CMN 548 MODULE 5 PSYCHOPHARMACOLOGY EXAM QUESTIONS AND ANSWERS VERIFIED 100% CORRECT

CMN 548 MODULE 5 PSYCHOPHARMACOLOGY EXAM QUESTIONS AND ANSWERS VERIFIED 100% CORRECT What does phase 1 of a nonclinical study entail and what is the goal? - ANSWER Initial introduction of the new drug to humans, usually in healthy volunteers. - 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 is the goal? - ANSWER -Initial controlled efficacy studies in patients with the disease or condition. - Determine optimal doses of the drug, common short term side effects and risks What does phase 3 of a nonclinical study entail and what is the goal? - ANSWER -Evaluate the overall risk-to-benefit relationship of the drug and to provide an 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 What does phase 4 of a nonclinical study entail and what is the goal? - ANSWER -- Drug has been approved, post marketing activities - Elucidate specific issues about a drug, which are considered important for optimal use but not essential to know before drug approval - Studies for approval of additional indications - Surveillance for adverse events Amisulpiride, fluphenazine, haloperidol, perphenazine, pimozide , and sulpiride are all classified by this mechanism of action. - ANSWER -Dopamine receptor antagonists. "Dopamine blockers" - Antipsychotics - Reduce positive episodes of psychotic episodes Chlorpromazine, loxapine, thioridazine are all classified by this mechanism of action. - ANSWER -Dopamine and serotonin receptor antagonists. Akathisia is a side effect of which medication class? - ANSWER -Dopamine D2 blockers - Amisulpiride, fluphenazine, haloperidol, perphenazine, pimozide , and sulpiride - Dopamine and serotonin blockers: Chlorpromazine, loxapine, thioridazine What is the most common acute manifestation of EPS? - ANSWER -Akathisia - inability to sit still, restlessness - Onset after 5 days - Treat with anticholinergics or can use propranolol What is the most effective treatment of EPS? - ANSWER -Anticholinergic agents - Can also use amantadine but is not a first line agent - Should try to reduce side effects by lowering dose of antipsychotic FIRST What are the main clinical features of Neuroleptic Malignant Syndrome? (NMS results from dopamine blockers) - ANSWER -- Hyperthermia - Severe muscular rigidity (PRESENTS AS THIS) - Autonomic instability (hyperthermia, tachycardia, high BP, tachypnea, diaphoresis) - Changing levels of consciousness *Often associated with elevations in creatinine phosphokinase (CPK) and aldolase What medication is effective in treating neuroleptic malignant syndrome and what is the dosing? - ANSWER -Dantrolene (Dantrium) IV 0.8-2.5 mg/kg every 6 hours - Max dailt dose 10mg/kg - Convert to oral when symptoms subside - Treatment normally lasts 5-10 days unless a long acting injectable medication was the cause What is the supportive treatment for neuroleptic malignant syndrome? (Aside from Dantrolene) - ANSWER -- Discontinue antipsychotics - Correct fluid and electrolyte imbalances - Treat fever, hyper and hypotension - Bromocriptine or Amantadine can be added Can antipsychotics be resumed after neuroleptic malignant syndrome resolves? - ANSWER -Yes - Preference for low potency medications What is tardive dyskinesia? - ANSWER -A movement disorder that can follow chronic treatment with antipsychotic medications. - Characterized by mouth and tongue movements, facial grimacing, irregular limb movements, slow writhing trunk movements What is the likely underlying cause of Tardive Dyskinesia? - ANSWER Increased sensitivity of dopamine receptors in the basal ganglia. Should dopamine blockers be increased to reduce tardive dyskinesia sympptoms? - ANSWER -Only if the movements are severe and incapacitating. - The disorder is most often not progressive and can improve in most patients. - Can be switched to dopamine-serotonin antagonists such as clozapine What are withdrawal emergent dyskinesias? - ANSWER -If patients have their dosages of antipsychotic medication either decreased or discontinued, abnormal movements may worsen temporarily or appear for the first time and then diminish. Which patient populations are at highest risk for tardive dyskinesia? - ANSWER -- Older women - Patients with affective disorders - 10-20% incidence in treatment 1 year How often should patients receiving dopamine blockers be evaluated for tardive dyskinesia? - ANSWER -Every 6 months - Can evaluate severity using the Abnormal Involuntary Movements Scale (AIMS) Why does clozapine (Clozaril, DSA antipsychotic) have a lower risk of tardive dyskinesia? - ANSWER -It does not result in the increased sensitivity of striatal D2 receptors, which is associated with typical neuroleptics and has been theorized to result in TD. What is the mechanism of action of the two medications approved for treatment of Tardive Dyskinesia? - ANSWER -VMAT2 inhibitors - Can be given in conjunction with antipsychotics What medication is contraindicaated in the treatment of antipsychotic induced hypotension? - ANSWER -Epinephrine - due to beta stimulation it worsens hypotension