Psychopharmacology, exam 2 Flashcards
Psychotropic meds do NOT cure patients with mental health disorders. So, if they don’t “cure” patients, what are they used for?
Psychotropic drugs help to manage the symptoms and manifestations of mental illness, so that a patient can function.
A patient is prescribed Lithium for her bipolar disorder. The patient says, “Thank god, I can finally cure my bipolar!” What is incorrect about this patients thinking? What is the lithium used for?
The psychotropic drug, Lithium, is not a cure for her illness. The lithium is used to help manage her bipolar symptoms so she can function more appropriately.
What is a big reason for non-compliance for patients taking psychotropic meds?
The patient states that they started feeling better, so they stopped taking their medication.
“Yeah, I stopped taking those pills yesterday. I started feelings better a week ago, so I figured I didn’t need them anymore.”
This sentence demonstrates a common statement regarding the patients what?
Non-compliance
What are 3 ways to ensure proper patient compliance?
-Encourage follow-up processes
-Make sure a patient understands the medication side effects
-Ensure proper administration of meds
“Start low and go slow.”
This sentence is in regard to what?
Medication dosage levels for children and the elderly.
What system is reduced in elderly patients that necessitates a lower dosage of medication?
Elderly patients have reduced metabolisms.
Why does “Start low and go slow” apply to children?
Children have underdeveloped metabolisms.
Most psychotropic meds have their effects at what synapse?
Neuronal synapse
Psychotropic meds having their effects at the neuronal synapse produces changes in what 2 things?
Neurotransmitter release and the receptors to which they bind.
Chemicals that convey information across the synaptic cleft, and are essential to human emotion and behavior are known as what?
Neurotransmitters
What do neurotransmitters convey their information across?
The synaptic cleft
Match these neurotransmitters with what they effect: Adrenaline, Noradrenaline, Dopamine, Serotonin
a.) Mood
b.) Concentration
c.) Pleasure
d.) Fight-or-flight
a.) Mood
-Serotonin
b.) Concentration
-Noradrenaline
c.) Pleasure
-Dopamine
d.) Fight-or-flight
-Adrenaline
Match these neurotransmitters with what they effect: Gaba, Acetylcholine, Glutamate, Endorphins
a.) Learning
b.) Calming
c.) Euphoria
d.) Memory
a.) Learning
-Acetylcholine
b.) Calming
-Gaba
c.) Euphoria
-Endorphins
d.) Memory
-Glutamate
What is the most common neurotransmitter? It is involved with learning and memory.
Glutamate is the most common neurotransmitter, and it is involved with learning and memory.
Which neurotransmitter regulates the development and creation of nerve contracts?
Glutamate
Produced in stressful situations. Increases heart rate and blood flow, leading to a physical boost and heightened awareness.
Which Neurotransmitter is this?
1.) Noradrenaline
2.) Serotonin
3.) Acetylcholine
4.) Adrenaline
5.) Glutamate
6.) Gaba
7.) Endorphins
8.) Dopamine
4.) Adrenaline is produced in stressful situations. Increases heart rate and blood flow, leading to a physical boost and heightened awareness.
Calms firing nerves in the central nervous system. High levels improve focus, low levels cause anxiety. Also contributes to motor control and vision.
Which neurotransmitter is this?
1.) Noradrenaline
2.) Serotonin
3.) Acetylcholine
4.) Adrenaline
5.) Glutamate
6.) Gaba
7.) Endorphins
8.) Dopamine
6.) Gaba calms firing nerves in the central nervous system. High levels improve focus, low levels cause anxiety. Also contributes to motor control and vision.
Positively effects attention and responding actions in the brain. Contracts blood vessels, increasing blood flow.
Which neurotransmitter is this?
1.) Noradrenaline
2.) Serotonin
3.) Acetylcholine
4.) Adrenaline
5.) Glutamate
6.) Gaba
7.) Endorphins
8.) Dopamine
1.) Noradrenaline positively affects attention and responding actions in the brain. It contracts blood vessels, increasing blood flow.
Involved in thought, learning, and memory. Activates muscle action in the body. Also associated with attention and awakening.
Which neurotransmitter is this?
1.) Noradrenaline
2.) Serotonin
3.) Acetylcholine
4.) Adrenaline
5.) Glutamate
6.) Gaba
7.) Endorphins
8.) Dopamine
3.) Acetylcholine is associated with thought, learning, and memory. It activates muscle action in the body. Also associated with attention and awakening
Feelings of pleasure, also addiction, movement, and motivation. People repeat behaviors that lead to it.
Which neurotransmitter is this?
1.) Noradrenaline
2.) Serotonin
3.) Acetylcholine
4.) Adrenaline
5.) Glutamate
6.) Gaba
7.) Endorphins
8.) Dopamine
8.) Dopamine releases feelings of pleasure, addiction, movement, and motivation. Repeated behaviors lead to more dopamine release.
Involved in learning and memory, regulates the development and creation of nerve contracts. The most common neurotransmitter.
Which neurotransmitter is this?
1.) Noradrenaline
2.) Serotonin
3.) Acetylcholine
4.) Adrenaline
5.) Glutamate
6.) Gaba
7.) Endorphins
8.) Dopamine
5.) Glutamate is involved in learning and memory, and it regulates the development and creation of nerve contracts. Glutamate is the most common neurotransmitter.
Contributes to well-being and happiness. Helps the sleep cycle and digestive system regulation. It is affected by exercise and light exposure.
Which neurotransmitter is this?
1.) Noradrenaline
2.) Serotonin
3.) Acetylcholine
4.) Adrenaline
5.) Glutamate
6.) Gaba
7.) Endorphins
8.) Dopamine
2.) Serotonin contributes to well-being and happiness. It helps with the sleep cycle and digestive system regulation. It is affected by exercise and light exposure.
Released during exercise, excitement, and sex. It produces feelings of well-being, bliss, and reduces pain.
Which neurotransmitter is this?
1.) Noradrenaline
2.) Serotonin
3.) Acetylcholine
4.) Adrenaline
5.) Glutamate
6.) Gaba
7.) Endorphins
8.) Dopamine
7.) Endorphins are released during exercise, excitement, and sex. They produce feelings of well-being, bliss and reduced pain.
Gaba and Glutamate are a part of what neurotransmitter classification?
Amino Acids
Norepinephrine, dopamine, and serotonin are a part of what neurotransmitter classification?
Monoamines
Endorphins are a part of what neurotransmitter classification?
Neuropeptides
Acetylcholine’s are a part of what neurotransmitter classification?
Cholinergic
Antipsychotics, Mood Stabilizers, Antidepressants, Anxiolytic/Antianxiety,
Sedatives/hypnotics, and Stimulants are all types of meds that affect mood and behavior. Because of this, what classification would these drugs be placed under?
Psychotropic drugs
Lithium is the most common stabilizer of a persons what?
Mood; Lithium is a Mood stabilizer.
What is an example of an anxiolytic/antianxiety drug?
Benzodiazepines
In addition to being used as an anxiolytic/antianxiety medication, Benzodiazepines are used for what?
Symptoms of alcohol withdrawal and perioperative sedations
What is a mental disorder that a stimulant may be used for?
ADHD
sedation, dizziness, confusion, hallucinations, dry mouth and urine retention are ALL possible side effects of what drug type?
a.) Anticholinergics
b.) Extrapyramidals
c.) Psychotropics
d.) Tardive Dyskinesia’s
e.) Antipsychotics
a.) Anticholynergic side effects are sedation, dizziness, confusion, hallucinations, dry mouth and urine retention
“Neuroleptics” is another word for what drug class?
Antipsychotics
“Extrapyramidal symptoms” are drug-induced movement disorders. What drug class is a big cause of Extrapyramidal symptoms?
Antipsychotics
Dystonia, Akathisia, Psuedoparkinsons, and Tardive Dyskinesia are all examples of what?
Extrapyramidal symptoms
Antipsychotics are a big cause of extrapyramidal symptoms. What does “extrapyramidal symptoms” mean?
Drug-induced movement disorders.
Involuntary muscle spasms in the face, legs, arms and neck that mainly effects men, and people under 25, are all markers of what type of extrapyramidal symptom?
a.) Tardive Dyskinesia
b.) Psuedoparkinsons
c.) Dystonia
d.) Akathisia
c.) Dystonia
Dystonia is involuntary muscle spasms in the face, legs, arms, and neck that mainly effect men and people under the age of 25
What extrapyramidal symptom is marked by motor restlessness and fidgeting in women, between 50-60 days after drug therapy starts?
a.) Psuedoparkinsons
b.) Akathisia
c.) Tardive Dyskinesia
d.) Dystonia
b.) Akathisia is marked by motor restlessness and fidgeting in women, 50-60 days after antipsychotic drug therapy starts.
What extrapyramidal symptom is marked by tremors, shuffling gait, drooling, and is found mainly in women, the elderly, and the dehydrated within the 1st week of drug therapy?
a.) Psuedoparkinsons
b.) Tremornergia
c.) Akathisia
d.) Tardive Dyskinesia
a.) Psuedoparkinsons is marked by tremors, a shuffling gait, drooling, and is mainly found in women, the elderly, and dehydrated patients in the 1st week of drug therapy.
What extrapyramidal symptom is marked by irreversible, bizarre tongue and facial movement?
a.) Psuedoparkinsons
b.) Dysphasia
c.) Akathisia
d.) Tardive Dyskinesia
d.) Tardive Dyskinesia is marked by irreversible tongue and face movements.
True or False:
Tardive Dyskinesia is an acute, sudden response to antipsychotic drug therapy that is irreversible.
False:
Tardive Dyskinesia is not sudden, and its warning signs are early, so the disease can be halted if the drug therapy is stopped BEFORE it becomes Tardive Dyskinesia.
What scale is used to assess for early warning signs of Tardive Dyskinesia?
The AIMS scale
Place the AIMS scale numbers in order of severity:
0, 1, 2, 3, 4
-None
-Minimal (Normal)
-Mild
-Moderate
-Severe
It goes in order:
0-None
1-Minimal (Normal)
2-Mild
3-Moderate
4-Severe
Which generation of meds is considered typical, and which is atypical?
-1st generation
-2nd generation
1st generation is typical.
2nd generation is atypical.
Tardive Dyskinesia is more common in typical antipsychotic drugs. Which generation is that?
1st generation
What two FDA-approved medications are used to treat tardive dyskinesia?
a.) Melatonin and Botox
d.) B6 and Valenzona
c.) Austido and Ingrezza
d.) Benadryl and Choco lax
c.) Austido and Ingrezza are approved to treat tardive dyskinesia.
Fun fact, Botox is used to treat it as well.
B6 and other vitamins have no evidence that they treat tardive dyskinesia, but some people think that they help.
Cogentin, Benadryl, Symmetrel, and Artane are used to treat what type of symptoms?
Extrapyramidal symptoms
What are the names of 4 drugs that some extrapyramidal symptoms are treated with?
-Cogentin
-Benadryl
-Symmetrel
-Artane
A rare, but fatal complication that is more common in 1st generation antipsychotic drugs, and requires ICU monitoring, is called what?
Neuroleptic Malignant syndrome.
What are the markers of Neuroleptic Malignant syndrome?
-Super high fever (107F)
-Muscle rigidity
-Tachycardia
-Tachypnea
What drugs are used to counteract Neuroleptic malignant syndrome?
Dantrolene Sodium drugs
Dantrolene Sodium drugs are used to counteract what syndrome?
Neuroleptic Malignant syndrome
A patient is suddenly experiencing Myoclonus, (involuntary muscle contractions), along with mild shivering and diarrhea. It is found that he has been taking SSRIs for 3 days. What is the patient experiencing?
Serotonin syndrome.
How does an SSRI cause Serotonin Syndrome?
It causes too much free serotonin to float around.
A patient taking an SSRI is experiencing high fever, seizures, and rigid muscles. What is the patient experiencing? How is it treated?
Severe Serotonin syndrome.
Treatment for Serotonin syndrome is to stop taking the medication (SSRI) and wait up to 72 hours for symptoms to wane.
The blockage of dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery, are the expected actions of what drug class?
Typical Antipsychotics.
What are some diseases that would be treated with Typical Antipsychotics?
-Schizophrenia
-Manic Bipolar disorder
-Dementia
-Tourette’s
-Acute and Chronic Psychosis
Thorazine and Mellaril are Typical Antipsychotic drugs with what level of potency?
Low potency
Haldol and Prolixin are Typical Antipsychotic drugs with what level of potency?
High potency
If you wanted to give a patient with schizophrenia a high potency typical antipsychotic, what would be a drug that you use?
Haldol or Prolixin
What is the Antipsychotic drug that is mainly used to treat Schizophrenia?
Haldol
What are 2 low potency typical antipsychotic drugs that you might give to a patient with dementia?
Thorazine and Mellaril
Orthostatic hypertension is a risk when taking Typical Antipsychotic drugs. What are 3 ways to lower the risk of Orthostatic Hypertension?
-Monitor vital signs
-Give SLOW positional changes
-Teach a patient about the effects of their Antipsychotic medication
1st generation typical Antipsychotics typically have what suffix in their name that allows for easier recognition?
-Zine
If an Antipsychotic drug has the suffix
“-Zine” in the name, it is most likely a what?
1st generation Typical Antipsychotic
“Neuroendocrine” effects of Antipsychotic drugs can be gynecomastia, and galactorrhea. What is the difference between gynecomastia and galactorrhea?
Gynecomastia is the development of excess breast tissue in men.
Ak: Man-Boobs.
“Guy”-neco is man-titties.
Galactorrhea is lactating when you shouldn’t be.
“Lact”-orrhea is lactation.
Gynecomastia and galactorrhea are classified as “neuroendocrine” effects because their effects have to do with what?
Hormones (endocrine system)
An Agranulocyte is a white blood cell (WBC), and the suffix “-Osis” means: Cellular lysis (death).
So, what is Agranulocytosis?
WBC death
What does Agranulocytosis mean for the body?
An increased risk of infection and decreased immunity due to WBC death.
The atypical antipsychotic with which agranulocytosis can occur, is named what?
Clozapine
Clozapine is an Atypical antipsychotic drug that can lead to decreased immune function. How does it do this?
By causing Agranulocytosis.
Skin effects such as photosensitivity and contact dermatitis can result from what class of drug?
Typical antipsychotic drugs
A patient is given a Typical Antipsychotic drug to treat Manic Bipolar disorder. The patient asks, “How long will it take before they start to work?” What is the appropriate response?
a.) I am not sure; An individual’s immune function makes it so that the time it takes varies.
b.) Most likely you should feel the effects within 24-72 hours.
c.) Most likely it will take between 2-4 weeks. But it may take months.
d.) The therapeutic effects will work when they work, so long as you maintain usage.
c.) Most Typical Antipsychotics take anywhere from 2-4 weeks to start affecting the patient but can also take months.
That is why it is important to stress that patients keep up with their meds and do not quit early.
Which of these patient diagnoses would the giving of a Typical Antipsychotic be contraindicated?
-Severe depression
-Parkinson’s disease
-Prolactin-Dependent Breast cancer
-Severe hypotension
All of them
Typical Antipsychotic drugs have negative interactions when used concurrently with what other 3 things?
-Anticholynergic effect drugs
-CNS depressants
-Levodopa
An advantage of atypical antipsychotics is that they relieve both positive AND negative symptoms.
What is the difference between a positive symptom and a negative symptom?
A positive symptom is a symptom that SHOULD be present with a disease.
(Ex: Schizophrenia positive symptoms are hallucinations, and delusions.)
A negative symptom is when you are lacking a normal bodily behavior or function because of the disease.
(Ex: Schizophrenia negative symptom is low energy)
One of the most common Atypical Antipsychotics is risperidone. What is the brand name of Risperidone?
Risperdal
Risperdal can be given through with administration route? How long does it last?
Risperdal can be given as an IM injection that lasts 2 weeks
Another common Atypical Antipsychotic is aripiprazole. What is the brand name for aripiprazole?
Abilify
Abilify and Risperdal are two examples of what type of drug class?
Atypical Antipsychotic
The atypical antipsychotic ziprasidone is NOT used in patients with heart problems because it increases their QT intervals. What is the brand name for ziprasidone?
Geodon
Geodon, the atypical antipsychotic, is not used for patient with heart problems. Why?
It increases their QT intervals.
If you wanted to treat both positive and negative symptoms, which of the 2 antipsychotic drug classes would you use? Typical, or Atypical?
Atypical treats positive and negative symptoms
If a patient is being monitored for agranulocytosis after taking the atypical antipsychotic drug, Clozaril/Clozapine, how often would they have to come in to have their lab values checked?
What if they were moved to outpatient?
Every week
Every week for 6 months.
What drug is the gold standard in treatment for mood-stabilizers?
Lithium
What are the lab values for Lithium?
0.6-1.2
What is the teratogenic class of Lithium?
D, or X depending on who you ask…
But officially D
Why is Lithium a class D drug?
Because it takes 1 to 3 weeks for Lithium to have therapeutic effects, which is 1 to 3 weeks of the drug affecting the baby.
What is the most common drug used to treat bipolar disorder and acute mania?
Lithium
True or False:
Lithium can be used to treat Bulimia, Schizophrenia, and Alcoholism.
True:
Lithium can be used to treat Bulimia, Schizophrenia, and Alcoholism.
What is the therapeutic name for mood-stabilizers?
Anticonvulsants
Depakote is an Anticonvulsant, and it is used alongside what other mood-stabilizer to treat acute manic attacks?
Depakote is used with Lithium to treat acute manic attacks.
Depakote is used to DECREASE manic attacks, and then Lithium is used for long-term care.
If you see Stevens-Johnstons syndrome, this is a side effect from what type of drug class?
Anticonvulsants
Nystagmus is also an adverse CNS effect from Anticonvulsants. What is Nystagmus?
Nystagmus is when you can’t control your eye movements.
Leukopenia, anemia, and thrombocytopenia are all examples of Dyscrasia. Dyscrasia is an adverse side effect of Anticonvulsants. What is Dyscrasia?
Abnormal blood levels, usually low.
-Leukopenia is low WBC
-Anemia is low RBC
-Thrombocytopenia is low platelets
“Your blood is a Dyscrasia!!!!”
Monoamine Oxidase Inhibitors are rarely used antidepressants because of all the different interactions they have. What are these antidepressant “Monoamine Oxidase Inhibitors” casually called?
MAOIs
What type of antidepressants require strict diet adjustments to use?
MAOIs
Nardil, Marplan, parnate, and emsam patches are all examples of what type of antidepressant?
MAOIs.
You know they are MAOIs because of their goofy fuckin names that you’ve never heard of, because they are rarely used.
Serotonin, Dopamine, Adrenaline, and Noradrenaline are all Monoamine neurotransmitters. Because of this, what type of Antidepressant class would inhibit them?
MAOIs
High-Tyramine foods, like aged cheese, and meats like salami and pepperoni, as well as drinks like red wine and beer, all have adverse reactions when used with what class of Antidepressant?
MAOIs
They are the “no-fun-food” drugs.
MAOIs: Nardil, Parnate, and Marplan adverse medication interactions can be remembered with the pneumonic: NPM. What does NPM mean?
-No
-Popular
-Meds
Aw shit, this guy has tremors, he is sweating, and dizzy! Aw shit, this fucker’s eating a god-damn block of cheddar cheese! He’s got a pounding heartbeat and his blood pressure it up! Oh fuck!! He’s got a fuckin’ jar of pickles too, oh Christ! Is that a bottle of fuckin’ red wine?!? You fool!!!!
What is this patient experiencing? Why?
Adverse reactions of MAOIs from interactions with High-tyramine foods like aged cheese, and red-wine
True or False:
Cream cheese and cottage cheese are ok for patients using MAOIs.
True:
Cream cheese and cottage cheese tyramine amounts are low.
True or False:
Yogurt, sour cream, gouda, and mozzarella cheese are ok to take when on MAOIs
True:
In moderation. These are higher levels on tyramine than cottage cheese and cream cheese, but still safe if spaced out.
True or False:
Raisins, Swiss cheese, Parmesan, and sourcrout are ok to take when on MAOIs.
False:
Aged cheeses like Swiss and Parmesan, as well as Raisins and sourcrout are bad because they are high in tyramine.
Also, sourcrout is German, and the Germans started both WW1 and WW2. So, it’s bad just because of that.
The Tricyclic class of Antidepressants inhibit 3 things. Hence the “-Tri” prefix in Tricyclics. What are the 3 things that Tricyclics inhibit?
-Serotonin
-Norepinephrine
-Alpha Receptors
“Got depression? Got Bipolar? Then hop on an “x” and ride away!”
What is the “x” in this sentence?
Tricyclic
What would a Tricyclic typically be used for? (Hop on a tricyclic and ride away!)
Depression or Bipolar
Serotonin, Norepinephrine, and Alpha receptors are inhibited by what class of Antidepressants?
Tricyclic
True or False:
Diabetic, Seizure, and Coronary issue patients are safe to use Tricyclics because of its Anticholynergic effects.
False:
Diabetic, Seizure, and Coronary issue patients should NOT take tricyclics.
Here’s an example of an atypical antidepressant:
“Depression hurts, “x” can help.”
What Atypical Antidepression drug belongs where the “x” is?
Cymbalta
John is on the atypical antidepressant drugs: Wellbutrin, to treat depression, and Zyban, to stop smoking. He is scheduled to take them ever 4-6 hours. John realizes that he missed his 2nd dose of the day, and it is time for his 3rd dose. John decides to take his 2nd dose of the day with his 3rd dose of the day.
Is it ok to double up on an antidepressant drug dose?
What will happen if John dose this?
No, never double up on any drug dose. educate patient of proper dosage procedures in the future. Skip the 2nd dose and just get on track tomorrow.
If John doubles up, he will risk a seizure.
How does Zyban help stop smoking?
It inhibits dopamine uptake.
What is the therapeutic drug classification for Benzodiazepines?
Antianxiety
The biggest side effects overall for Benzodiazepines is what?
Sedation
CNS depressions such as sedation, lightheadedness, and ataxia are common in what kind of antianxiety drug type?
Benzodiazepines
Benzodiazepines are typically used for what type of short-term abuse?
Short term alcohol abuse.
Why is Benzodiazepine really only treated for short-term alcohol abuse, rather than long term?
Because Benzo has high addiction levels.
Diazepam and Alprazolam are the generic names for what two Benzodiazepines?
-Diazepam is Valium
-Alprazolam is Xanax
Valium and Xanex are the most common brands of what type of drug?
Benzodiazepines
What’s a good way to remember schedule 4 drug types, like Benzodiazepines?
“4 a.m.”
4, meaning drug schedule IV
a.m. meaning that benzodiazepine generic names often end with “-am.”
Atypical Antianxiety drugs like BuSpar (Buspirone) can have their effects increased when used with what food?
Grapefruit juice
Buspirone, aka, BuSpar, is a big player in the atypical Antianxiety drugs. It is more fast acting than other drugs. How long does it usually take for BuSpar to take effect?
1-2 weeks
BuSpar is an atypical antianxiety drug used in OCD and PSTD patients, but it is used sparingly, because it can cause too much what?
CNS depression
Because BuSpar, aka. Buspirone, can cause too much CNS depression in anxiety disorder patients, it is known as having a paradoxical drug effect. What does this mean?
That it can paradoxically create MORE anxiety, instead of relieving it.
What kind of drug classification is Adderall under?
Stimulants
Stimulants like Adderall raise the levels of 3 monoamine into the CNS. What are these 3?
-Serotonin
-Norepinephrine
-Dopamine
Why would you give stimulants in the morning, but not the evening?
You will interfere with sleep if you give stimulants at night.
Development of psychotic symptoms, chest pain, dysrhythmias, weight loss and CNS stimulation are all adverse effects of what drug type?
Stimulants
Symptoms of lithium toxicity are likely to appear when the patient’s serum level is at or above …
A. 0.5 mEq/L
B. 5.0 mEq/L
C. 1.5 mEq/L
D. 1500 mEq/L
C.) 1.5
Lithium levels are 0.6-1.2
Benzodiazepines, used for anxiety, produce a calming effect by which of the following actions?
A. Depressing the CNS
B. Decreasing levels of norepinephrine and serotonin in the brain
C. Decreasing levels of dopamine in the brain
D. Inhibiting production of the enzyme MAO
A.) Depressing the CNS
