NSG552. / Psychopharmacology. / Exam. / 1
1. What./are./the./6./general./principles./of./psychopharmacological./treatment?:./-
Safety./Tol
erability./Ef
lcacy./Prac
ticality
Treatment./accessibility./Treat
ment./compliance
2. Pharmacokinetics:./How./the./drug./moves./in./the./body../(ex../Where./is./it./absorbed?./How./and./where./is.
/it./metabolized?./Where./is./it./excreted?)
3. Pharmacodynamics:./What./the./drug./does./to./the./body../(consider./mechanism./of./action)
4. Define./First-
generation./antipsychotics:./Referred./to./as./Typical./Antipsychotics../Most./have./strong./bond./with./D2./re
ceptors./only,./cause./EPS./symptoms./faster./due./to./prolonged./receptor./dissociation,./have./more./dangerous./side./ette
ct./profiles,./have./been./around./longer,./more./ettective./at./treating./positive./symptoms,./less./expensive.. / (Ex../Haloperidol
,./Chlorpromazine,./Thioridazine,./Fluphenazine)
5. Define./Second-
generation./antipsychotics:./Referred./to./as./Atypical./Antipsychotics../Most./have./a./weak./bond./with./D2.
/receptors./and./block./serotonin./receptors./leading./to./anti-
depressive./and./anxiolytic./ettects../They./cause./less./EPS./due./to./rapid./receptor./disassociation./which./leads./to./rapid.
/dopamine./neurotransmission../Have./less./dangerous./side./ettect./profiles./but./can./cause./metabolic./syndromes,./have
./been./around./shorter./time,./more./expensive,./more./ettective./at./treating./negative./symptoms./but./can./treat./positive./sy
mptoms./as./well,./long-
acting./injections./available. / for./several./of./these../(Ex../Risperidone,./Clozapine,./Quetiapine,./Aripiprazole,./Ziprasidon
e)
6. Extra./Pyramidal./Symptoms./(EPS):./Side./ettects./caused./by./certain./antipsychotic./medications,./which./
include:./involuntary./or./uncontrollable./movements../tremors../muscle./contractions.
7. Tardive./dyskinesia:./A./neurological./disorder./characterize./by./involuntary./movement./of./the./face./and./jaw.
8. Upregulation:./Occurs./through./chronic./use./of./antagonists./which./causes./an./increase./in./the./number./of./
receptors,./externalization./of./receptors,./and./increased./sensitivity./of./the./receptors../Prolonged./use./of./antagonist./
->./Up-regulation./of./receptors./->./Sudden./withdrawal./of./antagonist./-
>./increased./number./of./receptors./and./increased./sensitivity./of./receptors./*YOU./MUST./GRADUALLY./TAPER./A./DRUG
./TO./AVOID./BINDING./TO./ALL./NEW./RECEPTORS./FROM./UPREGULATION
, NSG552. / Psychopharmacology. / Exam. / 1
9. Down. / regulation:. / Occurs./by./chronic./exposure./of./agonists./which./causes./decreased./number./of./receptor
s,./internalization./of./receptors,./and./decreased./sensitivity./of./the./receptors../Prolonged./use./of./agonist./->./down-
regulation./of./receptors./->./decreased./ettectiveness./of./agonist./mediated./clinical./response.
, NSG552. / Psychopharmacology. / Exam. / 1
You./have./two./options:
1./Increase./the./drug./dose./OR./2./Switch./to./another./drug(BEST./OPTION)
10. Receptor./profile:./The./receptors./that./each./drug./binds./to
./(example,./risperidone's./receptor./profile./would./like...
(a) Blockade./of./5HT2A./and./D2./receptors
(b) High./aflnity./for./a1,./a2,./and./H1./receptors)
11. Binding:. / Refers./to./a./drug./metabolite./or./neurotransmitter./attaching./to./a./receptor
12. Affinity:./refers./to./the./"preference"./or./likelihood./of./a./drug./to./bind./to./a./certain./receptor../Linked./to./potency.
13. CYP450:./A./group./of./enzymes./in./the./liver./that./metabolize./ditterent./drugs../There./are./six.
14. List./ the./7./CYP450./Enzymes:./(1)./CYP1A2
(2) CYP2B6
(3) CYP2C9
(4) CYP2C19
(5) CYP2D6
(6) CYP3A4
(7) CYP2EI
15. CYP2B6:./Metabolizes./arteminsin,./bupropion,./cyclophosphamide,./efavirenz,./ketamine,./and./methadone./(2B6,
./there./are./two./psych./drugs./(bupropion,./methadone./(ketamine...?)./and./six./altogether.
16. CYP1A2:. / metabolizes. / AcetAminophen. / (two. / As)
17. CYP2C9:./ metabolizes./Warfarin/Coumadin./(think./warfarin./factors./2,./C,./9)
18. CYP2C19:./metabolizes./PPIs,./antidepressants,./antiplatelet,./antifungals,./and./anticancer./drugs./(2C19,./two./se
e./one,./there./is./only./one./class./of./psych./drugs./that./are./metabolized,./you./ONLY./SEE./one!./antidepressants)
19. CYP2D6:. / Metabolizes./Cardiovascular./drugs./(2-D./echo,./echo./is./a./test./for./heart)
20. CYP3A4:./Most./common./and./ambiguous./(if./not./above,./then./it's./this./one,./a./lot./of./psych./drugs./are./involved./w
ith./this./one)
21. CYP2EI:./ETOH./(You./have./to./be./21./to./drink)
22. CYP450. / inhibitors:. / Decreases./drug./metabolism:
(1) Valproate
(2) Ketoconazole
(3) Isoniazid
(4) Sulfonamides
(5) Chloramphenicol
1. What./are./the./6./general./principles./of./psychopharmacological./treatment?:./-
Safety./Tol
erability./Ef
lcacy./Prac
ticality
Treatment./accessibility./Treat
ment./compliance
2. Pharmacokinetics:./How./the./drug./moves./in./the./body../(ex../Where./is./it./absorbed?./How./and./where./is.
/it./metabolized?./Where./is./it./excreted?)
3. Pharmacodynamics:./What./the./drug./does./to./the./body../(consider./mechanism./of./action)
4. Define./First-
generation./antipsychotics:./Referred./to./as./Typical./Antipsychotics../Most./have./strong./bond./with./D2./re
ceptors./only,./cause./EPS./symptoms./faster./due./to./prolonged./receptor./dissociation,./have./more./dangerous./side./ette
ct./profiles,./have./been./around./longer,./more./ettective./at./treating./positive./symptoms,./less./expensive.. / (Ex../Haloperidol
,./Chlorpromazine,./Thioridazine,./Fluphenazine)
5. Define./Second-
generation./antipsychotics:./Referred./to./as./Atypical./Antipsychotics../Most./have./a./weak./bond./with./D2.
/receptors./and./block./serotonin./receptors./leading./to./anti-
depressive./and./anxiolytic./ettects../They./cause./less./EPS./due./to./rapid./receptor./disassociation./which./leads./to./rapid.
/dopamine./neurotransmission../Have./less./dangerous./side./ettect./profiles./but./can./cause./metabolic./syndromes,./have
./been./around./shorter./time,./more./expensive,./more./ettective./at./treating./negative./symptoms./but./can./treat./positive./sy
mptoms./as./well,./long-
acting./injections./available. / for./several./of./these../(Ex../Risperidone,./Clozapine,./Quetiapine,./Aripiprazole,./Ziprasidon
e)
6. Extra./Pyramidal./Symptoms./(EPS):./Side./ettects./caused./by./certain./antipsychotic./medications,./which./
include:./involuntary./or./uncontrollable./movements../tremors../muscle./contractions.
7. Tardive./dyskinesia:./A./neurological./disorder./characterize./by./involuntary./movement./of./the./face./and./jaw.
8. Upregulation:./Occurs./through./chronic./use./of./antagonists./which./causes./an./increase./in./the./number./of./
receptors,./externalization./of./receptors,./and./increased./sensitivity./of./the./receptors../Prolonged./use./of./antagonist./
->./Up-regulation./of./receptors./->./Sudden./withdrawal./of./antagonist./-
>./increased./number./of./receptors./and./increased./sensitivity./of./receptors./*YOU./MUST./GRADUALLY./TAPER./A./DRUG
./TO./AVOID./BINDING./TO./ALL./NEW./RECEPTORS./FROM./UPREGULATION
, NSG552. / Psychopharmacology. / Exam. / 1
9. Down. / regulation:. / Occurs./by./chronic./exposure./of./agonists./which./causes./decreased./number./of./receptor
s,./internalization./of./receptors,./and./decreased./sensitivity./of./the./receptors../Prolonged./use./of./agonist./->./down-
regulation./of./receptors./->./decreased./ettectiveness./of./agonist./mediated./clinical./response.
, NSG552. / Psychopharmacology. / Exam. / 1
You./have./two./options:
1./Increase./the./drug./dose./OR./2./Switch./to./another./drug(BEST./OPTION)
10. Receptor./profile:./The./receptors./that./each./drug./binds./to
./(example,./risperidone's./receptor./profile./would./like...
(a) Blockade./of./5HT2A./and./D2./receptors
(b) High./aflnity./for./a1,./a2,./and./H1./receptors)
11. Binding:. / Refers./to./a./drug./metabolite./or./neurotransmitter./attaching./to./a./receptor
12. Affinity:./refers./to./the./"preference"./or./likelihood./of./a./drug./to./bind./to./a./certain./receptor../Linked./to./potency.
13. CYP450:./A./group./of./enzymes./in./the./liver./that./metabolize./ditterent./drugs../There./are./six.
14. List./ the./7./CYP450./Enzymes:./(1)./CYP1A2
(2) CYP2B6
(3) CYP2C9
(4) CYP2C19
(5) CYP2D6
(6) CYP3A4
(7) CYP2EI
15. CYP2B6:./Metabolizes./arteminsin,./bupropion,./cyclophosphamide,./efavirenz,./ketamine,./and./methadone./(2B6,
./there./are./two./psych./drugs./(bupropion,./methadone./(ketamine...?)./and./six./altogether.
16. CYP1A2:. / metabolizes. / AcetAminophen. / (two. / As)
17. CYP2C9:./ metabolizes./Warfarin/Coumadin./(think./warfarin./factors./2,./C,./9)
18. CYP2C19:./metabolizes./PPIs,./antidepressants,./antiplatelet,./antifungals,./and./anticancer./drugs./(2C19,./two./se
e./one,./there./is./only./one./class./of./psych./drugs./that./are./metabolized,./you./ONLY./SEE./one!./antidepressants)
19. CYP2D6:. / Metabolizes./Cardiovascular./drugs./(2-D./echo,./echo./is./a./test./for./heart)
20. CYP3A4:./Most./common./and./ambiguous./(if./not./above,./then./it's./this./one,./a./lot./of./psych./drugs./are./involved./w
ith./this./one)
21. CYP2EI:./ETOH./(You./have./to./be./21./to./drink)
22. CYP450. / inhibitors:. / Decreases./drug./metabolism:
(1) Valproate
(2) Ketoconazole
(3) Isoniazid
(4) Sulfonamides
(5) Chloramphenicol
