Psychopharmacology 6630 Midterm Study Guide (Walden)

Serotonin regulates - ANSWER-Mood, emotion, feeding, and reproductive behavior This class of antidepressants binds to presynaptic SERT and inhibits them from reuptake of serotonin to increase levels in the synaptic cleft to bind with postsysnaptic 5HT2 receptors - ANSWER-SSRIs First line therapy for MDD due to milder side effect profiles - ANSWER-SSRIs Six Common SSRIs - ANSWER-citalopram, escitalopram, fluoxetine, fluvoxamine, sertraline, paroxetine Onset of therapeutic benefit from SSRIs - ANSWER-4-6 weeks In addition to MDD, SSRIs also treat - ANSWER-Chronic Anxiety, PTSD, OCD, and eating disorders (bulimia) Five Common side effects of SSRIs include - ANSWER-Anxiety, insomnia, GI distress, sexual dysfunction (ED), SIADH Severe side effect of SSRIs in children/adolescents under age 25 years old - ANSWER-suicidal ideation Life threatening adverse effect of SSRIs, especially when used in combination with other serotonergic drugs (SNRIs, TCAs, MAOIs, etc.) - ANSWER-Serotonin Syndrome Excess accumulation of serotonin resulting in overstimulation of the nervous system - ANSWER-Serotonin Syndrome Seven symptoms of Serotonin Syndrome - ANSWER-Flushing, hyperthermia, agitation, muscle rigidity, seizure, coma, HYPERreflexia The treatment for serotonin syndrome - ANSWER-Cyproheptadine (5-HT2 receptor antagonist) Cyproheptadine treats serotonin syndrome by - ANSWER-blocking 5-HT2 receptors (serotonin antagonist) When SSRIs or SNRIs are stopped abruptly, common symptoms of withdrawal include - ANSWER-Irritability, headaches, and insomnia Medicine specific side effect of citalopram - ANSWER-Prolonged QT interval (normal=0.4.-0.44 seconds) This SSRI is pregnancy category D due to associations with congenital heart defects - ANSWER-Paroxetine All SSRIs but paroxetine (D) are pregnancy category - ANSWER-C Three SSRIs that are inhibitors of Cytochrome P450 enzymes - ANSWER-fluoxetine, fluvoxamine, and paroxetine Five common SNRIs include - ANSWER-duloxetine, venlafaxine, desvenlafaxine, milnacipran, levomilnacipran This antidepressant class of medications works by binding to presynaptic SERT and NET to inhibit them from reuptake of serotonin and norepinephrine to increase their levels in the synaptic cleft - ANSWER-SNRIs In addition to MDD SNRIs treat - ANSWER-Anxiety and neuropathic pain (peripheral neuropathy) Medication specific indications of duloxetine: - ANSWER-urinary incontinence and Fibromyalgia Medication specific indications of venlafaxine: - ANSWER-social anxiety, panic disorders, PTSD, OCD, postmenopausal hot flashes Six common side effects of SNRIs include: - ANSWER-Insomnia, nausea, sexual dysfunction, hypertension, sweating, headaches Severe side effect of SNRIs in children/adolescents under age 25 years old: - ANSWER-suicidal ideation Life threatening adverse effect of SNRIs, especially when used in combination with other serotonergic drugs: - ANSWER-Serotonin Syndrome This SNRI is an inhibitor of Cytochrome P450 enzymes: - ANSWER-venlafaxine This SNRI is hepatotoxic: - ANSWER-duloxetine MAOIs increase the levels of: - ANSWER-Serotonin, Norepinephrine, and Dopamine Norepinephrine regulates: - ANSWER-alertness and focus Dopamine regulates: - ANSWER-cognitive function, motivation, and awakeness In the synaptic cleft, Monoamine Oxidase A breaks down: - ANSWER-Serotonin, Norepinephrine, and Dopamine In the synaptic cleft, Monoamine Oxidase B breaks down: - ANSWER-Dopamine MAOIs are especially effective in: - ANSWER-Atypical depression (mood responds to positive events and symptoms include increased appetite, weight gain, sleepiness, and fatigue) Non-selective MAOIs inhibit enzymes: - ANSWER-MAO-A and MAO-B Selective MAOIs only inhibit the enzyme: - ANSWER-MAO-B Three non-selective MAOIs: - ANSWER-isocarboxazid, phenelzine, tranylcypromine Non-selective MAOIs increase the levels of these neurotransmitters: - ANSWER-Serotonin, Norepinephrine, Dopamine These three non-selective MAOIs bind irreversibly to MAO enzymes to permanently block their function: - ANSWER-isocarboxazid, phenelzine, tranylcypromine Two selective MAOIs: - ANSWER-selegeline, rasagiline Selective MAOIs increase the level of this neurotransmitter: - ANSWER-Dopamine These selective MAOIs are more commonly prescribed to treat Parkinson's Disease (a neurodegenerative disorder that effects the dopaminergic neurons in the substantia nigra region of the brain): - ANSWER-selegeline, rasagiline Adverse effects of MAOIs include: - ANSWER-Serotonin syndrome and hypertensive crisis Before starting another antidepressant MAOIs should be stopped for at least: - ANSWER-Two weeks (to allow for the body to replace MAO enzymes so that serotonin syndrome does not occur) Five main symptoms of hypertensive crisis: - ANSWER-hyperthermia, hypertension, tachycardia, arrhythmias, agitation Hypertensive crisis commonly occurs when people taking MAOIs consume foods or drinks high in: - ANSWER-tyramine (cheese, wine, beer, cured/smoked meats) Foods and drinks rich in tyramine: - ANSWER-cheese, wine, beer, cured/smoked meats When uninhibited, these two enzymes are responsible for breaking down tyramine: - ANSWER-MAO-A and MAO-B When tyramine is not broken down, it increases the release of this neurotransmitter, which causes hypertensive crisis: - ANSWER-Norepinephrine Due to its action as an adrenergic antagonist this drug is the treatment of hypertensive crisis: - ANSWER-Phentolamine TCAs are subdivided into these two groups: - ANSWER-Tertiary TCAs and Secondary TCAs Three Tertiary TCAs: - ANSWER-amitriptyline, imipramine, clomipramine Two Secondary TCAs: - ANSWER-desipramine, nortriptyline Tertiary TCAs are non-selective and act on: - ANSWER-Serotonin and Norephinephrine transporters (increase 5HT and NE) Secondary TCAs are selective and act only on: - ANSWER-Norepinephrine transporters (increase NE) Therapeutic benefits from TCAs typically take approximately: - ANSWER-2-4 weeks In addition to treatment of depression, other indications for TCAs include: - ANSWER-Phobic disorders, chronic neuropathic pain, migraine prophylaxis Medication specific indication for clomipramine: - ANSWER-OCD Medication specific indication for imipramine: - ANSWER-Nocturnal enuresis In addition to SERTs and NETs, TCAs block (causes side effects): - ANSWER-Histamine (H1) receptors, Muscarinic receptors, and Alpha 1 receptors TCAs inhibitory effects on Histamine (H1) receptors results in this side effect: - ANSWER-sedation TCAs inhibitory effects on Muscarinic receptors results in this side effect profile: - ANSWER-anticholinergic side effects These TCAs more commonly cause anticholinergic side effects: - ANSWER-amitriptyline, imipramine, clomipramine (Tertiary TCAs) These are five main anticholinergic side effects: - ANSWER-dry mouth, tachycardia, urinary retention, confusion, hallucinations (common with Tertiary TCAs, amitriptyline, imipramine, clomipramine) TCAs inhibitory effects on Alpha 1 receptors results in this side effect: - ANSWER-orthostatic hypotension This class of antidepressants is especially cardiotoxic and may cause arrhythmias and prolonged QT interval: - ANSWER-TCAs Treatment of cardiotoxicity from TCAs: - ANSWER-Sodium Bicarbonate The three most common causes of death from TCAs (The 3C's): - ANSWER-Convulsion, Coma, and Cardiotoxicity This class of antidepressants inhibits Cytochrome P450 Enzymes: - ANSWER-TCAs Combining these substances with Cytochrome P450 enzyme inhibitors can result in severe respiratory depression and death due to toxic levels: - ANSWER-Ethanol and sedative hypnotics (benzos) These two neuron types have abundant Alpha 2 receptors: - ANSWER-Noradrenergic and Serotonergic When stimulated Alpha 2 receptors inhibit the activity of the presynaptic neuron and decrease the release of these two neurotransmitters: - ANSWER-Norepinephrine and Serotonin Six common Atypical Antidepressants used for individuals that did not respond to other antidepressants: - ANSWER-mirtazapine, trazadone, nefazodone, vilazodone, vortioxetine, bupropion This antidepressant effects Alpha 2 receptors, 5-HT2A receptors, 5-HT3A receptors, and Histamine H1 receptors: - ANSWER-mirtazapine The primary antidepressant action of this drug comes from inhibition of the Alpha 2 receptors, which reduces the inhibition of the synaptic neuron, and thus increases Norepinephrine and Serotonin release - ANSWER-mirtazapine As a Serotonin Antagonist, this Atypical Antidepressant blocks 5-HT2A and 5-HT3A receptors to increase the amount of Serotonin available to bind to 5-HT1A receptors which are more strongly linked to depression: - ANSWER-mirtazapine Mirtazapine's inhibition of 5-HT3A receptors reduces: - ANSWER-nausea and vomiting Mirtazapine's inhibition of Histamine H1 receptors causes: - ANSWER-sedation (could be desirable side effect for depressed individuals with insomnia) For depressed individuals with anorexia, increased appetite and weight gain, are possibly beneficial side effects of this Atypical Antidepressant: - ANSWER-mirtazapine As Serotonin Antagonists, these two Atypical Antidepressants block 5-HT2A receptors so that more Serotonin is available to bind to 5-HT1A receptors which are more strongly linked to depression: - ANSWER-trazodone and nefazodone In addition to inhibition of 5-HT2A receptors, these two Atypical Antidepressants increase levels of Serotonin in the synaptic cleft through weak inhibition of Serotonin reuptake transporters: - ANSWER-trazodone and nefazodone These two Atypical Antidepressants are strong H1 receptor inhibitors, and therefore commonly used to treat insomnia: - ANSWER-trazodone and nefazodone These two Atypical Antidepressants may cause orthostatic hypotension and priapism through Alpha-1 receptor inhibition: - ANSWER-trazodone and nefazodone In rare cases, this Atypical Antidepressant is known to cause severe liver damage: - ANSWER-nefazodone Similar to SSRIs, these two Atypical Antidepressants are strong inhibitors of Serotonin reuptake transporters on the presynaptic neuron: - ANSWER-vilazodone and vortioxetine These two Atypical Antidepressants bind to and stimulate 5-HT1A receptors: - ANSWER-vilazodone (partial agonist) and vortioxetine (full agonist) Vilazodone or Vortioxetine, which of these Atypical Antidepressants is a partial agonist?: - ANSWER-vilazodone Vilazodone or Vortioxetine, which of these Atypical Antidepressants is a full agonist?: - ANSWER-vortioxetine Since they enhance the effects of Serotonin through two different mechanisms, these two Atypical Antidepressants can cause serotonin syndrome: - ANSWER-vilazodone and vortioxetine Six common side effects of vilazodone (primarily anticholinergic, **unique to vilazodone**): - ANSWER-sedation, blurred vision, orthostatic hypotension, urinary retention, tachycardia, **weight gain** Six common side effects of vortioxetine (primarily anticholinergic, **unique to vortioxetine**): - ANSWER-sedation, blurred vision, orthostatic hypotension, urinary retention, tachycardia, **abnormal dreams** This Atypical Antidepressant does not have a serotonergic effect: - ANSWER-bupropion This Atypical Antidepressant binds to Norepinephrine and Dopamine reuptake transporters and inhibits them, leading to increased levels of 5HT and DA in their synaptic clefts: - ANSWER-bupropion In addition to SERT and DAT inhibition this Atypical Antidepressant blocks nicotinic (acetylcholine) receptors: - ANSWER-bupropion Due to inhibition of nicotinic (acetylcholine) receptors, this Atypical antidepressant is useful in smoking cessation: - ANSWER-bupropion This Atypical Antidepressant has the least sexual side effects of all the antidepressants: - ANSWER-bupropion Due to its noradrenergic (excitatory) effects, this Atypical Antidepressant may cause tachycardia, insomnia, and a lower seizure threshold: - ANSWER-bupropion These two neuron types have abundant Alpha 2 receptors: - ANSWER-Noradrenergic and Serotonergic When stimulated Alpha 2 receptors inhibit the activity of the presynaptic neuron and decrease the release of these two neurotransmitters: - ANSWER-Norepinephrine and Serotonin In addition to SERT and DAT inhibition this Atypical Antidepressant blocks nicotinic (acetylcholine) receptors: - ANSWER-bupropion Due to inhibition of nicotinic (acetylcholine) receptors, this Atypical antidepressant is useful in smoking cessation: - ANSWER-bupropion This Atypical Antidepressant has the least sexual side effects of all the antidepressants: - ANSWER-bupropion Due to it's noradrenergic (excitatory) effects, this Atypical Antidepressant may cause tachycardia, insomnia, and a lower seizure threshold: - ANSWER-bupropion Schizophrenia is suspected to be related to altered levels of this neurotransmitters: - ANSWER-Dopamine These are the two categories of Antipsychotics: - ANSWER-first generation (typical) and second generation (atypical) Within the brain, Dopamine is found in these four main Dopamine pathways: - ANSWER-Mesolimbic (motivation and desire), Mesocortical (emotions), Nigrostriatal (motor neurons, controls involuntary movements and coordination), and Tuberoinfundibular (releases Dopamine to limit the secretion of Prolactin)