NR 546 Final PRACTICE EXAM Psychopharmac
vc vc vc vc vc
ology
NR546 MIDTERM EXAM Q AND A
WhatvcshouldvcthevcPMHNPvcconsidervcwhenvcprescribingvcchemicalvcrestraints?vc-vcanswer---allergyvcstatus
-priorvcmedvchxvcforvcadversevcdrugvcreactionsvcr/tvcthevcmedsvcorderedvcinvcthevcchemicalvcrestraint
-statevcregulationsvcregardingvcchemicalvcrestrainsvcmustvcbevcreviewed
ArevcthevcPMHNPvcandvcothervcstaffvcliablevcifvcthevcclientvchasvcanvcallergicvcreactionvcorvcadversevcsidevceffectsvctovcthev
ugsvcusedvcforvcchemicalvcrestraint?vc-vcanswer--No.
Thevcclientvchasvcbeenvccourt-
orderedvctovctakevcthevcprescribedvcmedicationsvcandvcthevcstandingvcordervcforvcchemicalvcrestraintsvcisvcapproved.vcTh
PMHNPvcandvcothervcstaffvcarevcnotvcliablevcifvcthevcpatientvchasvcanvcallergicvcreactionvcorvcadversevcsidevceffects.
HowvcdoesvcreviewingvcthevcgeneticvcmakeupvcofvcavcclientvchelpvcguidevcthevcPMHNPvcinvcselectingvcmedicationvcforvccli
ts?vc-vcanswer---
Geneticvctestingvccanvcassistvcbyvcprovidingvcmorevcinformationvconvchowvcclientsvcmayvcrespondvctovccertainvcpsychotro
cvcmedications
-
providesvcinformationvconvchowvcavcclientvcmayvcbreakvcdownvcandvcmetabolizevcmedicationsvcbasedvconvcthevccytochro
evcP450vcsystem.
TanrıkuluvcandvcErbaşvc(2020)vcinvestigatedvcidenticalvctwinsvctovcdeterminevcthevcpresencevcofvcanvcinheritedvclinkvcforv
hizophreniavcandvcwhyvconevctwinvcmayvcdevelopvcschizophreniavcwhenvcthevcothervcdoesvcnot.vcWhenvctwovcpeoplevcha
vc100%vcidenticalvcDNA,vcwhyvcdon'tvcbothvcpersonsvcdevelopvcthevcexactvcillnesses?
vcStudiesvcofvcidenticalvcDanishvctwinsvcfoundvcthatvcifvconevctwinvchadvcschizophrenia,vcthevcothervctwinvchadvcavc50%vclife
mevcriskvcofvcdevelopingvcschizophreniavc(Lemvighvcetvcal.,vc2020).vcWhyvcisvctherevconlyvchalfvcthevcrisk?vc-vcanswer--
Bothvcenvironmentalvcandvcpsychosocialvcstressorsvccanvcimpactvcmentalvchealth.vcAlthoughvctwinsvcmayvchavevcidentic
vcgenes,vctheirvcgenevcexpressionvcmayvcbevcdifferent.
Therevcmayvcbevcanvcenvironmentalvcexposurevcthatvcturnedvcavcgenevc"on"vcthatvcshouldvchavevcbeenvc"off"vcforvconevctw
ctovcdevelopvcschizophreniavcandvcnotvcthevcother.
centralvcsulcusvc-vcanswer--separatesvcthevcfrontalvclobevcfromvcthevcparietalvclobe
frontalvclobevc-vcanswer--associatedvcwithvcmovement,vcintelligence,vcabstractvcthinking
broca'svcareavc-vcanswer--speechvcproduction
temporalvclobevc-vcanswer--involvesvcobjectvcidentificationvcandvcauditoryvcsignals
cerebellumvc-vcanswer--coordination
wernicke'svcareavc-vcanswer--speechvccomprehension
occipitalvclobevc-vcanswer--primaryvcvisualvcarea
parietalvclobevc-vcanswer--keepsvcusvcalertvctovcwhatvcisvcgoingvconvcaroundvcus
1vc/
vc42
, NR 546 Final PRACTICE EXAM Psychopharmac
vc vc vc vc vc
ology
sensoryvccortexvc-vcanswer--pain,vcheat,vcandvcothervcsensations
motorvccortexvc-vcanswer--movement
hippocampusvc-vcanswer--involvedvcinvcbothvcmemoryvcandvcanxiety
nucleusvcaccumbensvc-vcanswer--involvedvcinvcthevcrewardvcprocess
thalamusvc-vcanswer--involvedvcinvcsensoryvcorganvcandvcmotorvccommandvcprocessing
striatumvc-vcanswer--involvedvcinvccomplexvcmotorvcactions,vcalsovclinksvccognitionvctovcmotorvcactions
limbicvcsystemvc-vcanswer--includesvccircuitsvcthatvcarevcassociatedvcwithvcpleasurevcandvcreward
basalvcgangliavc-vcanswer--groupvcofvcstructuresvcinvolvedvcinvcvoluntaryvcmotorvcmovements
amygdalavc-vcanswer--involvedvcinvcemotionalvcregulationvcandvcperceptionvcofvcodors
corpusvccallosumvc-vcanswer--controlsvcthevccommunicationvcbetweenvcthevctwovcbrainvchemispheres
whitevcmattervc-vcanswer--
containsvcnervevcfibersvcthatvcconnectvcneuronsvcfromvcdifferentvcregionsvcintovcfunctionalvccircuits
greyvcmattervc-vcanswer--containsvcnervevccellsvcandvcdendrites
brainvctissuevc-vcanswer--madevcupvcofvcgreyvcmattervcandvcwhitevcmatter
dorsalvcstriatumvc-vcanswer--involvedvcinvccomplexvcmotorvcactionsvcandvclinkagevcofvccognitionvctovcmotorvcactions
-mainvcinputvcareavcforvcbasalvcganglia
*activatedvcwhenvcanticipatingvcorvcengagingvcinvcpleasure
Thevcfieldvcofvcepigeneticsvcisvcrapidlyvcgrowingvcandvccanvchelpvcexplainvchowvcgenevcexpressionvcis:vc-vcanswer--
influencedvcbyvcenvironmentalvcfactorsvcandvchowvcepigeneticsvccontributesvctovcthevcmanifestationvcofvcmentalvcillness
Howvcdoesvcepigeneticsvcimpactvcavcperson'svcmentalvchealth?vc-vcanswer--
internalvcorvcexternalvcfactorsvcactivatevcportionsvcofvcthevcgenomevcthatvcresultvcinvcthevcmanifestationvcofvcmentalvchealt
symptoms
-
activationvcisvcoftenvcavcresultvcofvcavcstressfulvcevent,vcwhich,vcwhenvccombinedvcwithvcthevcgeneticvcrisk,vcresultsvcinvcthe
isease
-genesvcbeingvconvcorvcoff
-
occurrencevcofvcsymptomsvcmayvcbevcthevcresultvcofvcinheritancevcofvcanvcabnormalvcgenevcorvcofvcnormalvcgenesvcbeing
on"vcwhenvctheyvcshouldvcbevc"off."
Typesvcofvcepigeneticvcchanges:vc-vcanswer--DNAvcMethylation
Histonevcmodification
Non-codingvcRNA
Thevcpotentialvclegalvcandvcethicalvcissuesvcimpactingvcmentalvchealthvctreatmentvcmustvcalsovcbevctakenvcintovcaccount,
cluding:vc-vcanswer---informedvcconsent
2vc/
vc42
, NR 546 Final PRACTICE EXAM Psychopharmac
vc vc vc vc vc
ology
-competencevctovcmakevchealthcarevcdecisions
-off-labelvcprescribing
Informedvcconsentvc-vcanswer--
Clientsvchavevcthevcrightvctovcreceivevcenoughvcinformationvctovcmakevcdecisionsvcaboutvctreatment.vc
-mustvcalsovcbevcinformedvcaboutvcpotentialvcrisksvcassociatedvcwithvcmedications.vc
-havevcthevcrightvctovcrefusevctreatment
-cannotvcbevcforciblyvcmedicatedvcinvcnon-
emergencies.vcHowever,vcclientsvccanvcbevcforciblyvcmedicatedvcifvctheyvcarevcviolentvctowardvcthemselvesvcorvcothersvca
dvcwhenvclessvcrestrictivevcmethodsvchavevcfailed
Compliancevc-vcanswer--
Avccourtvcordervcmayvcbevcissuedvcforvcavcclientvctovcreceivevctreatmentvcagainstvctheirvcwishesvcifvctheyvcarevcconsideredv
dangervctovcthemselvesvcorvcothers.
-Examples:vcclientsvcwithvcschizophreniavcorvcsexvcoffenders
-
Guardiansvccanvcprovidevcconsentvcforvcclientsvcwhovchavevclimitedvccognitivevccapabilitiesvcorvcarevcincompetentvctovcm
evcdecisions
-PMHNPsvcarevcresponsiblevcforvcbeingvcknowledgeablevcaboutvctheirvcstatevclawsvcandvcabidingvcbyvcthem.
Off-LabelvcPrescribingvc-vcanswer--
Somevcclientsvcmayvcbenefitvcfromvcthevcunapprovedvcusevcofvcavcdrugvcforvcsymptomvcmanagement.vc
-Example:vcmanyvcSSRIsvcusedvctovctxvcanxietyvcandvcOCDvcbutvcarevcnotvcFDAvcapprovedvcforvcusevcinvcthisvcdisorder.vc
-potentiallyvcraisesvcethicalvcandvclegalvcconcerns
-PMHNPvcmustvcremainvcupvctovcdatevcwithvcthevclatestvcrecommendationsvcforvcoff-labelvcprescribing.
Incidencevcofvcmentalvcillness-whatvcfactorsvcarevcincreasingvcthevcincidencevc-vcanswer--
Psychologicalvcandvcsociologicalvcfactors
Lifestylevcfactorsvcsuchvcasvcavcclient'svcsmokingvcstatus,vcdiet,vcexercise,vchistoryvcofvcmedicationvcadherence,vcorvchisto
vcofvcaddictionvcshouldvcbevcconsideredvcwhenvcprescribingvcpsychotropicvcmedications
Adherencevc-vcanswer--Persistence
-takingvcmedvcovervcintendedvctimevcperiod
Compliance
-takingvcmedvcasvcprescribed
leftvchemispherevc-vcanswer---speechvccomprehension
-wordvcrecognition
-grammar
-sequentialvcprocessing
-recognitionvcofvcdetail
-consciousvcmentalvcprocessing
rightvchemispherevc-vcanswer---prosodyvcofvcspeech
-emotionalvcmodulation
-visual-spatialvcskills
-recognitionvcofvcfacialvcexpression
-music
-abstractvcmathematicalvcskills
-holisticvcprocessing
3vc/
vc42
, NR 546 Final PRACTICE EXAM Psychopharmac
vc vc vc vc vc
ology
-unconsciousvcmentalvcprocessing
Pharmacokineticsvc-vcanswer--
thevcstudyvcofvcwhatvchappensvctovcavcdrugvcfromvcthevctimevcofvcadministrationvcuntilvcthevcparentvcdrugvcandvcallvcmetabo
esvcleavevcthevcbody
CYP450vc-vcanswer--
CYP450vcenzymesvcinvcthevcgutvcwallvcorvclivervcconvertvcdrugvcsubstratevcintovcavcbiotransformedvcproductvcinvcthevcbloo
tream,vcresponsiblevcforvcdegradatingvcofvcavclargevc#vcofvcpsychotropicvcdrugs
-Notvcallvcind.vchavevcsamevcgeneticvcformvcofvcCYP450vcenzymes,vcdeterminedvcwithvcpharmacogeneticvctesting
*Mostvcindividualsvchavevc"normal"vcratesvcofvcdrugvcmetabolismvcfromvcthevcmajorvcCYP450vcenzymesvcandvcarevcsaidv
cbevc"extensivevcmetabolizers", vcmostvcdrugvcdosesvcarevcsetvcforvcthesevcindividuals.
*geneticvcvariantsvcofvcthesevcenzymesvccanvcmakevcpoorvcmetabolizersvcorvcultravcrapidvcmetabolizers
Fivevcofvcthevcmostvcimportant:
CYP450vc1A2,vc2B6,vc2D6,vc2C9,vc2C19,vcandvc3A4.
ultravcrapidvcmetabolizersvc-vcanswer--elevatedvcenzymevcactivity
subtherapeuticvcdrugvclevels
poorvcefficacyvcwithvcstandardvcdoses
genotypingvc-vcanswer--thevcpatientvcforvcpharmacogenomicvcuse
-
genesvcforvcthesevcCYP450vcenzymesvccanvcnowvcbevcreadilyvcmeasuredvcandvcusedvctovcpredictvcwhichvcpatientsvcmigh
needvctovchavevcdosagevcadjustments
-measurementvcofvcgenesvcforvcdrugvcmetabolism
mostvccommonvctargetsvcofvcpsychotropicvcdrugsvc-vcanswer--G-proteinvcreceptors
-
Drugvcactionsvcatvcthesevcreceptorsvcoccurvcinvcavcspectrum,vcfromvcfullvcagonistvcactions,vctovcpartialvcagonistvcactions,vc
antagonism,vcandvcevenvctovcinversevcagonism.
Pharmacokineticsvcconceptsvc-vcanswer--absorption
distribution
metabolism
excretion
FlockhartvcTablevc-vcanswer--drugvcinteractionsvcthatvcarevcmediatedvcbyvccytochromevcP450vcenzymes
comprehensivevclistvcofvcdrugsvcandvcthevcinteractionsvcrelatedvctovcthevccytochromevcP450vcsystem
Neurotransmittersvc-vcanswer--
chemicalsvcreleasedvcbyvcneuronsvctovcsendvccommunicationvcacrossvcsynapticvccleftsvctovcothervcneurons
-impactvchumanvcemotionvcandvcbehavior
Neurotransmission:vc-vcanswer--
thevcchemicalvctransmissionvcofvcinformationvcbetweenvcneuronsvcandvctheirvctargetvccells
-
thevcchemicals,vcorvcneurotransmitters,vcarevcreleasedvcfromvctheirvctransportvcvesiclesvctovcbindvcwithvcreceptorvcsitesvct
performvctheirvcduties,vcwhichvcarevcexcitatoryvcorvcinhibitory
4vc/
vc42
vc vc vc vc vc
ology
NR546 MIDTERM EXAM Q AND A
WhatvcshouldvcthevcPMHNPvcconsidervcwhenvcprescribingvcchemicalvcrestraints?vc-vcanswer---allergyvcstatus
-priorvcmedvchxvcforvcadversevcdrugvcreactionsvcr/tvcthevcmedsvcorderedvcinvcthevcchemicalvcrestraint
-statevcregulationsvcregardingvcchemicalvcrestrainsvcmustvcbevcreviewed
ArevcthevcPMHNPvcandvcothervcstaffvcliablevcifvcthevcclientvchasvcanvcallergicvcreactionvcorvcadversevcsidevceffectsvctovcthev
ugsvcusedvcforvcchemicalvcrestraint?vc-vcanswer--No.
Thevcclientvchasvcbeenvccourt-
orderedvctovctakevcthevcprescribedvcmedicationsvcandvcthevcstandingvcordervcforvcchemicalvcrestraintsvcisvcapproved.vcTh
PMHNPvcandvcothervcstaffvcarevcnotvcliablevcifvcthevcpatientvchasvcanvcallergicvcreactionvcorvcadversevcsidevceffects.
HowvcdoesvcreviewingvcthevcgeneticvcmakeupvcofvcavcclientvchelpvcguidevcthevcPMHNPvcinvcselectingvcmedicationvcforvccli
ts?vc-vcanswer---
Geneticvctestingvccanvcassistvcbyvcprovidingvcmorevcinformationvconvchowvcclientsvcmayvcrespondvctovccertainvcpsychotro
cvcmedications
-
providesvcinformationvconvchowvcavcclientvcmayvcbreakvcdownvcandvcmetabolizevcmedicationsvcbasedvconvcthevccytochro
evcP450vcsystem.
TanrıkuluvcandvcErbaşvc(2020)vcinvestigatedvcidenticalvctwinsvctovcdeterminevcthevcpresencevcofvcanvcinheritedvclinkvcforv
hizophreniavcandvcwhyvconevctwinvcmayvcdevelopvcschizophreniavcwhenvcthevcothervcdoesvcnot.vcWhenvctwovcpeoplevcha
vc100%vcidenticalvcDNA,vcwhyvcdon'tvcbothvcpersonsvcdevelopvcthevcexactvcillnesses?
vcStudiesvcofvcidenticalvcDanishvctwinsvcfoundvcthatvcifvconevctwinvchadvcschizophrenia,vcthevcothervctwinvchadvcavc50%vclife
mevcriskvcofvcdevelopingvcschizophreniavc(Lemvighvcetvcal.,vc2020).vcWhyvcisvctherevconlyvchalfvcthevcrisk?vc-vcanswer--
Bothvcenvironmentalvcandvcpsychosocialvcstressorsvccanvcimpactvcmentalvchealth.vcAlthoughvctwinsvcmayvchavevcidentic
vcgenes,vctheirvcgenevcexpressionvcmayvcbevcdifferent.
Therevcmayvcbevcanvcenvironmentalvcexposurevcthatvcturnedvcavcgenevc"on"vcthatvcshouldvchavevcbeenvc"off"vcforvconevctw
ctovcdevelopvcschizophreniavcandvcnotvcthevcother.
centralvcsulcusvc-vcanswer--separatesvcthevcfrontalvclobevcfromvcthevcparietalvclobe
frontalvclobevc-vcanswer--associatedvcwithvcmovement,vcintelligence,vcabstractvcthinking
broca'svcareavc-vcanswer--speechvcproduction
temporalvclobevc-vcanswer--involvesvcobjectvcidentificationvcandvcauditoryvcsignals
cerebellumvc-vcanswer--coordination
wernicke'svcareavc-vcanswer--speechvccomprehension
occipitalvclobevc-vcanswer--primaryvcvisualvcarea
parietalvclobevc-vcanswer--keepsvcusvcalertvctovcwhatvcisvcgoingvconvcaroundvcus
1vc/
vc42
, NR 546 Final PRACTICE EXAM Psychopharmac
vc vc vc vc vc
ology
sensoryvccortexvc-vcanswer--pain,vcheat,vcandvcothervcsensations
motorvccortexvc-vcanswer--movement
hippocampusvc-vcanswer--involvedvcinvcbothvcmemoryvcandvcanxiety
nucleusvcaccumbensvc-vcanswer--involvedvcinvcthevcrewardvcprocess
thalamusvc-vcanswer--involvedvcinvcsensoryvcorganvcandvcmotorvccommandvcprocessing
striatumvc-vcanswer--involvedvcinvccomplexvcmotorvcactions,vcalsovclinksvccognitionvctovcmotorvcactions
limbicvcsystemvc-vcanswer--includesvccircuitsvcthatvcarevcassociatedvcwithvcpleasurevcandvcreward
basalvcgangliavc-vcanswer--groupvcofvcstructuresvcinvolvedvcinvcvoluntaryvcmotorvcmovements
amygdalavc-vcanswer--involvedvcinvcemotionalvcregulationvcandvcperceptionvcofvcodors
corpusvccallosumvc-vcanswer--controlsvcthevccommunicationvcbetweenvcthevctwovcbrainvchemispheres
whitevcmattervc-vcanswer--
containsvcnervevcfibersvcthatvcconnectvcneuronsvcfromvcdifferentvcregionsvcintovcfunctionalvccircuits
greyvcmattervc-vcanswer--containsvcnervevccellsvcandvcdendrites
brainvctissuevc-vcanswer--madevcupvcofvcgreyvcmattervcandvcwhitevcmatter
dorsalvcstriatumvc-vcanswer--involvedvcinvccomplexvcmotorvcactionsvcandvclinkagevcofvccognitionvctovcmotorvcactions
-mainvcinputvcareavcforvcbasalvcganglia
*activatedvcwhenvcanticipatingvcorvcengagingvcinvcpleasure
Thevcfieldvcofvcepigeneticsvcisvcrapidlyvcgrowingvcandvccanvchelpvcexplainvchowvcgenevcexpressionvcis:vc-vcanswer--
influencedvcbyvcenvironmentalvcfactorsvcandvchowvcepigeneticsvccontributesvctovcthevcmanifestationvcofvcmentalvcillness
Howvcdoesvcepigeneticsvcimpactvcavcperson'svcmentalvchealth?vc-vcanswer--
internalvcorvcexternalvcfactorsvcactivatevcportionsvcofvcthevcgenomevcthatvcresultvcinvcthevcmanifestationvcofvcmentalvchealt
symptoms
-
activationvcisvcoftenvcavcresultvcofvcavcstressfulvcevent,vcwhich,vcwhenvccombinedvcwithvcthevcgeneticvcrisk,vcresultsvcinvcthe
isease
-genesvcbeingvconvcorvcoff
-
occurrencevcofvcsymptomsvcmayvcbevcthevcresultvcofvcinheritancevcofvcanvcabnormalvcgenevcorvcofvcnormalvcgenesvcbeing
on"vcwhenvctheyvcshouldvcbevc"off."
Typesvcofvcepigeneticvcchanges:vc-vcanswer--DNAvcMethylation
Histonevcmodification
Non-codingvcRNA
Thevcpotentialvclegalvcandvcethicalvcissuesvcimpactingvcmentalvchealthvctreatmentvcmustvcalsovcbevctakenvcintovcaccount,
cluding:vc-vcanswer---informedvcconsent
2vc/
vc42
, NR 546 Final PRACTICE EXAM Psychopharmac
vc vc vc vc vc
ology
-competencevctovcmakevchealthcarevcdecisions
-off-labelvcprescribing
Informedvcconsentvc-vcanswer--
Clientsvchavevcthevcrightvctovcreceivevcenoughvcinformationvctovcmakevcdecisionsvcaboutvctreatment.vc
-mustvcalsovcbevcinformedvcaboutvcpotentialvcrisksvcassociatedvcwithvcmedications.vc
-havevcthevcrightvctovcrefusevctreatment
-cannotvcbevcforciblyvcmedicatedvcinvcnon-
emergencies.vcHowever,vcclientsvccanvcbevcforciblyvcmedicatedvcifvctheyvcarevcviolentvctowardvcthemselvesvcorvcothersvca
dvcwhenvclessvcrestrictivevcmethodsvchavevcfailed
Compliancevc-vcanswer--
Avccourtvcordervcmayvcbevcissuedvcforvcavcclientvctovcreceivevctreatmentvcagainstvctheirvcwishesvcifvctheyvcarevcconsideredv
dangervctovcthemselvesvcorvcothers.
-Examples:vcclientsvcwithvcschizophreniavcorvcsexvcoffenders
-
Guardiansvccanvcprovidevcconsentvcforvcclientsvcwhovchavevclimitedvccognitivevccapabilitiesvcorvcarevcincompetentvctovcm
evcdecisions
-PMHNPsvcarevcresponsiblevcforvcbeingvcknowledgeablevcaboutvctheirvcstatevclawsvcandvcabidingvcbyvcthem.
Off-LabelvcPrescribingvc-vcanswer--
Somevcclientsvcmayvcbenefitvcfromvcthevcunapprovedvcusevcofvcavcdrugvcforvcsymptomvcmanagement.vc
-Example:vcmanyvcSSRIsvcusedvctovctxvcanxietyvcandvcOCDvcbutvcarevcnotvcFDAvcapprovedvcforvcusevcinvcthisvcdisorder.vc
-potentiallyvcraisesvcethicalvcandvclegalvcconcerns
-PMHNPvcmustvcremainvcupvctovcdatevcwithvcthevclatestvcrecommendationsvcforvcoff-labelvcprescribing.
Incidencevcofvcmentalvcillness-whatvcfactorsvcarevcincreasingvcthevcincidencevc-vcanswer--
Psychologicalvcandvcsociologicalvcfactors
Lifestylevcfactorsvcsuchvcasvcavcclient'svcsmokingvcstatus,vcdiet,vcexercise,vchistoryvcofvcmedicationvcadherence,vcorvchisto
vcofvcaddictionvcshouldvcbevcconsideredvcwhenvcprescribingvcpsychotropicvcmedications
Adherencevc-vcanswer--Persistence
-takingvcmedvcovervcintendedvctimevcperiod
Compliance
-takingvcmedvcasvcprescribed
leftvchemispherevc-vcanswer---speechvccomprehension
-wordvcrecognition
-grammar
-sequentialvcprocessing
-recognitionvcofvcdetail
-consciousvcmentalvcprocessing
rightvchemispherevc-vcanswer---prosodyvcofvcspeech
-emotionalvcmodulation
-visual-spatialvcskills
-recognitionvcofvcfacialvcexpression
-music
-abstractvcmathematicalvcskills
-holisticvcprocessing
3vc/
vc42
, NR 546 Final PRACTICE EXAM Psychopharmac
vc vc vc vc vc
ology
-unconsciousvcmentalvcprocessing
Pharmacokineticsvc-vcanswer--
thevcstudyvcofvcwhatvchappensvctovcavcdrugvcfromvcthevctimevcofvcadministrationvcuntilvcthevcparentvcdrugvcandvcallvcmetabo
esvcleavevcthevcbody
CYP450vc-vcanswer--
CYP450vcenzymesvcinvcthevcgutvcwallvcorvclivervcconvertvcdrugvcsubstratevcintovcavcbiotransformedvcproductvcinvcthevcbloo
tream,vcresponsiblevcforvcdegradatingvcofvcavclargevc#vcofvcpsychotropicvcdrugs
-Notvcallvcind.vchavevcsamevcgeneticvcformvcofvcCYP450vcenzymes,vcdeterminedvcwithvcpharmacogeneticvctesting
*Mostvcindividualsvchavevc"normal"vcratesvcofvcdrugvcmetabolismvcfromvcthevcmajorvcCYP450vcenzymesvcandvcarevcsaidv
cbevc"extensivevcmetabolizers", vcmostvcdrugvcdosesvcarevcsetvcforvcthesevcindividuals.
*geneticvcvariantsvcofvcthesevcenzymesvccanvcmakevcpoorvcmetabolizersvcorvcultravcrapidvcmetabolizers
Fivevcofvcthevcmostvcimportant:
CYP450vc1A2,vc2B6,vc2D6,vc2C9,vc2C19,vcandvc3A4.
ultravcrapidvcmetabolizersvc-vcanswer--elevatedvcenzymevcactivity
subtherapeuticvcdrugvclevels
poorvcefficacyvcwithvcstandardvcdoses
genotypingvc-vcanswer--thevcpatientvcforvcpharmacogenomicvcuse
-
genesvcforvcthesevcCYP450vcenzymesvccanvcnowvcbevcreadilyvcmeasuredvcandvcusedvctovcpredictvcwhichvcpatientsvcmigh
needvctovchavevcdosagevcadjustments
-measurementvcofvcgenesvcforvcdrugvcmetabolism
mostvccommonvctargetsvcofvcpsychotropicvcdrugsvc-vcanswer--G-proteinvcreceptors
-
Drugvcactionsvcatvcthesevcreceptorsvcoccurvcinvcavcspectrum,vcfromvcfullvcagonistvcactions,vctovcpartialvcagonistvcactions,vc
antagonism,vcandvcevenvctovcinversevcagonism.
Pharmacokineticsvcconceptsvc-vcanswer--absorption
distribution
metabolism
excretion
FlockhartvcTablevc-vcanswer--drugvcinteractionsvcthatvcarevcmediatedvcbyvccytochromevcP450vcenzymes
comprehensivevclistvcofvcdrugsvcandvcthevcinteractionsvcrelatedvctovcthevccytochromevcP450vcsystem
Neurotransmittersvc-vcanswer--
chemicalsvcreleasedvcbyvcneuronsvctovcsendvccommunicationvcacrossvcsynapticvccleftsvctovcothervcneurons
-impactvchumanvcemotionvcandvcbehavior
Neurotransmission:vc-vcanswer--
thevcchemicalvctransmissionvcofvcinformationvcbetweenvcneuronsvcandvctheirvctargetvccells
-
thevcchemicals,vcorvcneurotransmitters,vcarevcreleasedvcfromvctheirvctransportvcvesiclesvctovcbindvcwithvcreceptorvcsitesvct
performvctheirvcduties,vcwhichvcarevcexcitatoryvcorvcinhibitory
4vc/
vc42
