CMN 548 Module 5 Psychopharmacology UPDATED ACTUAL Questions and
CORRECT Answers
What are the two basic mechanisms for studying - Measure the binding of a ligand (radioactively traced)
receptors? - Measure the physiologic consequences of agonist binding (and effects of the
antagonist)
How do didactic depictions of neurotransmitter signaling - There are hundreds to thousands of axons connecting to one dendrite
differ from real life? - A single transmitter can evoke multiple pathways
Pharmacokinetic drug interactions are... the effects of drugs on the PLASMA concentrations of each other
Pharmacokinetic concepts describe and predict... - the time course of drug concentration in different parts of the body
- onset, duration, absorption, distribution, metabolism, excretion
Remission - Preferred outcome of treatment
- Absolute score of 7 or less on the HAMD (Hamilton depression) scale
- <10 on the MADRS (Montgomery-Asberg Depression Rating Scale)
Responders are patients who... improve but do not experience full resolution of symptoms
- 50% of greater decrease from baseline on HAMD and MADRS depression
ratings
What is the probability of remission from OCD with SSRI - 38% full remission
treatment over 3 years of treatment? - 65% partial remission
Withdrawal symptoms are worse with drugs that have this Short elimination half life
pharmacokinetic property.
Which medications are most often associated with - Sedative hypnotics and opiates
mentally and physically distressing discontinuation - Barbiturate (part of the sedative hypnotic class) withdrawal can be fatal
reactions?
Which benzodiazepine produces more intense Alprazolam (Xanax)
withdrawal symptoms that it's counterparts?
Which SSRI produces more intense withdrawal symptoms Paroxetine (Paxil)
that it's counterparts?
Medications with this pharmacokinetic property have Long elimination half life
delayed discontinuation symptoms. - Fluoxetine (Prozac, SSRI) has a long elimination half life of its active metabolite
What is autoinhibition? Dose dependent inhibition of a medication's own metabolism
- Paroxetine (Paxil, SSRI) inhibits P450 CYP 2D6 which is what metabolizes the
medication
, Bupropion (Wellbutrin, atypical antidepressant) inhibits CYP 2D6
this enzyme system and paroxetine (Paxil, SSRI) is - Discontinuing bupropion would result in a rapid increase in metabolism of
metabolized by it. Paroxetine and drop in plasma concentrations
- Paroxetine would need to be increased
What effect have sustained release alprazolam, None.
paroxetine, and venlafaxine had on withdrawal reactions? - They do not reduce severity of withdrawal because the long half life is due to
delayed absorption not prolonged elimination
- Only benefit is the in reduced dosing frequency
Withdrawal symptoms present after hours or days of A few weeks
dose reduction or discontinuation and resolve within... - Persistent symptoms would indicate something besides withdrawal
- Psychotic and mood symptoms DO NOT usually reappear abruptly after
discontinuing long term treatment
Signal detection is more challenging for compounds The effect sizes are not large
developed for psychiatric disorders because....
What is expectation bias? A situation where either the staff conducting the trial or subjects in the trial or
both groups expect that the test drug will confer a benefit or that it is unlikely to
do so.
What effect does expectation bias play on drug trials? Staff may have an unconscious bias toward rating more beneficial effects than are
actually present.
- A larger trial may subsequently prove that there is no difference from the
placebo.
Explain the regression to mean phenomenon in drug As many trials enroll patients during an exacerbation of their illness, the
trials. phenomenon would tend to mean that future measurements would be less
extreme even if the subject is on a placebo.
CYP 450 testing to predict drug dosing and Personalized Medicine
responsiveness is one example of.... - Measuring patient 2D6 metabolism can also help determine dosing of fluoxetine
(Prozac, SSRI), a 2D6 inhibitor when combined with medications metabolized by
the same pathway
What is the ethical argument again whole genome Finding variants that indicate only susceptibility and not definite disease can alter
sequencing? the way a person lives their life (eg. schizophrenia)
What does phase 1 of a nonclinical study entail and what Initial introduction of the new drug to humans, usually in healthy volunteers.
is the goal? - Goal of obtaining pharmacokinetic and pharmacologic effects of the drug in
order to design a valid phase 2 study.
What does phase 2 of a nonclinical study entail and what Initial controlled efficacy studies in patients with the disease or condition.
is the goal? - Determine optimal doses of the drug, common short term side effects and risks
What does phase 3 of a nonclinical study entail and what Evaluate the overall risk-to-benefit relationship of the drug and to provide an
is the goal? adequate basis for product labeling.
- Generally has broader inclusion and exclusion criteria than phase 2 for a more
accurately representative population of people taking the medication
CORRECT Answers
What are the two basic mechanisms for studying - Measure the binding of a ligand (radioactively traced)
receptors? - Measure the physiologic consequences of agonist binding (and effects of the
antagonist)
How do didactic depictions of neurotransmitter signaling - There are hundreds to thousands of axons connecting to one dendrite
differ from real life? - A single transmitter can evoke multiple pathways
Pharmacokinetic drug interactions are... the effects of drugs on the PLASMA concentrations of each other
Pharmacokinetic concepts describe and predict... - the time course of drug concentration in different parts of the body
- onset, duration, absorption, distribution, metabolism, excretion
Remission - Preferred outcome of treatment
- Absolute score of 7 or less on the HAMD (Hamilton depression) scale
- <10 on the MADRS (Montgomery-Asberg Depression Rating Scale)
Responders are patients who... improve but do not experience full resolution of symptoms
- 50% of greater decrease from baseline on HAMD and MADRS depression
ratings
What is the probability of remission from OCD with SSRI - 38% full remission
treatment over 3 years of treatment? - 65% partial remission
Withdrawal symptoms are worse with drugs that have this Short elimination half life
pharmacokinetic property.
Which medications are most often associated with - Sedative hypnotics and opiates
mentally and physically distressing discontinuation - Barbiturate (part of the sedative hypnotic class) withdrawal can be fatal
reactions?
Which benzodiazepine produces more intense Alprazolam (Xanax)
withdrawal symptoms that it's counterparts?
Which SSRI produces more intense withdrawal symptoms Paroxetine (Paxil)
that it's counterparts?
Medications with this pharmacokinetic property have Long elimination half life
delayed discontinuation symptoms. - Fluoxetine (Prozac, SSRI) has a long elimination half life of its active metabolite
What is autoinhibition? Dose dependent inhibition of a medication's own metabolism
- Paroxetine (Paxil, SSRI) inhibits P450 CYP 2D6 which is what metabolizes the
medication
, Bupropion (Wellbutrin, atypical antidepressant) inhibits CYP 2D6
this enzyme system and paroxetine (Paxil, SSRI) is - Discontinuing bupropion would result in a rapid increase in metabolism of
metabolized by it. Paroxetine and drop in plasma concentrations
- Paroxetine would need to be increased
What effect have sustained release alprazolam, None.
paroxetine, and venlafaxine had on withdrawal reactions? - They do not reduce severity of withdrawal because the long half life is due to
delayed absorption not prolonged elimination
- Only benefit is the in reduced dosing frequency
Withdrawal symptoms present after hours or days of A few weeks
dose reduction or discontinuation and resolve within... - Persistent symptoms would indicate something besides withdrawal
- Psychotic and mood symptoms DO NOT usually reappear abruptly after
discontinuing long term treatment
Signal detection is more challenging for compounds The effect sizes are not large
developed for psychiatric disorders because....
What is expectation bias? A situation where either the staff conducting the trial or subjects in the trial or
both groups expect that the test drug will confer a benefit or that it is unlikely to
do so.
What effect does expectation bias play on drug trials? Staff may have an unconscious bias toward rating more beneficial effects than are
actually present.
- A larger trial may subsequently prove that there is no difference from the
placebo.
Explain the regression to mean phenomenon in drug As many trials enroll patients during an exacerbation of their illness, the
trials. phenomenon would tend to mean that future measurements would be less
extreme even if the subject is on a placebo.
CYP 450 testing to predict drug dosing and Personalized Medicine
responsiveness is one example of.... - Measuring patient 2D6 metabolism can also help determine dosing of fluoxetine
(Prozac, SSRI), a 2D6 inhibitor when combined with medications metabolized by
the same pathway
What is the ethical argument again whole genome Finding variants that indicate only susceptibility and not definite disease can alter
sequencing? the way a person lives their life (eg. schizophrenia)
What does phase 1 of a nonclinical study entail and what Initial introduction of the new drug to humans, usually in healthy volunteers.
is the goal? - Goal of obtaining pharmacokinetic and pharmacologic effects of the drug in
order to design a valid phase 2 study.
What does phase 2 of a nonclinical study entail and what Initial controlled efficacy studies in patients with the disease or condition.
is the goal? - Determine optimal doses of the drug, common short term side effects and risks
What does phase 3 of a nonclinical study entail and what Evaluate the overall risk-to-benefit relationship of the drug and to provide an
is the goal? adequate basis for product labeling.
- Generally has broader inclusion and exclusion criteria than phase 2 for a more
accurately representative population of people taking the medication
