psychotropic drugs

Question 1

sometimes referred to as the biological approach is a theoretical approach to understanding mental health disorders as biological malfunctions of the nervous system

Answer 1

biopsychiatry

Question 2

what are the disturbances of mental function?

Answer 2

environment
genes
altered neurons

norepinephrine
serotonin
dopamine
glutamate
y-aminobutyric acid (GABA)

Question 3

exerts an inhibitory effect on neurons in many parts of the brain. drugs that enhance this effect exert a sedative-hypnotic action on brain function or reduce anxiety

Answer 3

GABA

Question 4

can be used to decrease the tachycardia and agitation associated with anxiety

Answer 4

Beta-blockers

Question 5

most commonly used because of quick onset of action
bind to specific receptors adjacent to GABA receptors (accounts for its use as an anticonvulsant and its efficacy in reducing neuronal overexcitement in alcohol withdrawal)

Answer 5

Benzodiazepines

Question 6

what are the side effects of benzodiasepines?

Answer 6

interfere with motor ability, attention, and judgement

Question 7

what are examples of antianxiety and hypnotic drugs?

Answer 7

 Diazepam (Valium)
 Clonazepam (Rivotril)
 Alprazolam (Xanax)
 Lorazepam (Ativan)
 Flurazepam (Dalmane)
 Temazepam (Restoril)
 Triazolam (Halcion)
 Nitrazepam (Mogadon)
 Oxazepam (Serax)

Question 8

 A newer class of hypnotic, termed a Z drug.
 Promotes GABA and inhibits the release of neurotransmitters
 As a result, it has sedative effects as well as hypnotic, anxiolytic,
anticonvulsant, and muscle-relaxant effects
 Onset of action is faster than that of most benzodiazepines
 It is important to inform patients taking non-benzodiazepine hypnotic
drugs about the quick onset and advise them to take the drug only
when they are ready to go to sleep

Answer 8

short-acting sedative-hypnotic sleep agents (Z-hypnotics)

Question 9

what is an example of short-acting sedative-hypnotic sleep agents?

Answer 9

zopiclone (imovane)

Question 10

what is an example of a melatonin receptor agonist?

Answer 10

Buspirone hydrochloride (bustab)

Question 11

evidence points to the cause of depression as a transmission deficiency or norepinephrine or serotonin or both within the limbic system

Answer 11

antidepressant drugs

Question 12

block muscarinic receptors, giving
anticholinergic effects. Some TCAs block H1
receptors in the brain, producing drowsiness.
 Improvement in mood may take one to three
weeks or longer

Answer 12

Tricyclic antidepressants (TCAs)

Question 13

what are triclyclic antidepressants used to treat?

Answer 13

symptoms of depression
(insomnia,  appetite, excessive fatigue, 
libido, difficulty thinking/concentrating,
feelings of worthlessness)

Question 14

what are the side effects of tricyclic antidepressants (TCAs)?

Answer 14

 Dry mouth, blurred vision, tachycardia, urinary
retention & constipation, orthostatic hypotension
 Potentially lethal if taken in overdose
 MAOI’s contraindicated
 Most serious effects are cardiovascular

Question 15

what should the client know about tricyclic antidepressants?

Answer 15

 Take drugs as prescribed (do not alter dosage)
 Therapeutic effects may not occur for 2-3 wks
after initial therapy
 Avoid alcohol; be careful driving, and working
around machinery

Question 16

what are examples of tricyclic antidepressants?

Answer 16

 Nortriptyline hydrochloride (Aventyl, Norventyl)
 Amitriptyline hydrochloride (Elavil, Levate)
 Imipramine hydrochloride (Impril)
 Doxepin (Sinequan

Question 17

• First line therapy for most types of depression
• Block the reuptake of serotonin which increases
  the availability of serotonin at the synaptic gap
• Low adverse-effect profile
• MAOI’s should be discontinued for 14 days before
  starting SSRI’s
• Avoid alcohol and OTC Meds

Answer 17

selective serotonin reuptake inhibitors

Question 18

what are examples of selective serotonin reuptake inhibitors (SSRIs)?

Answer 18

 Fluoxetine hydrochloride (Prozac)
 Paroxetine hydrochloride (Paxil)
 Citalopram hydrobromide (Celexa)
 Escitalopram oxalate (Cipralex)
 Fluvoxamine maleate (Luvox)
 Sertraline hydrochloride (Zoloft)

Question 19

what are the side effects of SNRIs?

Answer 19

hypertension, dry mouth, sexual dysfunction

Question 20

 Increase both serotonin and norepinephrine
 Flexibility of working as an SSRI at lower doses (75
mg/day), affecting the reuptake of serotonin, and as
an SNRI at higher doses (150–225 mg/day)

Answer 20

serotonin-norepinephrine reuptake inhibitors (SNRIs)

Question 21

what are examples of SNRIs?

Answer 21

 Venlafaxine hydrochloride (Effexor XR)
 Venlafaxine succinate (Pristiq)
 Duloxetine hydrochloride (Cymbalta)

Question 22

 Class is represented by only one drug
 Acts by increasing norepinephrine, dopamine, and serotonin
transmission by acting as an antagonist at central
presynaptic α2-adrenergic receptors
 The normal function of these receptors is to inhibit
neurotransmitter release when norepinephrine binds to
them.
 any drug that prevents noradrenaline from binding to these
receptors will potentiate neurotransmitter release – reason
why this drug is called a disinhibitor

Answer 22

serotonin and norepinephrine disinhibitors (SNDIs)

Question 23

 Inhibits the enzyme MAO(located in neurons in liver),
interfering with the destruction of monoamine
neurotransmitters and increasing the synaptic level of the
transmitters norepinephrine, serotonin, dopamine, and
tyramine
 In the presence of MAO inhibitors (MAOIs), tyramine is not
destroyed in the liver, resulting in hypertensive crisis
 When MAOIs are taken, the patient must observe a tyramine-
free diet (See Table 13.5, pg 239: Foods that contain tyramine

Answer 23

monoamine oxidase inhibitors (MAOIs)

Question 24

what should the client know about MAOIs?

Answer 24

 Instruct clients not to eat foods containing tyramine &
tryptophan, caffeine-containing beverages, and beer &
wine
 Take drugs as prescribed; avoid altering dosage or
discontinuing the drug
 Avoid over activity b/c agents suppress angina pain
 Have vision checked periodically – optic toxicity
 Carry medic alert card

Question 25

what are examples of MAOIs?

Answer 25

 Phenelzine sulfate (Nardil)
 Tranylcypromine sulfate (Parnate)
 Selegiline hydrochloride (Anipryl)

Question 26

what are other antidepressant drugs?

Answer 26

 Bupropion hydrochloride (Wellbutrin, Zyban)
 Trazodone hydrochloride (Oleptro, Trazodone,
Trazorel)

Question 27

 Used to treat Bipolar Disorder (mania)
 Lithium carbonate inhibits 80% of acute manic and hypomanic
episodes within 10-21 days
 Anticonvulsants are also used
 Mechanism of action of lithium is unknown but is probably
related to affecting electrical conductivity in neurons
 May interact with sodium and potassium at the cell
membrane to stabilize electrical activity. Such a mechanism of
action would explain its ability to induce cardiac
dysrhythmias, convulsions, and tremor
 Lithium can also create fluid balance disturbances. For these
reasons, it has a low therapeutic index (ratio of lethal dose to
effective dose) and requires close monitoring of serum lithium
level (initially 3 times/week)

Answer 27

mood stabilizers

Question 28

what is an example of a mood stabilizer?

Answer 28

lithium carbonate

Question 29

 Alter electrical conductivity in membranes and reduce
the firing rate of very-high-frequency neurons in the
brain
 Used in reducing mood swings in bipolar patients

Answer 29

anticonvulsant drugs

Question 30

what are examples of anticonvulsant drugs?

Answer 30

 Valproate (available as sodium divalproex and valproic
acid [Depakene])
 Carbamazepine (Tegretol)
 Lamotrigine (Lamictal)
 Gabapentin (Neurontin)
 Topiramate (Topamax)
 Oxcarbazepine (Trileptal)

Question 31

what is the therapeutic level of lithium?

Answer 31

<0.4-1.2 mEq/L

Question 32

what is the toxicity level of lithum?

Answer 32

> 1.5-2.0 mEq/L

Question 33

what are the side effects of lithium toxicity?

Answer 33

Severe vomiting, slurred speech, muscle
weakness, lack of coordination, convulsions,
renal failure, and death may occur as a result of
lithium toxicity

Question 34

 First generation antipsychotic
 Strong antagonists (blocking agents)
 Bind to D2 receptors
 Block attachment of dopamine
 Reduce dopaminergic transmission
 Blocking dopamine reduces the positive
symptoms of schizophrenia, such as delusions and
hallucinations
 Produce neurologic adverse side effects
(Extrapyramidal side effects- EPS)
 Available in a depot (long-acting injectiable)

Answer 34

conventional (typical) antipsychotic drugs

Question 36

Antagonists (a substance that interferes with
or inhibits the action of another)of receptors
for
 Acetylcholine
 Norepinephrine
 Histamine

Answer 36

first-gen antipsychotic (conventional) drugs

Question 37

what are examples of first-gen antipsychotic drugs?

Answer 37

haloperidol (haldol)
thoridazine (mellaril)

Question 38

what are the motor disturbance adverse effects of first gen antipsychotic drugs?

Answer 38

parkinsonism,
akinesia, akathisia, dyskinesia, and tardive
dyskinesia

Question 39

what are the anticholinergic effects of first gen antipsychotic drugs?

Answer 39

blurred vision, dry mouth,
constipation, and urinary hesitancy

Question 40

what are the major adverse effects of first-gen antipsychotic drugs?

Answer 40

Vasodilation, orthostatic hypotension, &
ejaculatory failure, sedation and substantial
weight gain

Question 41

 Produce fewer extrapyramidal side effects
(EPS)
 Target both the negative and positive
symptoms
 Often chosen as first-line treatment

Answer 41

second-gen (atypical) antipsychotic drugs

Question 42

what are examples of dopamine and serotonin blockers?

Answer 42

clozapine
risperidone
olanzapine
ziprasidone hydrochloride monohydrate
paliperidone
paliperidone palmitate

Question 43

Induce agranulocytosis (decreased white blood cell
(WBC); pts at risk for infections)

Answer 43

clozapine

Question 44

 Reduces delusions and hallucinations
 Can cause orthostatic hypotension and sedation and
weight gain
 EPS are few

Answer 44

risperidone

Question 45

 Adverse effects include sedation, weight gain,
hyperglycemia with new-onset type 2 diabetes, and
higher risk for metabolic syndrome

Answer 45

olanzapine

Question 46

dopamine stabilizer

Answer 46

aripiprazole

Question 47

what are drugs for attention deficit hyperactivity disorder (ADHD)?

Answer 47

 Methylphenidate hydrochloride (Biphentin,
Concerta, Ritalin)
 Dextroamphetamines, such as amphetamine
aspartate monohydrate (Adderall XR)

Question 48

what are drugs for Alzheimer’s disease?

Answer 48

 Donepezil hydrochloride (Aricept)
 Galantamine hydrobromide (Reminyl)
 Rivastigmine hydrogen tartrate (Exelon)
 Memantine hydrochloride (Ebixa), a
noncompetitive N-methyl-D-aspartate (NMDA)
receptor antagonist
Other Drugs
(Cont.)

Question 49

what are the potential long-term effects of natural products?

Answer 49

 Nerve damage
 Kidney damage
 Liver damage

Question 50

what are examples of natural products?

Answer 50

St. Johns wort
ginkgo biloba

Question 51

 Improves mood
 Taken with SSRI’s can result in serotonin syndrome
(life-threatening)

Answer 51

St. Johns wort

Question 52

 Used for prevention and treatment of cognitive
decline, depression and memory loss associated with
ECT

Answer 52

ginkgo biloba