Psychopharm Final

What is the most likely type of drug to be prescribed for suspected Alzheimer’s Type Dementia?

Cholinesterase inhibitors (donepezil/Aricept, rivastigmine/Exelon, galantamine/Razadyne) help increase acetylcholine levels and provide modest symptom improvement

What is the mechanism of action for Donzepil (Aricept)?

inhibits acetylcholinesterase, preventing the breakdown of acetylcholine and increasing its concentration in the synaptic cleft and enhancing cholinergic transmission to improve cognitive function

Why do we say “suspected” Alzheimer’s Type Dementia?

a definitive diagnosis can only be made via autopsy; clinical features guide treatment

What is the most common form of dementia?

Alzheimer's disease, accounts for 60-80% of cases

What treatments have failed for Alzheimer's disease?

Statins

Anti-amyloid antibodies

Vitamin E

Estrogen

NSAIDs

What three herbaceuticals have the most efficacy?

Ginkgo biloba - cognition

St. John's Wort - depression

SAMe (S-Adenosyl Methionine) - mood

How is MDMA classed in terms of its effects (not the Federal Drug Schedules)?

Entactogen/empathogen

enhances empathy and emotional openness

What are the differences between D-amphetamine and L-amphetamine?

D-amphetamine provides more CNS stimulation, while L-amphetamine has more peripheral effects (e.g., cardiovascular)

What are the two isomers of amphetamine?

D-amphetamine and L-amphetamine

What are the big differences between medications and herbaceuticals?

Medications are regulated, standardized, and well-studied

Herbaceuticals are less regulated, have inconsistent dosing, and limited evidence

What is the therapeutic mechanism of psilocybin?

Modulate the serotonergic system, primarily through agonism at serotonin (5-HT2A) receptors

Which neurotransmitter offers the most untapped potential for treatments of dementias and schizophrenia?

Glutamate

What is the most promising NEW treatment for depression?

Ketamine/esketamine (rapid-acting NMDA antagonists)

Which drug has support for decreasing impulsive aggression?

SSRIs

Lithium

Propranolol

What are some problems for testing drugs on elderly samples?

Polypharmacy (using many different medications)

Comorbidities

Slower metabolism

Cognitive variability

What role should the phase of a patient’s addiction recovery play in treatment?

It guides appropriate interventions such as detox, relapse prevention, and therapy

What substance-related drug dependencies do we have treatment for?

Opioid dependency

Alcohol dependency

Nicotine dependency

What are the mechanisms of action for Naloxone/Naltrexone?

Opioid receptor antagonists

Naloxone is for acute reversal

Naltrexone is for long-term prevention

What are three pharmacotherapies for opioid dependence?

Methadone (full agonist)

Buprenorphine (partial agonist)

Naltrexone (antagonist)

What are some documented benefits for methadone therapy?

Reduces mortality

Reduces HIV transmission

Reduces crime rates

Improves functioning

What makes a client a good candidate for Naltrexone therapy?

Detoxed, highly motivated individual with no liver problems

What are some boundaries for physicians prescribing buprenorphine for opioid dependence?

Certification, patient capacities, and DEA rules, which are loosening with the MAT Act

What are the ratios for comorbid mental disorders in people with alcohol use disorders versus all other types of drug use disorders?

Comorbidity ratios are higher with other drugs than with alcohol

Why are some doctors reluctant to prescribe buprenorphine?

Stigma

Lack of training

Fear of oversight

Perceived difficulty

Believe they are replacing one addiction with another

What is a synaptic cleft?

a physical gap across which neurotransmitters diffuse

What is a neurotransmitter molecule?

A specialized chemical messenger that carries information from one neuron to another at the synapse

What is the first mechanism of action for the antidepressant sertaline/Zoloft?

Inhibit the extra-cellular transport molecule

What is the key mechanism of action in all families of benzodiazepines?

GABA agonism

What is the biggest problem with tyramine intolerance?

NE release and its consequences

What is NOT a vegetative symptom of depression?

low self-esteem

Which of the following is NOT a mechanism of action for psychotropic medications?

Creating new functions in a cell

What is metabolic tolerance?

When enzymes that are responsible for drug metabolism increase in response to the consistent presence of the drug

What is the best example of cross-tolerance?

Benzodiazepines and alcohol

What is a loading dose?

An initial dose that is higher than subsequent doses

What is the primary mechanism of therapeutic action for aripiprazole/Abilify?

the primary mechanism is unkwown

What else, besides being an atypical antipsychotic, can Olanzapine/Zyprexa be used as?

An anti-manic agent

Of the two families of benzodiazepine receptors, how many need to be targeted to create a hypnotic?

Only one of the two

What is the efficacy of Buspirone/BuSpar for anxiety?

Approximately 55%

What will stimulating an autoreceptor do?

Result in less neurotransmitter in the cleft

What is the best benzodiazepine for elderly patients?

one with a shorter half-life

What is the blood-brain barrier?

A lipophilicitious membrane psychotropic medications must pass through

What group of clients is it especially important to advocate for?

Children

What is an example of cellular tolerance?

Upregulation after taking SSRIs

What does the black box warning on SSRI antidepressants mean?

These medications are dangerous in vulnerable populations

What does the cellular/molecular theory of antidepressant action help us do?

Helps us make logical links between what medications do and lifestyle choices

For an older client (age 75), what would expect prescribers to do?

Start with a low dose to check the response

What was the most successful non-barbiturate alternative?

Benzodiazepines

Which of the following benzodiazepines has the longest half-life?

Valium/diazepam (2-keto compound)

What is a benefit of buspirone over benzodiazepines?

Its non-addictive properties

What is a potentially dangerous side effect of lithium?

When a high therapeutic dose becomes a toxic dose

What is one problem with a pediatric diagnosis of Bipolar I Disorder?

the criteria are not normed on that population

What drug is effective in treating Bipolar I Disorder but requires blood monitoring?

Lithium

What are effects of SSRI withdrawal/discontinuation syndrome?

can cause flu-like symptoms

can cause rebound of depression

can cause rebound anxiety

What is true for children with severe depression?

They should only be given SSRIs and be closely monitored

What are two on label uses for serotonin-dopamine antagonists (SDAs)?

Schizophrenia

Bipolar I Disorder

Major Depressive Disorder (MDD)

Explain the cellular/molecular theory of antidepressant action

take pill, get more epinephrine, then have more CAMP, which helps the brain grow new neurons

or take drug, increase NT levels, wait 4 weeks. If its working the person should feel better and have fewer receptors for those neurotransmitters but level will stay steady at this higher level

also increasing brain derived neurotropic factor helps (this is also increased with exercise, psychotherapy, and yoga)