2) receptors

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7
Q

What are the three categories of major side effects of first-generation antipsychotics?

A
  • Anticholinergic side effects
  • Extrapyramidal side effects
  • Neuroleptic malignant syndrome
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8
Q

What are anticholinergic side effects most likely associated with?

A

Low potency FGAs

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9
Q

List some examples of anticholinergic side effects.

A
  • Dry mouth
  • Blurred vision
  • Urinary retention
  • Constipation
  • Tachycardia
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10
Q

What are extrapyramidal side effects most likely associated with?

A

High-potency FGAs

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11
Q

Name some extrapyramidal side effects.

A
  • Parkinsonism
  • Dystonia
  • Akathisia
  • Tardive dyskinesia
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12
Q

What is tardive dyskinesia?

A

A potentially life-threatening side effect characterized by involuntary, rhythmic movements

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13
Q

What treatment options are available for tardive dyskinesia?

A
  • Gradually withdrawing the drug
  • Administering a benzodiazepine
  • Switching to a second-generation antipsychotic
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14
Q

What is neuroleptic malignant syndrome (NMS)?

A

A rare life-threatening side effect of antipsychotics

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15
Q

What are some symptoms of neuroleptic malignant syndrome?

A
  • Muscle rigidity
  • High fever
  • Autonomic dysfunction
  • Altered mental state
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16
Q

What should be done at the first sign of neuroleptic malignant syndrome symptoms?

A

Stop taking the drug and provide supportive therapy

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17
Q

What are second-generation antipsychotics also known as?

A

Atypical antipsychotics

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18
Q

Name two examples of second-generation antipsychotics.

A
  • Clozapine (Clozaril)
  • Risperidone (Risperdal)
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19
Q

How do second-generation antipsychotics primarily alleviate positive symptoms?

A

By blocking dopamine (especially D3 and D4) receptors

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20
Q

How do second-generation antipsychotics alleviate negative and cognitive symptoms?

A

By blocking serotonin receptors

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21
Q

What is a significant advantage of second-generation antipsychotics over first-generation antipsychotics?

A

Less likely to cause extrapyramidal side effects

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22
Q

What is metabolic syndrome associated with second-generation antipsychotics?

A

Substantial weight gain, high blood pressure, insulin resistance, hyperglycemia, increased risk for diabetes mellitus and heart disease

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23
Q

What dangerous conditions can clozapine and other SGAs cause?

A

Neutropenia and agranulocytosis

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24
Q

What is required for patients taking clozapine?

A

Regular blood tests

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25
Q

Fill in the blank: Clozapine is the only FDA-approved antipsychotic for _______.

A

treatment-resistant schizophrenia

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26
Q

What are the major types of antidepressants?

A

The major antidepressants include:
* SSRIs
* SNRIs
* NDRIs
* TCAs
* MAOIs

These classes of antidepressants are differentiated by their mechanisms of action and side effect profiles.

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27
Q

What are SSRIs and what do they primarily treat?

A

SSRIs are selective serotonin reuptake inhibitors used primarily to treat:
* Major depressive disorder
* Persistent depressive disorder
* Premenstrual dysphoric disorder
* OCD
* Panic disorder
* Generalized anxiety disorder
* PTSD
* Bulimia nervosa
* Premature ejaculation

Common SSRIs include fluoxetine, fluvoxamine, paroxetine, sertraline, and citalopram.

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28
Q

How do SSRIs exert their therapeutic effects?

A

SSRIs exert their therapeutic effects by blocking the presynaptic reuptake of serotonin, increasing its availability in the synaptic cleft.

This mechanism classifies SSRIs as serotonin agonists or indirect agonists.

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29
Q

What are some advantages of SSRIs over TCAs?

A

Advantages of SSRIs over TCAs include:
* Fewer side effects
* Safer in overdose
* Safer for older adults

SSRIs are less cardiotoxic and have a better safety profile.

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30
Q

What are common side effects of SSRIs?

A

Common side effects of SSRIs include:
* Mild anticholinergic effects
* Gastrointestinal disturbances
* Insomnia
* Anxiety
* Sexual dysfunction

Abrupt cessation can lead to discontinuation syndrome.

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31
Q

What is serotonin syndrome and what causes it?

A

Serotonin syndrome is a potentially fatal condition caused by:
* Combining an SSRI with an MAOI, lithium, or other serotonergic drugs.

Symptoms include extreme agitation, confusion, autonomic instability, and seizures.

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32
Q

What is tachyphylaxis in the context of SSRIs?

A

Tachyphylaxis, or antidepressant tolerance, occurs when a patient loses a previously effective antidepressant response despite staying on the same drug and dosage.

Common signs include apathy, fatigue, and sleep disturbances.

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33
Q

What are SNRIs and what conditions do they treat?

A

SNRIs include venlafaxine, duloxetine, and desvenlafaxine, treating:
* Major depressive disorder
* Social anxiety disorder
* Neuropathic pain

SNRIs inhibit the reuptake of serotonin and norepinephrine.

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34
Q

What are the side effects of SNRIs?

A

Side effects of SNRIs are similar to those of SSRIs and can include:
* Discontinuation syndrome
* Serotonin syndrome
* Elevated blood pressure

Caution is advised for patients with hypertension.

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35
Q

What are NDRIs and their primary uses?

A

NDRIs, such as bupropion, are used to treat:
* Major depressive disorder
* Smoking cessation

They inhibit the reuptake of norepinephrine and dopamine.

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36
Q

What are the advantages of bupropion?

A

Advantages of bupropion include:
* Few anticholinergic effects
* No sexual dysfunction
* Not cardiotoxic

It’s energizing, suitable for low energy patients.

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37
Q

What are TCAs and how are they categorized?

A

TCAs are tricyclic antidepressants categorized as:
* Tertiary amines (e.g., amitriptyline)
* Secondary amines (e.g., nortriptyline)

They inhibit the reuptake of serotonin and norepinephrine.

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38
Q

What are common side effects of TCAs?

A

Common side effects of TCAs include:
* Cardiovascular effects
* Anticholinergic effects
* Sedation
* Weight gain
* Sexual dysfunction

Secondary amines generally have fewer side effects.

39
Q

What are MAOIs and their primary use?

A

MAOIs, such as phenelzine and tranylcypromine, are used for:
* Treatment-resistant depression
* Atypical depression

They inhibit the enzyme monoamine oxidase, increasing norepinephrine, serotonin, and dopamine levels.

40
Q

What are potential side effects of MAOIs?

A

Potential side effects of MAOIs include:
* Anticholinergic effects
* Orthostatic hypotension
* Sedation
* Sexual dysfunction

They can cause hypertensive crisis with certain foods or medications.

41
Q

What are the categories of psychoactive drugs mentioned?

A

Sedatives, Hypnotics, and Anxiolytics; Narcotic-Analgesics (Opioids); Beta-Blockers

These categories encompass various drugs used for different therapeutic purposes.

42
Q

Name three examples of benzodiazepines.

A

Diazepam (Valium), Alprazolam (Xanax), Lorazepam (Ativan)

Benzodiazepines are primarily used to treat anxiety, insomnia, seizures, and alcohol withdrawal.

43
Q

What is the primary action of benzodiazepines?

A

Increase GABA activity

GABA is an inhibitory neurotransmitter that helps reduce neuronal excitability.

44
Q

List common side effects of benzodiazepines.

A
  • Drowsiness
  • Sedation
  • Weakness
  • Unsteadiness
  • Impaired memory and concentration
  • Anticholinergic effects
  • Sexual dysfunction
  • Disorientation and confusion in older adults

These side effects can vary in severity depending on the individual.

45
Q

What can chronic use of benzodiazepines lead to?

A
  • Tolerance
  • Dependence
  • Withdrawal symptoms

Withdrawal symptoms may include rebound anxiety, depression, anorexia, delirium, and seizures.

46
Q

What is the importance of gradual tapering when discontinuing benzodiazepines?

A

To prevent symptom reemergence and severe withdrawal symptoms

The tapering schedule depends on factors like the benzodiazepine dose and half-life.

47
Q

True or False: Combining benzodiazepines with alcohol can be lethal.

A

True

The combination creates a synergistic depressant effect.

48
Q

Name three examples of barbiturates.

A

Thiopental (Pentothal), Amobarbital (Amytal), Secobarbital (Seconal)

Barbiturates enhance GABA activity and are used in various medical treatments.

49
Q

What are the side effects of barbiturates?

A
  • Drowsiness
  • Dizziness
  • Confusion
  • Ataxia
  • Cognitive impairment
  • Paradoxical excitement

These effects can impact a person’s ability to function normally.

50
Q

What is the function of azapirones, and name one example.

A

Used to treat generalized anxiety disorder; Example: Buspirone (BuSpar)

Azapirones do not cause sedation, dependence, or tolerance.

51
Q

What are narcotic-analgesics, and what do they mimic?

A

They mimic the effects of the body’s natural analgesics (endorphins and enkephalins)

These drugs are used for pain relief and anesthesia.

52
Q

List examples of natural and synthetic narcotic-analgesics.

A
  • Natural: Opium, Morphine, Heroin, Codeine
  • Synthetic: Methadone, Oxycodone, Hydrocodone, Fentanyl

Methadone is also used for heroin detoxification.

53
Q

What are common side effects of narcotic-analgesics?

A
  • Dry mouth
  • Nausea
  • Pupil constriction
  • Postural hypotension
  • Drowsiness
  • Dizziness
  • Constipation
  • Respiratory depression

Overdose can lead to convulsions, coma, and death.

54
Q

What are initial withdrawal symptoms from narcotic-analgesics similar to?

A

The flu

Symptoms include runny nose, watery eyes, nausea, and muscle aches.

55
Q

What is the role of beta-blockers?

A

Inhibit the activity of the sympathetic nervous system

They are used to treat various conditions including hypertension and anxiety.

56
Q

Give an example of a beta-blocker and its side effects.

A

Propranolol (Inderal); Side effects include hypotension, decreased sex drive, insomnia

Propranolol is noted for alleviating somatic symptoms of anxiety.

57
Q

What happens if beta-blockers are abruptly discontinued?

A

Can cause rebound hypertension, tremors, headaches, confusion, and cardiac arrhythmia

Gradual tapering is recommended to avoid these effects.

58
Q

What are mood stabilizers used to treat?

A

Bipolar disorder

Mood stabilizers include lithium and anticonvulsant medications.

59
Q

What is the first-line drug for acute mania and classic bipolar disorder?

A

Lithium (Eskalith, Lithobid)

Lithium is effective for euphoric mania without rapid cycling.

60
Q

List common side effects of lithium.

A
  • Nausea
  • Vomiting
  • Diarrhea
  • Metallic taste
  • Increased thirst
  • Weight gain
  • Hand tremor
  • Fatigue
  • Impaired memory and concentration

Regular monitoring of lithium levels is necessary to avoid toxicity.

61
Q

What can lithium toxicity cause?

A
  • Seizures
  • Coma
  • Death

Lithium levels must be regularly checked.

62
Q

What are the anticonvulsant drugs used for treating bipolar disorder?

A

Carbamazepine (Tegretol) and valproic acid (Depakene)

These are used for acute mania and mixed episodes.

63
Q

List common side effects of anticonvulsant drugs.

A
  • Nausea
  • Dizziness
  • Sleepiness
  • Lethargy
  • Ataxia
  • Tremor
  • Visual disturbances
  • Impaired concentration

Blood levels must be monitored to avoid serious side effects.

64
Q

What drugs are used to treat Alzheimer’s disease?

A

Cholinesterase inhibitors and NMDA receptor antagonist

These drugs slow the progression of Alzheimer’s disease.

65
Q

Name some cholinesterase inhibitors used for Alzheimer’s disease.

A
  • Tacrine (Cognex)
  • Donepezil (Aricept)
  • Rivastigmine (Exelon)
  • Galantamine (Razadyne)

All four are approved for mild and moderate Alzheimer’s disease.

66
Q

Which cholinesterase inhibitor is also approved for severe Alzheimer’s disease?

A

Donepezil (Aricept)

Tacrine is not commonly prescribed due to serious side effects.

67
Q

What is the role of the NMDA receptor antagonist memantine in Alzheimer’s treatment?

A

Regulates the activity of glutamate

Memantine (Namenda) is approved for moderate to severe Alzheimer’s disease.

68
Q

What are the first-line pharmacological treatments for ADHD?

A

Psychostimulants

Include methylphenidate, pemoline, and amphetamine-dextroamphetamine.

69
Q

List some common side effects of psychostimulants used for ADHD.

A
  • Insomnia
  • Nervousness
  • Decreased appetite
  • Weight loss
  • Abdominal pain

These drugs can suppress growth in children but can be reversed with drug holidays.

70
Q

What is a potential issue with using stimulant drugs in college students and adults without ADHD?

A

They may not improve reading comprehension and fluency

Evidence suggests negative effects on working memory and academic performance.

71
Q

Name some second-line medications for ADHD.

A
  • Atomoxetine (Strattera)
  • Guanfacine (Intuniv)
  • Clonidine (Kapvay)

These are prescribed when patients cannot tolerate stimulants or have significant comorbidities.

72
Q

What is atomoxetine’s mechanism of action?

A

Norepinephrine reuptake inhibitor

It is the most commonly prescribed nonstimulant for ADHD.

73
Q

What are the third-line pharmacological treatments for ADHD?

A
  • Tricyclic desipramine (Norpramin)
  • NDRI bupropion (Wellbutrin)

These also increase dopamine and norepinephrine levels.

74
Q

Which drugs are used to treat alcohol use disorder?

A
  • Disulfiram (Antabuse)
  • Naltrexone (ReVia)
  • Acamprosate (Campral)
  • Topiramate (Topamax)

Disulfiram causes unpleasant symptoms when combined with alcohol.

75
Q

What is the action of naltrexone in treating alcohol use disorder?

A

Reduces pleasurable effects and craving for alcohol

Acamprosate primarily reduces craving.

76
Q

What types of medications are used to treat tobacco use disorder?

A
  • Nicotine replacement therapy (NRT)
  • Bupropion
  • Varenicline

NRT helps prevent withdrawal symptoms.

77
Q

What is the FDA-approved treatment for cocaine use disorder?

A

None

Research has not strongly supported any particular drugs for effectiveness.

78
Q

Which drugs have shown some evidence of effectiveness for increasing abstinence in cocaine use disorder?

A
  • Bupropion
  • Topiramate
  • Psychostimulants (e.g., modafinil, dextroamphetamine)

A recent meta-analysis suggested these may be helpful.

79
Q

What is the main active ingredient of cannabis?

A

Tetrahydrocannabinol (THC)

THC stimulates the release of dopamine in the ventral striatum.

80
Q

What psychoactive effects does THC exert?

A

Stimulating the release of dopamine in the ventral striatum

This is part of the brain’s mesolimbic dopaminergic reward pathway.

81
Q

What is Dronabinol oral solution (Syndros) approved for?

A

Treatment of anorexia and weight loss for patients with AIDS and chemotherapy-induced nausea and vomiting

Approved by the U.S. FDA.

82
Q

Which two psychedelic drugs have received breakthrough therapy designations from the FDA?

A
  • A form of LSD for generalized anxiety disorder
  • Psilocybin for major depressive disorder and treatment-resistant depression
83
Q

What is the role of serotonin in the action of psychedelic drugs?

A

Psychedelic drugs are serotonin agonists, increasing the effects of serotonin

LSD also increases the effects of dopamine, while psilocybin alters glutamate levels.

84
Q

What is the definition of drug half-life?

A

The time needed for the blood level of the drug to decrease to 50% of its peak level.

85
Q

How does drug half-life affect dosing intervals?

A

Short half-life drugs require shorter dosing intervals, and longer half-life drugs require longer intervals.

86
Q

What should be considered when prescribing drugs to older adults?

A

Start low and go slow

This means starting at a low dose and gradually increasing it.

87
Q

What is drug tolerance?

A

A gradual reduction in a drug’s effects requiring higher doses to achieve the same effect.

88
Q

What is cross-tolerance?

A

Tolerance to one drug resulting in tolerance to other drugs in the same class.

89
Q

What does the therapeutic index (TI) measure?

A

A drug’s safety.

90
Q

How is therapeutic index calculated in animal studies?

A

LD50 divided by ED50 (LD50/ED50).

91
Q

What do LD50 and ED50 represent?

A
  • LD50: Lethal dose for 50% of the test sample
  • ED50: Effective dose for 50% of the test sample.
92
Q

What is the significance of a narrow therapeutic window?

A

TI equals 1.0 or less, indicating the drug is not very safe and requires close monitoring.

93
Q

What characterizes a drug with a wide therapeutic window?

A

ED50 is lower than LD50 or TD50, making it safer.

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