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MH701 Frontier exam(111 questions fully solved)
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What is pharmacodynamics? - answer What the drug does to the body What is pharmacokinetics - answer What the body does to the drug (absorption, distribution, metabolism, excretion) Psychotropic medications - answer medications used to treat psychiatric disorders What is pharmacogenetics - answer Explains how genetic variation leads to altered drug
responses in different individuals and ethnic groups What is drug toxicity? - answer The degree to which a drug can be poisonous or harmful. it occurs when too much of the drug is accumulated in the bloodstream. (CYP system determines this) What is steady state? - answer Condition in which the rate of absorption equals the rate of elimination. It is acheived in 4-5 half-lives. What is drug half-life? - answer The time required for the amount of drug in the body to decrease by 50% Classes of psychotropic drugs - answer Antidepressants Antipsychotics Mood stabilizers Anxiolytics Hypnotics Cognitive enhancers, and Stimulants
Inverse Agonist - answer Chemical substance that produces effects opposite those of a particular neurotransmitter What is the significance of understanding about CYP 450 when prescribing various medications that may affect this? - answer Inducers-speed up other drugs' metabolism Which equals leaving the body quicker Which equal little to no effect intended effect. Inhibitors- block the enzyme so decreases the body's ability to use drug Which leaves too much circulating drug What medications will most be affected by CYP 450? - answer Inducers Mnemonic- CRAPGPS Cabamazepine Rifampin Alcholol Phenytion
Griseofulvin Phenobarbital Sulfonylureas Inhibitors Mnemonic- SICKFACES.COM@GQ Sodium Valproate Isoniazid Cimetidine Ketoconazole Fluconazole Amiodarone/alcohol Chloramphenicol Erythromycin Sulfonamides Cipro Omeprazole Along with Grapefruit juice and Quinidine What are the 4 tracts of the basal ganglia that can affect psychiatric or neurological disorders? - answer Striatum (composed of
Subthalamic nucleus-ballistic movements, sudden limb jerks like projectile movement What is the function of the limbic system related to psychiatric disorders? - answer Motivation, emotion, learning, and memory. Operates by influencing the endocrine system and the autonomic nervous system.
social withdrawal, irritability. monoamine neurotransmitters - answer dopamine, epinephrine, norepinephrine, serotonin Excitatory neurotransmitters - answer Glutamate Inhibitory neurotransmitters - answer GABA First line treatment MDD - answer SSRIs What are some of the common SSRIs you would expect to prescribe for a patient who has MDD? - answer Fluoxetine (Prozac) and escitalopram (Lexapro) for adolescents Fluoxetine, Sertraline, Citalopram, Escitalopram, Paroxetine, Fluvoxamine What are some good clinical guidelines when prescribing antidepressants? - answer *The most common clinical mistake leading to an unsuccessful trial of an
What is common first line treatment for MDD for children and adolescents? - answer SSRIs Fluoxetine (Prozac) and escitalopram (Lexapro) What are some of the common reasons for treatment failure? - answer The most common clinical mistake leading to an unsuccessful trial of an antidepressant drug is the use of too low a dosage for too short a time Too low of a dose for too little time, wrong diagnosis, nonadherence, comorbidities, new stressor What is next steps after a treatment failure?
Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable, and duration must be at least 1 year. Dysthymia treatment options - answer (SSRIs) venlafaxine and bupropion are an effective treatment for patients. Individual insight-oriented psychotherapy is the most common treatment method for dysthymia Bupropion (Wellbutrin) MOA NDRI - answer Blockade of norepinephrine and dopamine reuptake increases the available pool of these amines in the synaptic cleft. Contraindications: Hx of seizures
Therapeutics: Can help patients who need to gain weight Can help with anxiety and sleep-related to sedation Can boost the efficacy of other antidepressants Depression (especially patients with insomnia) Anxiety Nightmare suppression Helpful for sleep with children/adolescents. MAOIs (monoamine oxidase inhibitors) - answer Phenelzine (Nardil) is an example. Hypertensive crisis may occur with tyramine food ingestion ( aged and fermented foods), so care must be taken to avoid these substances. Educate the client to avoid all medications until discussed with provider. Many food/drug interactions
Therapeutics: Depression, panic disorder, Bulimia, and PTSD - if all other classes have failed and pt appropriate. ACTION is on NE, SE, Epinephrine, Dopamine, and tyramine Trazodone (Desyrel) Nefazadone (Serzone) - answer Enhances 5HT activity Therapeutics: Depression, anxiety - off label sleep, these are best as augmenting therapies and not monotherapy Contraindications: Hepatic impairment, taking MAOI, carbamazepine can decrease effects significantly, can lower the seizure threshold with other antidepressants, can interfere w potency of HTN drugs, can interfere with warfarin Can cause priapism (TrazeBONE)
numerous genotypes/phenotypes have been isolated for psychotropics, antidepressants, neuroleptics and opioids. There are even guidelines that have been established for specific TCAs and SSRIs based on CYP testing. Of note, the utilization has not been perfected since CYP450 is not the only factor in pharmacokinetics. Lifestyle, substance abuse, polypharmacy, diet are only a few other factors that may limit CYP genotypes/phenotypes from being the final determination in prescribing. Dopamine - answer A neurotransmitter associated with movement, attention and learning and the brain's pleasure and reward system. Called the pleasure chemical ● Too much dopamine in area of the brain and too low in another area of the brain has been associated with schizophrenia
● Too little is associated with some forms of depression as well as the muscular rigidity and tremors found in Parkinson's disease. Serotonin (5-HT) - answer Plays a role in mood, anxiety, emotions, appetite, ● sleep, appetite, and impulsive and aggressive behavior ● Too little serotonin is associated with depression Norepinephrine - answer ● Neurotransmitter associated with arousal and Fight or flight ● Too much of this w/ no actual danger can leave a person anxious and hyperactive ● Too little norepinephrine has been associated with depression Histamine - answer *Histaminergic cell bodies are found in the tuberomamillary neurons. The firing of these neurons has to do with the sleep-wake cycle.
Low levels can lead to fatigue and poor brain activity. Increased levels of glutamate can cause death to the neurons (nerve cells) in the brain. Dysfunction in glutamate levels are involved in many neurodegenerative diseases such as Alzheimer's, Parkinsons, Huntingtons, and Tourettes. High levels also contribute to Depression, OCD, and Autism. GABA - answer A major inhibitory neurotransmitter. The neurotransmitter that inhibits transmission from one nerve to the next in the CNS. Too much can cause CNS depression, respiratory depression and sedation Too little can cause seizures. Drugs affecting this transmitter are benzodiazepines, sedatives and hypnotics.
SNRIs. Venlafaxine and Desvenlafaxine (Effexor— Pristiq) duloxetine (Cymbalta) - answer Therapeutics: Depression, anxiety, panic disorder. May be useful if pt failed SSRI, can help with MELANCHOLY depression, helpful for chronic pain, some off-label use for ADHD Contraindications: Uncontrolled angle closure glaucoma, with MAOI. Caution with HTN, cardiac disease, bipolar (must have mood stabilizer also), seizure disorder Duloxetine (Cymbalta) SNRI - answer Well- documented efficacy for painful manifestations of depression, approved in many countries for urinary incontinence SSRIs contraindications - answer Can lengthen the QT interval and cause drug- induced long QT syndrome. This risk
