MH 701 Safety Exam 1 Study Guide Graded A+

1. T/F - Both genetic and environmental factors influence individual response to, and tolerability of, psychotropic agents. - True 2. T/F - FDA approved psychotropics are similar in overall effectiveness for their indicated disorder. - True 3. The dopamine systems highly relevant to psychiatry include: - a. Nigrostriatal i. Degeneration leads to Parkinson's ii. Drugs that inhibit dopamine here cause EPS b. Mesocorticolimbici. Reward pathway (addiction) ii. Target of antipsychotic properties (dopamine receptor antagonist drugs) controlling positive symptoms (hallucinations, delusions) iii. May simultaneously worsen negative symptoms c. Tuberohypophyseali. drugs that work here may disinhibit prolactin release and lead to galactorrhea 4. The main excitatory neurotransmitter of the central nervous system is - glutamic acid [glutamate] a. It is required for learning and memory; Low levels can lead to fatigue and poor brain activity; neurodegenerative diseases such as Alzheimer's disease, Parkinson's, Huntington's, and Tourette's. b. Increased levels of glutamate can cause death to the neurons (nerve cells) in the brain, Depression, OCD, and Autism. 5. A relative measure of the toxicity or safety of a drug and is defined as the ratio of the median toxic dose to the median effective dose is referred to as - therapeutic index. 6. The Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 is a - reference manual by the American Psychiatric Association to classify mental disorders.7. In patients who are ultra-rapid or extensive metabolizers, the concentrations of a drug may be - lower than expected. 8. Pharmacokinetics best describes what - the body does to the drug. 9. GABAergic deficit has been associated with - anxiety and anxiety disorders, schizophrenia, alcohol dependence, seizure disorders. 10. The main inhibitory neurotransmitter of the central nervous system is - GABA 11. Drug class currently recommended as first-line medications in the treatment of childhood anxiety and child/adolescent major depressive disorder is - SSRIs 12. What antidepressants would NOT be the best choice for a patient with a history of suicidal ideation? - TCAs 13. Antidepressants with dual action on both serotonergic and noradrenergic receptors demonstrate greater efficacy in - melancholic depressions / the treatment of major depression. 14. MOA of: Sertraline [Zoloft]: - S-RI (Serotonin Reuptake Inhibitor) i. Boosts neurotransmitter serotonin ii. Blocks serotonin reuptake pump (serotonin transporter) iii. Desensitizes serotonin receptors, especially serotonin 1A receptors iv. Presumably increases serotonergic neurotransmission 14. MOA of: Mirtazapine [Remeron]: - SN-RAn (Serotonin Norepinephrine Receptor Antagonist)- i. Boost neurotransmitters serotonin and norepinephrine/noradrenaline ii. Blocks alpha 2 adrenergic presynaptic receptor, thereby increasing norepinephrine neurotransmission iii. Blocks alpha 2 adrenergic presynaptic receptor on serotonin neurons (heteroreceptors), thereby increasing serotonin neurotransmission; this is a novel mechanism independent or norepinephrine and serotonin reuptake; blocks 5HT2A, 5HT2C, and 5HT3 serotonin receptors iv. Blocks H1 histamine receptors14. MOA of: Amitriptyline [Elavil]- - TCA (Tricyclic Antidepressant) i. Boosts neurotransmitters serotonin and norepinephrine/noradrenaline ii. Blocks serotonin reuptake pump (serotonin transporter), presumably increasing serotonergic neurotransmission iii. Blocks norepinephrine reuptake pump (norepinephrine transporter), presumably increasing noradrenergic neurotransmission; presumably desensitizes both serotonin 1A receptors and beta adrenergic receptors iv. Since dopamine is inactivated by norepinephrine reuptake in frontal cortex, which largely lacks dopamine transporters, amitriptyline can increase dopamine neurotransmission in this part of the brain