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WALDEN 6630 PSYCHOPHARMACOLOGY
MIDTERM STUDY GUIDE QUESTIONS WITH
100% ACCURATE ANSWERS (LATEST) A+
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Serotonin regulates - Accurate answers Mood, emotion, feeding, and reproductive behavior This class of antidepressants binds to presynaptic SERT and inhibits them from reuptake of serotonin to increase levels in the synaptic cleft to bind with postsysnaptic 5HT2 receptors - Accurate answers SSRIs First line therapy for MDD due to milder side effect profiles - Accurate answers SSRIs Six Common SSRIs - Accurate answers citalopram, escitalopram, fluoxetine, fluvoxamine, sertraline, paroxetine Onset of therapeutic benefit from SSRIs - Accurate answers 4-6 weeks In addition to MDD, SSRIs also treat - Accurate answers Chronic Anxiety, PTSD, OCD, and eating disorders (bulimia) Five Common side effects of SSRIs include - Accurate answers Anxiety, insomnia, GI distress, sexual dysfunction (ED), SIADH Severe side effect of SSRIs in children/adolescents under age 25 years old - Accurate answers suicidal ideation Life threatening adverse effect of SSRIs, especially when used in combination with other serotonergic drugs (SNRIs, TCAs, MAOIs, etc.) - Accurate answers Serotonin Syndrome Excess accumulation of serotonin resulting in overstimulation of the nervous system - Accurate answers Serotonin Syndrome Seven symptoms of Serotonin Syndrome - Accurate answers Flushing, hyperthermia, agitation, muscle rigidity, seizure, coma, HYPERreflexia The treatment for serotonin syndrome - Accurate answers Cyproheptadine (5-HT2 receptor antagonist) Cyproheptadine treats serotonin syndrome by - Accurate answers blocking 5-HT2 receptors (serotonin antagonist)
When SSRIs or SNRIs are stopped abruptly, common symptoms of withdrawal include - Accurate answers Irritability, headaches, and insomnia Medicine specific side effect of citalopram - Accurate answers Prolonged QT interval (normal=0.4.- 0.44 seconds) This SSRI is pregnancy category D due to associations with congenital heart defects - Accurate answers Paroxetine All SSRIs but paroxetine (D) are pregnancy category - Accurate answers C Three SSRIs that are inhibitors of Cytochrome P450 enzymes - Accurate answers fluoxetine, fluvoxamine, and paroxetine Five common SNRIs include - Accurate answers duloxetine, venlafaxine, desvenlafaxine, milnacipran, levomilnacipran This antidepressant class of medications works by binding to presynaptic SERT and NET to inhibit them from reuptake of serotonin and norepinephrine to increase their levels in the synaptic cleft - Accurate answers SNRIs In addition to MDD SNRIs treat - Accurate answers Anxiety and neuropathic pain (peripheral neuropathy) Medication specific indications of duloxetine: - Accurate answers urinary incontinence and Fibromyalgia Medication specific indications of venlafaxine: - Accurate answers social anxiety, panic disorders, PTSD, OCD, postmenopausal hot flashes Six common side effects of SNRIs include: - Accurate answers Insomnia, nausea, sexual dysfunction, hypertension, sweating, headaches Severe side effect of SNRIs in children/adolescents under age 25 years old: - Accurate answers suicidal ideation Life threatening adverse effect of SNRIs, especially when used in combination with other serotonergic drugs: - Accurate answers Serotonin Syndrome This SNRI is an inhibitor of Cytochrome P450 enzymes: - Accurate answers venlafaxine This SNRI is hepatotoxic: - Accurate answers duloxetine MAOIs increase the levels of: - Accurate answers Serotonin, Norepinephrine, and Dopamine Norepinephrine regulates: - Accurate answers alertness and focus
Due to its action as an adrenergic antagonist this drug is the treatment of hypertensive crisis: - Accurate answers Phentolamine TCAs are subdivided into these two groups: - Accurate answers Tertiary TCAs and Secondary TCAs Three Tertiary TCAs: - Accurate answers amitriptyline, imipramine, clomipramine Two Secondary TCAs: - Accurate answers desipramine, nortriptyline Tertiary TCAs are non-selective and act on: - Accurate answers Serotonin and Norephinephrine transporters (increase 5HT and NE) Secondary TCAs are selective and act only on: - Accurate answers Norepinephrine transporters (increase NE) Therapeutic benefits from TCAs typically take approximately: - Accurate answers 2-4 weeks In addition to treatment of depression, other indications for TCAs include: - Accurate answers Phobic disorders, chronic neuropathic pain, migraine prophylaxis Medication specific indication for clomipramine: - Accurate answers OCD Medication specific indication for imipramine: - Accurate answers Nocturnal enuresis In addition to SERTs and NETs, TCAs block (causes side effects): - Accurate answers Histamine (H1) receptors, Muscarinic receptors, and Alpha 1 receptors TCAs inhibitory effects on Histamine (H1) receptors results in this side effect: - Accurate answers sedation TCAs inhibitory effects on Muscarinic receptors results in this side effect profile: - Accurate answers anticholinergic side effects These TCAs more commonly cause anticholinergic side effects: - Accurate answers amitriptyline, imipramine, clomipramine (Tertiary TCAs) These are five main anticholinergic side effects: - Accurate answers dry mouth, tachycardia, urinary retention, confusion, hallucinations (common with Tertiary TCAs, amitriptyline, imipramine, clomipramine) TCAs inhibitory effects on Alpha 1 receptors results in this side effect: - Accurate answers orthostatic hypotension This class of antidepressants is especially cardiotoxic and may cause arrhythmias and prolonged QT interval: - Accurate answers TCAs Treatment of cardiotoxicity from TCAs: - Accurate answers Sodium Bicarbonate
The three most common causes of death from TCAs (The 3C's): - Accurate answers Convulsion, Coma, and Cardiotoxicity This class of antidepressants inhibits Cytochrome P450 Enzymes: - Accurate answers TCAs Combining these substances with Cytochrome P450 enzyme inhibitors can result in severe respiratory depression and death due to toxic levels: - Accurate answers Ethanol and sedative hypnotics (benzos) These two neuron types have abundant Alpha 2 receptors: - Accurate answers Noradrenergic and Serotonergic When stimulated Alpha 2 receptors inhibit the activity of the presynaptic neuron and decrease the release of these two neurotransmitters: - Accurate answers Norepinephrine and Serotonin Six common Atypical Antidepressants used for individuals that did not respond to other antidepressants:
- Accurate answers mirtazapine, trazadone, nefazodone, vilazodone, vortioxetine, bupropion This antidepressant effects Alpha 2 receptors, 5-HT2A receptors, 5-HT3A receptors, and Histamine H receptors: - Accurate answers mirtazapine The primary antidepressant action of this drug comes from inhibition of the Alpha 2 receptors, which reduces the inhibition of the synaptic neuron, and thus increases Norepinephrine and Serotonin release
- Accurate answers mirtazapine As a Serotonin Antagonist, this Atypical Antidepressant blocks 5-HT2A and 5-HT3A receptors to increase the amount of Serotonin available to bind to 5-HT1A receptors which are more strongly linked to depression: - Accurate answers mirtazapine Mirtazapine's inhibition of 5-HT3A receptors reduces: - Accurate answers nausea and vomiting Mirtazapine's inhibition of Histamine H1 receptors causes: - Accurate answers sedation (could be desirable side effect for depressed individuals with insomnia) For depressed individuals with anorexia, increased appetite and weight gain, are possibly beneficial side effects of this Atypical Antidepressant: - Accurate answers mirtazapine As Serotonin Antagonists, these two Atypical Antidepressants block 5-HT2A receptors so that more Serotonin is available to bind to 5-HT1A receptors which are more strongly linked to depression: - Accurate answers trazodone and nefazodone In addition to inhibition of 5-HT2A receptors, these two Atypical Antidepressants increase levels of Serotonin in the synaptic cleft through weak inhibition of Serotonin reuptake transporters: - Accurate answers trazodone and nefazodone These two Atypical Antidepressants are strong H1 receptor inhibitors, and therefore commonly used to treat insomnia: - Accurate answers trazodone and nefazodone
These two neuron types have abundant Alpha 2 receptors: - Accurate answers Noradrenergic and Serotonergic When stimulated Alpha 2 receptors inhibit the activity of the presynaptic neuron and decrease the release of these two neurotransmitters: - Accurate answers Norepinephrine and Serotonin In addition to SERT and DAT inhibition this Atypical Antidepressant blocks nicotinic (acetylcholine) receptors: - Accurate answers bupropion Due to inhibition of nicotinic (acetylcholine) receptors, this Atypical antidepressant is useful in smoking cessation: - Accurate answers bupropion This Atypical Antidepressant has the least sexual side effects of all the antidepressants: - Accurate answers bupropion Due to it's noradrenergic (excitatory) effects, this Atypical Antidepressant may cause tachycardia, insomnia, and a lower seizure threshold: - Accurate answers bupropion Schizophrenia is suspected to be related to altered levels of this neurotransmitters: - Accurate answers Dopamine These are the two categories of Antipsychotics: - Accurate answers first generation (typical) and second generation (atypical) Within the brain, Dopamine is found in these four main Dopamine pathways: - Accurate answers Mesolimbic (motivation and desire), Mesocortical (emotions), Nigrostriatal (motor neurons, controls involuntary movements and coordination), and Tuberoinfundibular (releases Dopamine to limit the secretion of Prolactin) Functions of the Mesolimbic pathway: - Accurate answers motivation and desire Function of the Mesocortical pathway: - Accurate answers emotions Functions of the Nigrostriatal pathway: - Accurate answers controls involuntary movements and coordination (contains motor neurons) Function of the Tuberoinfundibular pathway: - Accurate answers releases Dopamine to limit the secretion of Prolactin Another region of the CNS that is rich in Dopamine receptors and is responsible for initiating the vomiting reflex: - Accurate answers Chemoreceptor trigger zone Another pathway of the CNS that is rich in Dopamine receptors and is responsible for eating behavior: - Accurate answers Medullary Periventricular In this brain region, high levels of Dopamine cause positive symptoms of psychosis (delusions, hallucinations, disorganized thought): - Accurate answers Mesolimbic
In this brain region, low levels of Dopamine cause negative symptoms of psychosis (lack of motivation, social withdrawal, flat affect): - Accurate answers Mesocortical These three Typical Antipsychotics have high potency: - Accurate answers haloperidol, trifluoperazine , and fluphenazine These three Typical Antipsychotics have low potency: - Accurate answers thioridazine, chlorpromazine, and thiothixene In conditions such as Schizophrenia, these medications alleviate positive symptoms of psychosis (delusions, hallucinations, disorganized thought) by blocking Dopamine D2 receptors in the Mesolimbic pathway, but also block Dopamine receptors in the Mesocortical pathway which might worsen negative symptoms (lack of motivation, social withdrawal, flat affect): - Accurate answers First Generation (Typical) Antipsychotics Six psychiatric indications for First Generation (Typical) Antipsychotics: - Accurate answers Psychosis, Delirium, Bipolar Disorder, OCD, Tourette Syndrome, Huntington Disease Three side effects of Typical Antipsychotics associated with the Tuberoinfundibular pathways include: - Accurate answers Oligomennorhea, Galactorrhea, Gynecomastia Side effects of Typical Antipsychotics associated with the Nigrostriatal pathway can cause extrapyramidal symptoms such as: - Accurate answers acute dyskinesias and dystonic reactions, tardive dyskinesia, pseudoparkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome One possible extrapyramidal symptom of typical antipsychotics, that can occur within a few hours or days of treatment, that involves uncontrollable muscle spasms, frequently of the tongue, face, neck, back, or extraocular muscles (olygogyric crisis): - Accurate answers Dystonia A spasm of the extraocular muscles causing an upward and outward position of the eyes (possible extrapyramidal symptom associated with typical antipscyhotics can occur within hours to days of treatment): - Accurate answers Oculogyric Crisis This extrapyramidal symptom involves a feeling of restlessness and an urge to move the limbs. It can occur within a few days to a month of Typical Antipsychotic use: - Accurate answers Akathisia This extrapyramidal symptom is characterized by muscle rigidity (usually in the facial muscles, giving the face a wooden mask-like appearance), bradykinesia, and tremors. It can occur within a few days to a month of Typical Antipsychotic use: - Accurate answers Pseudoparkinsonism This extrapyramidal symptom is characterized by constant, involuntary, rhythmic movements. usually of the perioral muscles, causing a person to involuntarily smack or purse their lips. It can occur within a few months to years of Typical Antipsychotic use: - Accurate answers Tardive Dyskinesia Unlike more acute extrapyramidal symptoms, this one can be irreversible and so the antipscyhotic should be discontinued at the first sign: - Accurate answers Tardive Dyskinesia
Five other indications for Atypical Antipsychotics: - Accurate answers Bipolar disorder, OCD, Anxiety, Depression, Tourette Syndrome First line agent for Acute Mania: - Accurate answers Atypical Antipsychotics Because they also block D2 receptors in the tuberoinfundibular pathway Atypical Antipsychotics can cause: - Accurate answers Hyperprolactinemia Hyperprolactinemia caused by Atypical Antipsychotics blocking D2 receptors in the tuberoinfundibular pathway can result in these three side effects: - Accurate answers Oligomenorrhea, Galactorrhea, and Gynecomastia Because of its effect on blocking dopamine receptors in the tuberoinfundibular pathway, this Atypical Antipsychotic is the most likely to cause Hyperprolactinemia (oligomennorhea, galactorrhea, and gynecomastia): - Accurate answers risperidone Atypical Antipsychotics also block Dopamine receptors in the Nigrostriatal pathway and can cause these symptoms: - Accurate answers Extrapyramidal symptoms (dyskinesias and dystonic reactions, tardive dyskinesia, pseudoparkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome) Acute extrapyramidal symptoms include: - Accurate answers Dystonia, Akathisia, and Pseudoparkinsonism Tardive (delayed) extrapyramidal symptoms include: - Accurate answers Tardive Dyskinesia and Neuroleptic Malignant Syndrome This generation of Antipsychotics binds more loosely to D2 receptors and can get "kicked off' if there is a lot of Dopamine around resulting in less extrapyramidal symptoms: - Accurate answers Second- Generation Antipsychotics (Atypical)
- First generation Antipsychotics (Typical) bind more tightly to D2 receptors and are not "kicked off" when excess Dopamine is around. This characteristic makes them more likely to cause: - Accurate answers Extrapyramidal Symptoms (dyskinesias and dystonic reactions, tardive dyskinesia, pseudoparkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome) Less severe neurotransmitter side effects of Atypical Antipsychotics include: - Accurate answers ORTHOSTATIC HYPOTENSION (Alpha-1 receptor inhibition), ANTICHOLINERGIC SIDE EFFECTS (muscarinic receptor inhibition), and SEDATION (H1 receptor inhibition). Metabolic side effects of Atypical Antipsychotics include: - Accurate answers Weight gain, dyslipidemia, hyperglycemia, and increased cardiovascular risk These two Atypical Antipsychotics tend to cause the most weight gain: - Accurate answers clozapine and olanzapine This Atypical Antipsychotic has the least impact on weight gain: - Accurate answers aripiprazole
Two serious medication specific side effects of clozapine include: - Accurate answers Seizures and Agranulocytosis (leading to frequent and overwhelming infections) These two labs must be monitored regularly with use of clozapine: - Accurate answers WBC and ANC Due to this medications possible side effects of Agranulocytosis and subsequent risk for infections, this Atypical Antipsychotic is only used if a client has not responded to other Antipsychotics: - Accurate answers clozapine Cardiac side effects of Atypical Antipsychotics (especially ziprasidone) include: - Accurate answers Prolongation of the QT interval (normal = 0.4-0.44 seconds) This Atypical Antipsychotic has the greatest effect on QT interval prolongation and should not be prescribed for people with arrhythmias: - Accurate answers ziprasidone Lithium is primarily used in the treatment of: - Accurate answers Bipolar Disorder The mechanism of action for this medication is unknown but it acts as a mood stabilizer that can smooth out the "highs and lows": - Accurate answers Lithium Symptoms of Manic episodes: - Accurate answers energetic, overly happy/optimistic, high self- esteem, reckless behavior, pressured speech, racing thoughts, delusions of grandeur Used as maintenance therapy in Bipolar Disorder to decrease the frequency and magnitude of ups and downs: - Accurate answers Lithium Sometimes used for the treatment of Acute Manic Episodes, although the treatment of choice is Antipsychotics: - Accurate answers Lithium This mood stabilizer is indicated for Unipolar Depression that does not respond to antidepressants: - Accurate answers Lithium This mood stabilizer is taken orally, absorbed rapidly from the GI tract, is not metabolized by the liver, and is almost exclusively excreted by the kidneys: - Accurate answers Lithium This mood stabilizer has a narrow therapeutic window and requires close monitoring of serum levels: - Accurate answers Lithium These four types of medications decrease glomerular filtration rate (GFR) which impairs the elimination of Lithium and makes it very easy to overdose: - Accurate answers thiazides, loop diuretics, NSAIDS, and ACE inhibitors Common side effects of Lithium: - Accurate answers nausea, vomiting, diarrhea, mild tremor, symptoms of nephrogeneic diabetes insipidus (polyuria and polydipsia), hypothyroid symptoms (weight gain, cold sensitivity, bradycardia, mental slowness, constipation, and reactive goiter), leukocytosis,
