MSN 671 Final Study Guide
Classic Synaptic Neurotransmission - answerSynthesis of neurotransmitter (NT).
Storage in presynaptic vesicles. Release into synaptic cleft via calcium influx. Binding to
postsynaptic receptors (ionotropic or metabotropic).
Reuptake - answerTransporters: SERT, DAT, NET — targets of SSRIs (fluoxetine
Prozac, sertraline Zoloft, escitalopram Lexapro, paroxetine Paxil, citalopram Celexa),
SNRIs (venlafaxine Effexor, duloxetine Cymbalta), TCAs (amitriptyline Elavil,
nortriptyline Pamelor), stimulants (methylphenidate Ritalin, amphetamine salts Adderall,
lisdexamfetamine Vyvanse).
Enzymatic breakdown - answerMAO — phenelzine Nardil, tranylcypromine Parnate;
COMT — entacapone Comtan; acetylcholinesterase — donepezil Aricept, rivastigmine
Exelon, galantamine Razadyne.
Diffusion away - answerE.g., histamine, dopamine in PFC.
Ligand-gated ion channels - answerIonotropic: NT binds → ion flow directly (e.g.,
GABAa, NMDA).
Voltage-sensitive ion channels - answerOpen/close in response to voltage (Na⁺, Ca²⁺,
K⁺).
Sodium channels - answerCritical for action potential propagation. Drugs that block
include carbamazepine (Tegretol), tricyclic antidepressants (Elavil, Pamelor, Tofranil),
lidocaine (Xylocaine).
Presynaptic transporters - answerSERT, DAT, NET recycle NT; targets of SSRIs,
SNRIs, TCAs, stimulants.
Norepinephrine - answerLocus coeruleus origin; regulates attention, arousal, BP.
Acetylcholine - answerBasal forebrain; memory/cognition. Loss in Alzheimer's disease
→ acetylcholinesterase inhibitors: donepezil (Aricept), rivastigmine (Exelon),
galantamine (Razadyne).
Melatonin - answerSecreted from pineal gland during darkness. Regulated by SCN.
MT1 = sleep onset, MT2 = circadian regulation.
Serotonin (5HT) - answerRaphe nuclei; mood, sleep, anxiety.
, Dopamine - answerReward, motivation, movement. Pathways: mesolimbic,
mesocortical, nigrostriatal, tuberoinfundibular.
GABA - answerMajor inhibitory NT.
GABAa - answerIonotropic = benzodiazepines — lorazepam (Ativan), clonazepam
(Klonopin), diazepam (Valium); Z-drugs — zolpidem (Ambien), eszopiclone (Lunesta).
GABAb - answerMetabotropic = baclofen (Lioresal).
Histamine - answerTMN of hypothalamus; wakefulness.
Tardive Dyskinesia - answerChronic D2 blockade → receptor
upregulation/supersensitivity in nigrostriatal pathway → involuntary movements.
Breast discharge (galactorrhea) - answerD2 blockade in tuberoinfundibular pathway →
↑ prolactin release.
Metabolic Monitoring in Antipsychotics - answerMonitor: weight, BMI, waist
circumference, BP, fasting glucose, HbA1c, lipids. Clozapine (Clozaril) & olanzapine
(Zyprexa) highest risk.
Bipolar Depression Treatments - answerApproved agents: quetiapine (Seroquel),
lurasidone (Latuda), olanzapine/fluoxetine combo (Symbyax), cariprazine (Vraylar).
Mood stabilizers: lithium carbonate (Lithobid), lamotrigine (Lamictal). Antidepressant
monotherapy is contraindicated.
Augmenting SSRIs/SNRIs in Unipolar Depression - answerAtypical antipsychotics:
aripiprazole (Abilify), brexpiprazole (Rexulti), quetiapine XR (Seroquel XR). Lithium
carbonate (Lithobid). Thyroid hormone (T3) — Cytomel. Buspirone (Buspar).
Weight gain/metabolic risk - answerclozapine (Clozaril) > olanzapine (Zyprexa) >
quetiapine (Seroquel) > risperidone (Risperdal) > ziprasidone (Geodon), lurasidone
(Latuda), aripiprazole (Abilify), cariprazine (Vraylar).
Breast discharge (hyperprolactinemia) - answerrisperidone (Risperdal), paliperidone
(Invega) > others.
Motor effects - answerhigh-potency typicals (haloperidol Haldol) > atypicals.
Anticholinergic/antihistaminic binding - answerclozapine (Clozaril), olanzapine
(Zyprexa), quetiapine (Seroquel) > aripiprazole (Abilify), ziprasidone (Geodon),
lurasidone (Latuda).
Sedation - answerclozapine (Clozaril), quetiapine (Seroquel) > risperidone (Risperdal),
aripiprazole (Abilify), cariprazine (Vraylar).
Classic Synaptic Neurotransmission - answerSynthesis of neurotransmitter (NT).
Storage in presynaptic vesicles. Release into synaptic cleft via calcium influx. Binding to
postsynaptic receptors (ionotropic or metabotropic).
Reuptake - answerTransporters: SERT, DAT, NET — targets of SSRIs (fluoxetine
Prozac, sertraline Zoloft, escitalopram Lexapro, paroxetine Paxil, citalopram Celexa),
SNRIs (venlafaxine Effexor, duloxetine Cymbalta), TCAs (amitriptyline Elavil,
nortriptyline Pamelor), stimulants (methylphenidate Ritalin, amphetamine salts Adderall,
lisdexamfetamine Vyvanse).
Enzymatic breakdown - answerMAO — phenelzine Nardil, tranylcypromine Parnate;
COMT — entacapone Comtan; acetylcholinesterase — donepezil Aricept, rivastigmine
Exelon, galantamine Razadyne.
Diffusion away - answerE.g., histamine, dopamine in PFC.
Ligand-gated ion channels - answerIonotropic: NT binds → ion flow directly (e.g.,
GABAa, NMDA).
Voltage-sensitive ion channels - answerOpen/close in response to voltage (Na⁺, Ca²⁺,
K⁺).
Sodium channels - answerCritical for action potential propagation. Drugs that block
include carbamazepine (Tegretol), tricyclic antidepressants (Elavil, Pamelor, Tofranil),
lidocaine (Xylocaine).
Presynaptic transporters - answerSERT, DAT, NET recycle NT; targets of SSRIs,
SNRIs, TCAs, stimulants.
Norepinephrine - answerLocus coeruleus origin; regulates attention, arousal, BP.
Acetylcholine - answerBasal forebrain; memory/cognition. Loss in Alzheimer's disease
→ acetylcholinesterase inhibitors: donepezil (Aricept), rivastigmine (Exelon),
galantamine (Razadyne).
Melatonin - answerSecreted from pineal gland during darkness. Regulated by SCN.
MT1 = sleep onset, MT2 = circadian regulation.
Serotonin (5HT) - answerRaphe nuclei; mood, sleep, anxiety.
, Dopamine - answerReward, motivation, movement. Pathways: mesolimbic,
mesocortical, nigrostriatal, tuberoinfundibular.
GABA - answerMajor inhibitory NT.
GABAa - answerIonotropic = benzodiazepines — lorazepam (Ativan), clonazepam
(Klonopin), diazepam (Valium); Z-drugs — zolpidem (Ambien), eszopiclone (Lunesta).
GABAb - answerMetabotropic = baclofen (Lioresal).
Histamine - answerTMN of hypothalamus; wakefulness.
Tardive Dyskinesia - answerChronic D2 blockade → receptor
upregulation/supersensitivity in nigrostriatal pathway → involuntary movements.
Breast discharge (galactorrhea) - answerD2 blockade in tuberoinfundibular pathway →
↑ prolactin release.
Metabolic Monitoring in Antipsychotics - answerMonitor: weight, BMI, waist
circumference, BP, fasting glucose, HbA1c, lipids. Clozapine (Clozaril) & olanzapine
(Zyprexa) highest risk.
Bipolar Depression Treatments - answerApproved agents: quetiapine (Seroquel),
lurasidone (Latuda), olanzapine/fluoxetine combo (Symbyax), cariprazine (Vraylar).
Mood stabilizers: lithium carbonate (Lithobid), lamotrigine (Lamictal). Antidepressant
monotherapy is contraindicated.
Augmenting SSRIs/SNRIs in Unipolar Depression - answerAtypical antipsychotics:
aripiprazole (Abilify), brexpiprazole (Rexulti), quetiapine XR (Seroquel XR). Lithium
carbonate (Lithobid). Thyroid hormone (T3) — Cytomel. Buspirone (Buspar).
Weight gain/metabolic risk - answerclozapine (Clozaril) > olanzapine (Zyprexa) >
quetiapine (Seroquel) > risperidone (Risperdal) > ziprasidone (Geodon), lurasidone
(Latuda), aripiprazole (Abilify), cariprazine (Vraylar).
Breast discharge (hyperprolactinemia) - answerrisperidone (Risperdal), paliperidone
(Invega) > others.
Motor effects - answerhigh-potency typicals (haloperidol Haldol) > atypicals.
Anticholinergic/antihistaminic binding - answerclozapine (Clozaril), olanzapine
(Zyprexa), quetiapine (Seroquel) > aripiprazole (Abilify), ziprasidone (Geodon),
lurasidone (Latuda).
Sedation - answerclozapine (Clozaril), quetiapine (Seroquel) > risperidone (Risperdal),
aripiprazole (Abilify), cariprazine (Vraylar).
