Psychopharmacology

Question 1

effects of psychoactive drugs

Answer 1

agonists –> produces effect similar to neurotrans
—direct agonist: mimics the effect of neurotrans
–indirect agonist: attach to receptor site to facilitate action of the neurotrans
inverse agonists –> produces opposite effect of neurotrans
partial agonists –> produces similar but lesser effect
antagonists –> reduce or block effects of neurotrans
–direct antagonist: attach to receptor site to block
–indirect antagonist: attach to site and interfere with action of neurotrans

Question 2

Traditional/conventional vs atypical/novel antipsychotics

Answer 2

traditional = effective for + Sx, less effective for -
used for: schizophrenia, acute mania, delusions/hallucinations from MDD, organic psychoses
atypical= effective for both + and - Sx
used for: schizophrenia, Clozapine used for bipolar not responding to mood stabilizer, depression and suicidality, addiction, hostility, motor Sx of Huntington’s and Parkinson’s

Question 3

side effects of traditional antipsychotics

Answer 3

1) extrapyramidal effects: due to effects on dopamine receptors in caudate nucleus
e.g., tardive dyskinesia (late-occuring, more in females and older patients)
TD can be relieved by discontinuing drug, adding a benzo or other GABA agonist.
Haloperidol = most severe side effects
2) anticholinergic effects: “dry” Sx, tachycardia
3) neuroleptic malignant syndrome (NMS): rapid onset of motor, mental and autonomic Sx

Question 4

conventional/typical antipsychotics

Answer 4

holperidol (Haldol)
thiothixene (Narvane)
fluphenazine (Prolixin)
chlorpromazine (Thorazine)

Question 5

atypical antipsychotics

Answer 5

clozapine (Clozaril)
resperidone (Risperdal)
olanzapine (Zyprexa)
quetiapine (Seroquel)

Question 6

traditional antipsychotics exert effects by ______

Answer 6

blocking dopamine receptors (at D2 receptors)

Question 7

atypical/novel antipsychotics exert effects by _____

Answer 7

blocking D4 dopamine receptors AND receptors for serotonin and glutamate

Question 8

side effects of atypical antipsychotics

Answer 8

anticholinergic effects
lowered seizure threshold
sedation
less common extrapyramidal side effects (except for akathisia)
agranulocytosis
neuroleptic malignant syndrome (NMS)

Question 9

Tricyclic antidepressants

Answer 9

amitriptyline (Elavil, Endep)
nortriptyline (Pamelor)
doxepin (Sinequan, Adapin)
imipramine (Trofanil)
clomipramine (Anafranil)

Question 10

TCAs most effective for ______

Answer 10

depression with vegetative, somatic Sx
Panic Disorder
Agoraphobia
Bulimia
OCD (esp chlomipramine)
enuresis (imipramine)
neuropathic pain (amitriptyline, nortriptyline)

Question 11

mode of action of TCAs

Answer 11

block reuptake of norepi, serotonin, and/or dopamine

Question 12

catecholamine hypothesis

Answer 12

depression caused by deficiency of norepinephrine

Question 13

side effects of TCAs

Answer 13

***CARDIOTOXIC***
anticholinergic effects
confusion
drowsiness
fatigue
weight gain
fine tremor
paresthesia
blood dyscrasia

Question 14

SSRIs

Answer 14

fluoxetine (Prozac)
fluvoxamine (Faverin, Luvox)
paroxetine (Paxil)
setraline (Zoloft)

Question 15

SSRIs most effective for _____

Answer 15

melancholic depressions
OCD
Bulimia
Panic Disorder
PTSD

Question 16

Side effects of SSRIs

Answer 16

GI disturbance
insomnia
anxiety
headache
sissiness
anorexia
tremor 
frequent urination
sexual dysfunction

Question 17

advantages of SSRIs over TCIs

Answer 17

less cardiotoxic
safer in overdose
cognitive impairment less likely

Question 18

serotonin syndrome

Answer 18

neurological effects (headache, nystagmus, tremor, dizziness, unsteady gait)
cardiac arrhythmia
coma/death

Question 19

MAOIs

Answer 19

isocarboxazid (Marplan)
phenelzine (Nardil)
tranylcypromine (Parnate)

Question 20

MAOIs best for treating _____

Answer 20

atypical depressions involving anxiety, reversed vegetative Sx, interpersonal sensitivity

Question 21

MAOIs side effects

Answer 21

hypertensive crisis -- when taken with tyramine foods
anticholinergic effects
insomnia
agitation
confusion
skin rash
weight gain
edema
headache
dizziness
tremor
blood dycrasia

Question 22

tyramine-rich foods

Answer 22

aged cheeses and meats, beer, red wine, chicken liver, avocados, bananas, lava beans, soy sauce

Question 23

Sx of hypertensive crisis

Answer 23

severe headache
stiff neck
rapid heart rate
nausea/vomiting
sweating
sensitivity to light

Question 24

NDRIs (norepi dopamine reuptake inhibitor)

Answer 24

buproprion (Wellbutrin)
used for MDD, depressive phase of BP
used under name Zyban for smoking cessation
can aggregate preexisting psychosis and seizures

Question 25

SNRIs (serotonin norepi reuptake inhibitor)

Answer 25

venlafaxine (Effexor) duloxetine (Cymbalta) used of MDD, GAD, social anxiety, OCD some pain syndromes (fibromyalgia, mixed headaches, back pain, peripheral nueropathic pain)

Question 26

Modd stabilizers

Answer 26

lithium | carbamazepine

Question 27

lithium best for ____

Answer 27

"classic" BP with manic episodes with elevated mood and without rapid cycling reduces or eliminates manic symptoms and suppresses mood swings

Question 28

lithium toxicity

Answer 28

``` diarrhea ataxia drowsiness slurred speech confusion coarse tremor can result in seizures, coma and death must regulate serum lithium levels in blood ```

Question 29

if taking lithium, must avoid ____

Answer 29

``` fluctuations in salt intake caffeine alcohol other diuretics contraindicated for: cardiovascular, thyroid, kidney, liver and GI problems ```

Question 30

Carbamazepine (Tegretol)

Answer 30

was anticonvulsant drug also effective for mania "rapid cycling" BP + dysphoric mania also valproic acid (Depakote) and clonazepam (Klonopin)

Question 31

side effects of carbamazepine

Answer 31

``` dizziness ataxia visual disturbances anorexia nausea rash bad for cardio conduction patients slight risk for agranulocytosis and aplastic anemia ```

Question 32

sedative-hypnotics include _____

Answer 32

barbiturates anxiolytics alcohol

Question 33

withdrawal Sx of sedative-hypnotics

Answer 33

``` tremors anxiety nausea/vomiting paranoia extreme cases: hallucinations, delirium, convulsive seizures ```

Question 34

barbiturates exert effect by ____

Answer 34

interrupting impulses to the RAS

Question 35

benzodiazepines

Answer 35

``` diazepam (Valium) alprazolam (Xanax) oxapam (Serax) triazolam (Halcion) chlordiazepoxide (Librium) lorazepam (Ativan) ```

Question 36

benzodiazepines work by ____

Answer 36

stimulating inhibitory action of GABA

Question 37

side effects of benzodiazepines

Answer 37

``` drowsiness dizziness lethargy slurred speech ataxia impaired psychomotor ability ---------- irritability, hostility, paradoxical agitation, increased disorientation, sleep disturbance (reduced REM), ante grade amnesia, depression ```

Question 38

azapirone (buspirone)

Answer 38

first anxiolytic without sedation | need to take for several weeks before effective

Question 39

Beta-Blockers used for ____

Answer 39

``` high blood pressure angina/cardiovascular disorders tremors migraines glaucoma reducing palpitations, tremor and excessive sweating from anxiety ```

Question 40

beta-blockers work by _____

Answer 40

blocking beta-andrenergic receptors (which respond to epinephrine and norepinephrine) Propranolol (Inderal)

Question 41

side effects of propranolol

Answer 41

``` bradycardia shortness of breath arterial insufficiency (like Raynaud's) nausea diarrhea depression dizziness sexual dysfunction trouble sleeping numbness/tingling in fingers/toes ```

Question 42

propranolol is potentially lethal for people with ____

Answer 42

respiratory issues | obstructive pulmonary disease

Question 43

narcotics-analgesics (opiods)

Answer 43

``` natural opiods (opium, morphine, codeine) semi-synthetics of morphine (heroin, Percodan, Dilaudid) pure synthetics (Demerol, Darvon, methadone) ```

Question 44

narcotics-analgesics (opiods) work by ____

Answer 44

opiod receptors in the spinal cord and amygdala, thalamus and hypothalamus

Question 45

enkephalins are ____

Answer 45

beta-endorphins

Question 46

signs of narcotic use are:

Answer 46

``` constricted pupils decreased visual acuity increased perspiration constipation nausea/vomiting respiratory depression ```

Question 47

narcotics overdose:

Answer 47

``` slow/shallow breathing muscle rigidity catalepsy clammy skin decreased blood pressure and pulse rate convulsions coma/death ```

Question 48

narcotics/opiod withdrawal symptoms

Answer 48

``` flu-like Sx stomach cramps nausea/vomiting weakness fever muscle and joint pain sweating insomnia ```

Question 49

psychostimulants

Answer 49

amphetamines (dexamphetamine sulphate) - for narcolepsy and ADHD methylphenidate (Ritalin, Concerta, Metadate) for ADHD

Question 50

psychostimulants work by ___

Answer 50

potentiating the release of norephinephrine and dopamine and block their reuptake

Question 51

side effects of amphetamines

Answer 51

``` restlessness insomnia poor appetite tremor palpitations cardia arrhythmia ```

Question 52

side effects of methyphenidate

Answer 52

``` decreased appetite insomnia dysphoria abdominal pain tachycardia ```

Question 53

anti-alcohol drugs

Answer 53

disulfiram (Antabuse) -- inhibits alcohol metabolism, causing accumulation of acetaldehyde and unpleasant reactions (nausea, vomiting, seating, headache, tachycardia, hypotension) naltrexone (ReVia, Vivitrol) -- opiod receptor antagonist - blocks craving for alcohol

Question 54

side effects of disulfam (Antabuse)

Answer 54

``` drowsiness depression disorientation headache restlessness impotence blood dyscrasia ```

Question 55

side effects of naltrexone

Answer 55

``` abdominal cramping nausea/vomiting insomnia nervousness headache joint and muscle pain ```