NR 546 MIDTERM EXAM: ADVANCED PSYCHOPHARMACOLOGY QUESTIONS & ANSWERS | COMPREHENSIVE REVIEW WITH CLINICIAN-VERIFIED RATIONALES | FOCUS ON SSRIs, SNRIs, TYPICAL/ATYPICAL ANTIPSYCHOTICS, LITHIUM, & GABAERGIC DRUG MECHANISMS

How does the orbitofrontal cortex (OFC) affect the amygdala?

inhibits and activates the amygdala

Wernicke's area is associated with which of the following?

speech comprehension

The limbic system is associated with which of the following

emotion and learning

Which brain structure is most associated with long term memory?

hippocampus

When prescribing psychotropic medications, the PMHNP knows that these medications work within which specific areas?

mood

Which of the following are involved in regulating neurotransmission via excitation-secretion coupling?

voltage-sensitive sodium channels and voltage-sensitive calcium channels

What system influences the length of time for a drug to achieve efficacy?

signal transduction cascades

One of the signal transduction cascades, pass the message from a first receptor to a second messenger.

G protein linked systems

Human central nervous system communication at synapses is which of the following?

chemical

Which of the following is an excitatory neurotransmitter?

glutamate

Which statement correctly pairs the pharmacodynamic effect with its definition?

antagonist effect - drug binds to receptor, but does not activate a response

A major current hypothesis for the cause of schizophrenia proposes that N-methyl-d-aspartate (NMDA) receptors may be which of the following?

Correct!

hypofunctional

Which medication is least associated with weight gain?

aripiprazole

Which dopamine pathway is associated with positive symptoms of schizophrenia?

mesolimbic pathway

Which pathway is associated with negative symptoms?

The mesocortical pathway

Is part of the extrapyramidal nervous system and associated with extrapyramidal symptoms (EPS)

nigrostriatal pathway

This pathway is associated with hyperprolactinemia.

The tuberoinfundibular pathway

A 34-year old male recently began experiencing breast secretions while receiving risperidone . Which dopamine pathway is associated with this side effect?

tuberoinfundibular pathway

A 44-year-old woman is initiated on an atypical antipsychotic for the treatment of schizophrenia. Regarding affinity, atypical antipsychotics demonstrate which of the following most often?

Atypical antipsychotics have equal positive symptom antipsychotic actions and low extrapyramidal symptoms.

is a syndrome that can be associated with several different psychiatric disorders. Symptoms include hallucinations, delusions, disorganized speech, disorganized behavior, and distortions of reality. This syndrome can affect a person's cognition, affective response, communication, capacity to recognize reality, and ability to relate to others.

psychosis

What Diagnosis require the presence of psychosis?

schizophrenia

substance-induced psychotic disorders

schizophreniform disorder

schizoaffecive disorder

delusional disorder

brief psychotic disorder

psychotic disorder due to a medical condition

What diagnosis has a diagnosis of psychosis as a feature?

mania

depression

cognitive disorders

dementia

What are some positive symptoms?

Hallucinations

Delusions

Thought disorder

Hostility

Excitability

What are some Negative symptoms?

Affective flattening

Alogia

Anhedonia

Amotivation

Asociality

What area of the brain is associated with negative and affective symptoms?

Mesocortical and ventromedial prefrontal cortex:

What area of the brain is associated with cognitive symptoms?

Dorsolateral

What area of the brain is associated with aggressive, impulsive symptoms?

Orbitofrontal and connections to the amygdala

Non-selectively blocks dopamine D2 receptors, specifically in mesolimbic pathway. Improves Positive Symptoms

Use: Acute & Chronic Schizophrenia & Psychosis

First generation antipsychotics

are associated with movement, intelligence, abstract thinking, the ability to organize, personality, behavior, and emotional control. Traumatic brain injuries can result in personality changes, difficulty controlling emotions, and other cognitive functions

Frontal Lobes

responsible for proprioception, is the home of the somatic senses. This part of the brain helps a person to identify spatial relationships, interpret pain and touch in the body, and identify and give meaning to objects

Parietal Lobe (Middle Brain)

Damage to the anterior portion may cause asterogenesis, the loss of ability to recognize objects via the sense of touch. This may be experienced by patients with post cerebral vascular accidents

parietal Lobe

and involved in short-term memory, speech, auditory signals, and smell recognition. It identifies "what" things are - object identification. It contains the limbic system, amygdala, and hippocampus.

Temporal Lobe

Disorders from this lobe include dementia, affective disorders, and attention deficit hyperactivity disorders (ADHD).

Temporal Lobe

controls visual processing. Damage to this lobe results in the inability to form visual memories. Bilateral lobe damage results in the inability to recognize items by sight even though vision is normal.

Occipital Lobe

This separates the frontal lobe from the parietal lobe.

Central sulcus

This controls the communication between the two brain hemispheres. Is involved in attention, impulse control, and emotion regulation. It integrates impulses from both sides of the brain.

corpus callosum

This is located deep in the temporal lobes and is involved in anxiety and memory, and shifting short-term to long-term memory.

Hippocampus

This is located deep in the temporal lobes and involved in emotional regulation and perception of odors. All smells travel directly to this structure. Cooking smells can elicit memories of childhood events and holidays. A traumatic event can result in the formation of the fear response, causing the fight or flight reflex within the autonomic nervous system and affects the hypothalamic-pituitary-adrenal (HPA) axis causing the release of stress hormones

Amygdala

This is an egg-shaped structure involved in sensory organ and motor command processing. All sensory systems except for the olfaction process through the thalamus, which is responsible for processing all external information

Thalamus

A group of structures involved in voluntary motor movements, cognition, and emotion. Movement disorders include Parkinson's disease, obsessive-compulsive disorder (OCD), and Tourette syndrome.

Basal ganglia

This is involved in complex motor actions and linkage of cognition to motor actions. It is the main input area for the basal ganglia and is activated when anticipating or engaging in pleasure

Dorsal striatum

This is involved in the reward circuit and reinforces addictive behaviors.

Nucleus accumbens

This is associated with pleasure, reward, and reinforcing behavior. Drug abuse affects the limbic system, disrupting emotions and feelings associated with normal behavior.

Limbic system

Associated with movement, intelligence, abstract thinking. etc.

Frontal lobe

Associated with speech

Brocas area

Involves object identification and auditory signals

Temporal lobe

Involved in Coordination

cerebellum

Involved in Speech comprehension

Wernicke's area

Primary visual area

Occipital Lobe

Keeps us alert to what is going on around us

Parietal lobe

Involved in the reward process.

Nucleus accumbens

Involved in sensory organ and motor command processing

thalamus

Involved in complex motor actions, also links cognition to motor actions

Striatum

This includes circuits that are associated with pleasure and reward, emotion and learning

LIMBIC SYSTEM

A group of structures involved in voluntary motor movements

basal ganglia

Controls the communication between the two brain hemispheres

Corpus callosum

Contains nerve fibers that connect neurons from different regions into functional circuits

white matter

enzyme system mediates how the body metabolizes many drugs, including antipsychotics. The enzyme in the gut wall or liver converts the drug into a biotransformed product in the bloodstream. After passing through the gut wall and liver (left), the drug will exist partly as unchanged drug and partly as biotransformed drug

CYP450 system

Which medication classes increases serotonin?

SSRIs, Tricyclic, SNRIs

bind more potently to the 5HT 2A receptor than the D2. Sedation is common and relates to a high affinity for histamine. These medications have the least risk of EPS but a high risk for weight gain and metabolic abnormalities.

The "Pines"

more potently to the 5HT 2A receptor than to D2 or bine equally between the 2 receptors. These medications are less sedating and cause less weight gain, but have a higher risk for hyperprolactinemia and EPS.

Two dones and a rone

bind more potently to D2 receptors than to 5HT-2A. They have low risk of metabolic side effects and weight gain, but they have a potential for EPS. The rip binds equally to both D2 and 5HT-2A receptors. The medications has low risk for metabolic disorders.

2 Pips and a Rip

What medication has the highest risk for galactorrhea, due to hyperprolactinemia.

risperidone

Include other symptoms such as disorganized speech, disorganized behavior, gross distortions of reality testing, and as diminished emotional expression and decreased motivation.

Negative symptoms

If the functioning of this pathway is disrupted by lesions or drugs, prolactin levels can also rise. Elevated prolactin levels are associated with galactorrhea (breast secretions), gynecomastia (enlarged breasts especially in men), amenorrhea (loss of ovulation and menstrual periods), and possibly other problems such as sexual dysfunction.

tuberoinfundibular DA neurons

Projects from the midbrain VTA but sends its axons to areas of the prefrontal cortex, where they may have a role in mediating cognitive symptoms (dorsolateral prefrontal cortex or DLPFC) and affective symptoms (ventromedial prefrontal cortex or VMPFC) of schizophrenia.

The mesocortical dopamine pathway

which projects from the substantia nigra to the basal ganglia or striatum, is part of the extrapyramidal nervous system and controls motor function and movement.

Nigrostriatal dopamine pathway

projects from the midbrain ventral tegmental area (VTA) to the nucleus accumbens, a part of the limbic system of the brain thought to be involved in many behaviors such as pleasurable sensations,the powerful euphoria of drugs of abuse, and delusions and hallucinations of psychosis.

mesolimbic dopamine pathway

What are the three major hypotheses of pychosis?

The Dopamine theory, the Glutamate theory, and the serotonin theory.

Treat both positive and negative signs of psychosis. They are considered serotonin-dopamine antagonists, as they maintain D2 antagonism but also have simultaneous serotonin 5HT2A antagonism. Serotonin (5HT) can regulate DA release directly or indirectly, producing various effects on dopamine (DA) neurons. 5HT1A and 5HT2A receptors have opposite actions on dopamine release.

Stimulation of 5HT1A receptors increases dopamine release (a DA accelerator). Once bound to 5HT1A receptors, 5HT causes inhibition of its release, which results in increased dopamine output.

SGA 'atypical'

What antipsychotics have a black box warning in childen?

Aripiprazole and Quetiapine increases the risk of suicide

Drugs

citalopram (Celexa)

escitalopram (Lexapro)

fluoxetine (Prozac)

fluvoxamine (Luvox, Luvox CR)

paroxetine (Paxil, Paxil CR)

sertraline (Zoloft)

SSRI

are used for the treatment of all anxiety disorders. They act by preventing the reuptake of 5-HT by synapses in the brain.

SSRI

Are used to treat all anxiety disorders except obsessive compulsive disorder. SNRIs work by preventing the reuptake of 5-HT and NE by synapses in the brain. Compared with venlafaxine and desvenlafaxine, which have SRI activity and dose-related affinity for norepinephrine reuptake inhibition (NRI) primarily, duloxetine has more balanced SRI and NRI activities. Levomilnacipran has higher activity at NRI than SRI.

SNRI

Drugs

desvenlafaxine (Pristiq)

duloxetine (Cymbalta)

venlafaxine (Effexor, Effexor XR)

levomilnacipran (Fetzima)

SNRI

are FDA approved for short-term anxiety treatment and are used alone or as an adjunct to antidepressants. They bind to serotonin and dopamine receptors in the brain and increase norepinephrine metabolism in the brain.

Buspirone `Buspar'

Non-selectively blocks dopamine D2 receptors, specifically in mesolimbic pathway

amino acid that acts as the chief inhibitory neurotransmitter, and decrease neuroexcitability across the brain. This neurotransmitter help people relax, destress, and get some sleep

Gaba

When people dont have enough of this neurotransmitter, they may experience anxiety or even schizophrenia. Some meds use this neurotransmitters benefits to help people sleep for medical procedures.

Gaba

am also a monoamine neurotransmitter and I serve many functions in the human body. Do you remember learning about flight, fight, or fright? That's me, in excess. A little of me can get you up off the couch and have you alert, oriented, and ready to take on life's challenges. I can really help with focus and productivity which is why you see me with a cup of coffee.

Norepinephrine

too much can cause antsy, nervous, and affect your ability to focus

Norepinephrine

one of the key neurotransmitters that psychotropic drugs target. Within the central nervous system, I affect arousal, motivation, attention, learning, and REM sleep. I work within the parasympathetic nervous system too. I can make you sweat and salivate.

acetylcholine

Substances that block me can paralyze you because I am the link between the brain and muscles. When there's not enough of me, I can be involved in Alzheimer's and Parkinson's disease. Increase me, and I can help with symptoms, but be cautious, because I also have a role in addiction. Dr. Stahl refers to me as "the brain's own nicotine" when he talks about my role in addiction.

acetylcholine

I help to regulate mood. I've been called the "happy hormone," but actually I am not a hormone at all; I am a monoamine neurotransmitter. Your body synthesizes me naturally from tryptophan. I help to regulate sleep, arousal, libido, aggression, and pain perception.

serotonin ( 5HT )

I am one of the key monamine neurotransmitters that regulate mood. I am associated with executive function, your ability to perform well, be organized, and all those good things including emotional intelligence. That's when I'm working hard in the prefrontal cortex. I'm also essential to your movement and coordination. Being balanced is very important to me; too much or too little can cause problems.

Dopamine

When my levels are low you'll lose pleasure, interest, alertness, and even self-confidence. Low levels are also found in clients who have Parkinson's disease.

Dopamine

Too much of me is not always a good thing. I can lead to the hallucinations you see in schizophrenia and psychosis. Another thing, do you know that great feeling you get when you win something? That's me, at work in your reward center.

Dopamine

Some people have trouble with me because my reward properties can lead to all types of addictions.

Dopamine

amino acid and THE excitatory neurotransmitter. I've been referred to as the workhorse of the brain because I can affect almost every neuron in the brain. I'm quite the firecracker. You'll find me working hard all over the brain affecting energy, memory, learning, and neural plasticity. I also work to relay sensory information and regulate spinal and motor reflexes.

glutamate

When my levels are too high, I've been associated with schizophrenia, epilepsy, and mania.

glutamate

In depression is acetylcholine increased or decrease?

Increased

In depression is norepinephrine increased or decreased?

Decreased

In depression is histamine increased or decreased?

Decreased

In depression is glutamate increased or decreased?

Decreased

This is located deep in the temporal lobes and is involved in anxiety and memory, and shifting short-term to long-term memory

Hippocampus

This structured is impaired in schizophrenia and dementia

Hipocampus

This is associated with pleasure, reward, and reinforcing behavior. Drug abuse affects this system, disrupting emotions and feelings associated with normal behavior.

Limbic system

This is located deep in the temporal lobes and involved in emotional regulation and perception of odors. All smells travel directly to this. Cooking smells can elicit memories of childhood events and holidays. A traumatic event can result in the formation of the fear response, causing the fight or flight reflex within the autonomic nervous system and affects the hypothalamic-pituitary-adrenal (HPA) axis causing the release of stress hormones (e.g. cortisol). Also is involved in the interpretation of facial expressions and sexual stimuli.

Amygdala

This is involved in the reward circuit and reinforces addictive behaviors.

Nucleus Accumbens

A group of structures involved in voluntary motor movements, cognition, and emotion. movement disorders include Parkinson's disease, obsessive-compulsive disorder (OCD), and Tourette syndrome. The striatum is a group of structures that includes the caudate, putamen, and nucleus accumbens. The dorsal striatum contains the caudate nucleus and the putamen. The ventral striatum contains the nucleus accumbens. Both are involved in facilitating voluntary movement.

Basal Ganglia