WGU D345 Psychopharmacology Objective Assessment| 700+ Questions & Verified Answers | 2026–2027 Update | Exam Prep Guide

WGU D345 Psychopharmacology Objective Assessment| 700+ Questions & Verified Answers | 2026–2027 Update | Exam Prep Guide Q: Pharmacokinetics Answer What the body does to the drug (absorption, distribution, metabolism, excretion) First pass metabolism Q: Pharmacodynamics What drugs do to the body and how they do it. Answer Target sites for drug actions include receptors, ion channels, enzymes, and carrier proteins. Q: Acetylcholine/ Cholinergic Function: Learning, short-term memory, arousal, reward (delirium) Answer Synthesized by the basal nucleus of Meynert Q: What disease can be associated with low levels of Acetylcholine/Cholinergic ? Answer Alzheimer disease / Impaired memory Q: What disease can be associated with increased levels of Acetylcholine/Cholinergic ? Answer Parkinsoinian symptoms Q: What is the functions of serotonin (5-HT)? Answer Mood, satiety, temperature, sleep, pain sensitivity Q: What conditions are associated with low serotonin (5-HT) levels? Answer Depression, chronic pain symptoms, OCD, anxiety disorders, violence, schizo-affective, and personality disorders Q: Where is serotonin (5-HT) produced? Answer In the Raphe nuclei of the brain stem Q: What major neurotransmitter is implicated in mood and anxiety disorders? Answer Serotonin (5-HT) Q: What is glutamate? Answer A major excitatory neurotransmitter involved in memory. Q: What is associated with increased levels of glutamate? Answer Increased anxiety levels. Q: What disorders is glutamate implicated in? Answer Seizure disorders, bipolar disorders, and psychosis. Q: What psychiatric conditions can an imbalance in glutamate be seen in? Answer It is implicated in mood disorders and schizophrenia. Q: What are the effects of decreased levels of glutamate? Answer Memory and learning difficulties, and negative symptoms of schizophrenia. Q: What is the function of Acetylcholine? Answer Learning, short term memory, arousal, reward, and delirium. Q: Where is Acetylcholine synthesized? Answer In the basal nucleus of Meynert. Q: What condition is associated with low levels of Acetylcholine? Answer Alzheimer's disease and impaired memory. Q: What symptoms are associated with increased levels of Acetylcholine? Answer Parkinsonian symptoms. Q: What are the functions of Norepinephrine/Epinephrine? Answer Arousal, reward, attention Q: Which disorders are associated with low levels of Norepinephrine? Answer Mood and concentration disorders, including depression, schizophrenia, and Parkinson's disease Q: What is the effect of increased levels of Norepinephrine? Answer Implicated in anxiety High blood pressure,. Rapid or irregular heartbeat Excessive sweating Cold or pale skin Severe headaches Nervousness or jitters Pheochromocytoma Anxiety disorders Chronic stress Bipolar disorder Heart, blood vessel, and kidney damage Norepinephrine is released by the body as part of the fight-or-flight response to danger. Q: Where is Norepinephrine produced? Answer In the locus ceruleus of the pons and the medullary reticular formation Q: What neurotransmitter is implicated in mood, anxiety, and concentration disorders? Answer Norepinephrine Q: What are neuropeptides? Answer Substance P /endorphins Q: What is the role of neuropeptides in the body? Answer They trigger and control the body's response to stress, injury, and are involved in pain perception. Q: What is a consequence of low levels of neuropeptides? Answer Low levels are seen with substance abuse. 10 % of Caucasians are poor metabolizers of? Answer 2D6 20 % of Asians are poor metabolizers of ? 2C19, reduced activity Potency Relative doses required to achieve certain effects Distribution Redistributed in organs What type of patient can have erratic drug levels and higher risk for experiencing toxicity? People with high fat-to-lean body mass ration, people with low protein (albumin) levels, elderly Most psychotropic medications are ___________ and highly ________ __________. Lipophilic, protein bound What is absorption in pharmacology? The method and rate at which drugs leave the site of administration. Where does absorption of oral medications normally occur? In the small intestine. What organ processes drugs after absorption from the small intestine? The liver. What is half-life (t1/2)? The time needed to cleart of 50% of the drug from the plasma. How does half-life affect dosing intervals? Half-life determines the dosing interval for a drug. What does half-life indicate about reaching steady state? Half-life indicates the length of time to reach a steady state of a drug in the body. First-pass metabolism Process by which the drug is metabolized by cytochrome P450 enzymes occurring in the intestines and liver prior to going into the systemic circulation Partial agonist effect Drug does not fully activate the receptors Agonist effect Drug binds to receptors and activates a biological response Inverse agonist effect Drug causes the opposite effect of agonist; binds to same receptor Antagonist effect Drug binds to the receptor but does not activate a biological response Schedule 1 controlled substances Non-medicinal Substances Schedule I, are classified as high potential for abuse. No accepted medical use. Labeled C-1. -Examples: 1. heroin 2 hallucinogens 3. LSD 4. Marijuana(except when prescribed for cancer treatment. Schedule 2 controlled substances Medicinal Drugs in current use Substances with high potential for abuse and currently accepted medical uses. Written RX only No telephone orders are allowed No refills on RX Examples - Opium, Morphine, Hydromorphone (Dilaudid), Vicodin, Hydrocodone, Codeine, Fentanyl, Methadone, Cocaine, Amphetamine salts, and Oxycodone Schedule 3 controlled substances Medicinal drugs Written RX must be renewed every 6 months 5 refill limit Less abuse potential, moderate dependence liability; Example: Non-barbiturates, Non amphetamine stimulants, limited amount of certain narcotics (Tramadol, Codeine and hydrocodone products mixed with aspirin or acetaminophen) Testosterone, Ketamine Anabolic steroids Buprenorphine (Suboxone) Schedule IV controlled substances Substances in this schedule have a low potential for abuse relative to substances in Schedule III. Examples of Schedule IV substances include: Benzodiazepines, alprazolam (Xanax), carisoprodol (Soma), Zolpidem (Ambien), Dextropropexyphene (Darvon), Pentazocine (Tallinn), Modafinil (Prodigal), Amodafil (Nuvigil), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril), and triazolam (Halcion). Schedule V Controlled Substances Substances in this schedule have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics. Examples of Schedule V substances include: cough preparations containing not more than 200 milligrams of codeine per 100 milliliters or per 100 grams (Robitussin AC®, Cheratussin (Robitussin with Codeine) Phenergan with Codeine®), Promethazine (Phenergan), Bupreorphine (Buprenex), Diphenoxylate/ Atropine (Lomotil) and Ezogabine. What medication on a drug screen can result in False Positive for Alcohol? Valium What medication on a drug screen can result in False Positive for Amphetamine? Pseudoephedrine Nasal decongestants Wellbutrin Fluxetine What medication on a drug screen can result in False Positive for Benzodiazepines? Sertraline (Zoloft) What medication on a drug screen can result in False Positive for Cocaine? Amoxicillin, most antibiotics, NSAIDS Alcohol (ethanol), Beer, Wine, Spirits GABA Agonist Depressant, [GB+], [SE+], [GLU-], [Na-] Delirium Tremens. Delirium tremens is a life-threatening form of alcohol withdrawal. DT Sympathetic-Hallucinations-ESR^, Leukocytosis WBC^, LFT^ Alcohol Withdrawal: Anxiety, insomnia, tremor, seizures, hypertension MDMA (Ecstasy, E, X, XTC) Monoamine Releasing Agent, [DA+], [SE+], [NE+], [OXY+] SNS Symptoms: Derealization, mania, hallucinations, tachycardia, hypertension, Withdrawal Symptoms: Depression, irritability, fatigue, anorexia, **BRUXISM***(grinding your teeth) Mescaline (peyote, Cactus, Buttons) Serotonergic Psychedelic, [DA+], [SE+], Hallucinations, Used by Native Tribes for historical religious rituals Hallucinogens (LSD, Acid, Trips, Lucy) Serotonergic Psychedelic, [SE], Dissociative psychedelic ("mind-manifesting") drugs, [GLU-], [DA+], distort perceptions and evoke sensory images in the absence of sensory input Phencydidine (PCP, Angel Dust, IllY, Wet) NMDA Receptor Antagonist [GLU-], [DA+], Symptoms: Belligerence, impulsiveness, agitation, psychosis, delirium, fever, nystagmus *Pt exhibiting signs of horizon, vertical and or rotary that a nystagmus Hallucinogen persisting perception disorder (HPPD) A non-psychotic disorder in which a person experiences apparent lasting or persistent visual hallucinations or perceptual distortions after using drugs Ketamine (Ketalar, Vitamin K) NMDA Receptor Antagonist, [GLU-] Anesthesia, Depersonation, Hallucination, Epiphanies, Disorientation What happens with the eyes with THC? Injection- the primary effect on the eyes is redness due to dilated blood vessels, caused by THC lowering blood pressure, which makes the blood vessels in the eyes appear more visible, leading to a "red-eye" appearance What happens with the eyes with Stimulants? Mydriasis- dilation of the pupil of the eye. What happens with the eyes with Depressants? Miosis of the eye, also known as pinpoint pupils or pupillary miosis, is a condition where the pupils are constricted or very small. What happens with the eyes with PCP? Nystagmus is a condition that causes the eyes to move involuntarily, rhythmically, and repetitively. The movements can be side to side, up and down, or in a circular motion. Caffeine Adenosine Antagonist, [DA+], [SE+], [NE+], [GB-], [ACH+] Effects: Anxiety, insomnia, tachycardia, tachypnea Cannabis (Marijuana, Pot, Weed, Grass, THC) Synthetic Cannabis (Spice, K2) Camabinoid Receptor Partial Agonist, [CB-] Effects: Paranoia, euphoria/ relaxation, hunger, red eyes Cocaine (Coke, Crack, Snow) Triple Reuptake Inhibitor, [DA+], [SE+], [NE+], [Na-] SNS Effects: Euphoria, agitation, mydriasis, hypertension, tachycardia Withdrawal symptoms: Depression, Lethargy, Cravings Methamphetamine (Meth), Crystal, Speed, Crack) Monoamine Releasing Agent, [DA+], [SE+], [NE+] SNS Effects: Euphoria, Libido, mydriasis, hypotension, tachycardia Withdrawal symptoms: Depression, Lethargy, Appetite LDS (Acid, Trips, Lucy) Serotonergic Psychedelic, Hallucinogen, [SE+], [DA+], [NE+], [GLU+] Psilocybin ("Magic mushrooms"/"shrooms") Serotonergic Psychedelic, [SE+], [DA+] Effects: Sensory Distortion, Depersonalization, Anxiety/ Paranoia, Physical symptoms Bipolar Disorder A mood disorder associated with increased Glutamate Alzeheimer's Disease (AD) Acetylcholine Down Parkinson's Disease (PD) Dopamine Down Cholinesterase Inhibitors [ACh+] Antidementia Agents Donepezil (Aricept) Galantamine (Razadyne) Rivastigmine (Exelon) Memantine (Namenda) [Glu-], [SE-], [ACh-] Antidementia Agents "Memor-Time keeps the name in Da Head" Nicotine Nicotine Receptor Agonist, [DA+], [SE+], [NE+], [ACh+], [OP+] Effects:Alertness, Calmness, Anorexia, Hypertension, Tachycardia Withdrawal Symptoms: Irritability, Anxiety, Cravings, Appetite ADHD (Attention-Deficit Hyperactivity Disorder) Dopamine Impairment, Serotonin Impairment, Norepinephrine/Epinephrine Impairment Anxiety Decrease in GABA Increase Norepinephrine/Epinephrine Decrease Serotonin Tourette's Disorder Dopamine Impairment, Serotonin Impairment, GABA Impairment, Glutamate Impairment, Norepinephrine/Epinephrine Impairment Smoking Nicotine Receptor Partial Agonist Verenicline (Chantix) [ACh-] Dopamine Norepinephrine Reuptake Inhibitor Bupropion (Zyban) [DA+], [NE+] SEX, HAPPINESS, SMOKING Substance Abuse Decrease Opioid Neuropeptides Decrease Dopamine Autism Glutamine Impairment, Serotonin Impairment, GABA Impairment Schizophrenia Increased Dopamine (Mesolimbic) Decreased Dopamine (Mesocortical) Decreased Serotonin Decreased GABA Decreased Glutamate (Negative Symptoms of Schizophrenia) What are the negative symptoms of schizophrenia? -Apathy -Social withdrawal -Flat affect -Alogia (not speaking or one word answers) -Avolition (lack of motivation) What are the positive symptoms of schizophrenia? delusions, hallucinations, disorganized speech, disorganized or catatonic behavior Alzheimer's disease/ Impaired Memory Decreased Acetylcholine Decreased Glutamate Increased Dopamine Parkinson's disease Increased Acetylcholine Decreased Dopamine What type of neurotransmitter is dopamine? Catecholamine Where is dopamine produced in the brain? Substantial nigra and the ventral tegmental area What is the precursor of dopamine? Tyrosine How is dopamine removed from the synaptic cleft? By monoamine oxidase (MAO) enzymatic action Aspartate another excitatory neurotransmitter -works with glutamate Antisocial Personality Disorder Decreased Dopamine Addiction Impaired GABA Impaired Dopamine Mood Serotonin Impairment, Norepinephrine/Epinephrine Impairment Psychosis Increased Glutamate Increased Dopamine OCD Decreased Serotonin, Decreased Norepinephrine/Epinephrine Dopamine (DA) Four dopaminergic pathways 1) Mesocortical (DORSOLATERAL PREFRONTAL CORTEX) 2) Mesolimbic (Necleus accumbent) 3. Nigrostriatal (Basal ganglia) 4) Tuberoinfundibular (Hypothalamus) Increased levels of Dopamine Schizophrenia, Psychosis, and Mania Decreased levels of Dopamine Substance Abuse, Anhedonia, and Parkinson's Disease Dopamine Theory Hyperactive dopamine at D2 receptors in the mesolimbic pathway Replorization An Inhibitory Response Opening of Chloride Channels, Chloride goes into the cells and potassium leaves or both, a restoration phase when potassium leaves the cell or chloride enters the cell Mesocortical (DORSOLATERAL PREFRONTAL CORTEX) Antipsychotic medication increased dopamine in this pathway and decreases the negative symptoms Decreased Dopamine from VTA Cortex-DA from VTA-Cortex Cognition, Motivation (In Schizophrenia) (VTA) to Cortex = Negative Symptoms in Schizophrenia In Schizophrenia-Decrease DA Mesolimbic (Necleus accumbens) Ventral Tegmental Area(VTA) Nucleus Accumbens (NA) Rewards (addiction) (VTA to (NA) Positive Symptoms in Schizophrenia Too much Dopamine - Use antipsychiatic to Decrease Dopamine DA from VTA to NA IMPROVES POSITIVE SYMPTOMS Tuberoinfundibular (Hypothalamus) RISK GALACTORRHEA 7 AMENORRHEA Dopamine from Hypothalamus to Pituitary Gland = When Dopamine decreases Increased Prolactin causing GALACTORRHEA WHEN DOPAMINE INCREASES= DECREASED PROLACTIN PRODUCTION Nigrostriatal (basal ganglia) RISK EPS SYMPTOMS Motor coordination Dopamine from (Substantia Nigra to striatum: caudate + pitmen) In Schizophrenia when antipsychotics are used, Decreased dopamine affect induced PARKINSON'S SYMPTOMS Depolarization The initial phage of the action potential when sodium and calcium ions are rushing into the cell causing an Excitatory response Opening of the Calcium and Sodium Channels so the Ions go into the cell Peptides (Opioid Type) Too Much Insensitive to pain Catatonic-like movement disturbance Auditory hallucinations Decreased memory Peptides (Opioid Type) Too Little (Deficit) Hypersensitivity to pain & stress Decreased pleasure sensation Dysphoria Glutamine, Too Little (Deficit) Poor memory Low energy Distractible Glutamine, Too Much **Kindling Seizure Anxiety or Pain GABA, Too Much Reduced cellular excitability Sedation Impaired memory GABA, Too Little (Deficit) Irritability Hostility Tension & WOrry Anxiety Seizure activity Acetylcholine , Too Little (Deficit) Lack of inhibition Decreased momory Euphoria Antisocial Action Speech decreased Dry mouth, blurred vision, constipation Acetylcholine , Too Much Over- inhibition ANXIETY DEPRESSION Somatic complaints Self-consciousness Drooling EXTRAPYRAMIDAL MOVEMENTS GABA (gamma-aminobutyric acid) a major, MOST ABUNDANT INHIBITORY neurotransmitter Decreased GABA would increase ANXIETY Decreased GABA associated with DEPRESSION Site of action of benzodiazepines, alcohol, barbiturates, and other CNS depressants Benzodiazepines are used to bind with GABA receptors to potentiate calming effects of GABA Glutamate A UNIVERSAL EXCITATORY neurotransmitter; involved in the process of kindling, which is implicated in seizure disorders and possibly bipolar disorder Imbalance implicated in MOOD AND SCHIZOPHRENIA Amino Acids Building blocks of proteins linked by peptide bonds. GLUTAMINE ASPARTATE GABA GLYCINE What is serotonin also known as? 5-HT Where is serotonin produced in the brain? In the raphe nuclei of the brainstem What is the precursor of serotonin? Tryptophan How is serotonin removed from the synaptic cleft? Via an active reuptake process What major role does serotonin play in mental health? It is implicated in mood and anxiety disorders Epinephrine Also known as a catecholamine Produced by the adrenal glands Epinephrine system also referred to as the Adrenergic System What is another name for norepinephrine? Catecholamine Where is norepinephrine produced? Locus ceruleus of the pons What is the precursor of norepinephrine? Tyrosine How is norepinephrine removed from the synaptic cleft? Via an active reuptake process What major disorders is norepinephrine implicated in? Mood, anxiety, and concentration disorders What can happen when a MAOI is given with Tyramine rich food & drink ? Hypertensive Crisis What are Tyramine rich food & drinks ? cheese, meat, beer, yeast, soy, processed foods EPS symptoms Akathisia Acute dystonia Pseudoparkinsonism Tardive dyskinesia What can you do if a patient experiences EPS symptoms? Give patient Cogentin Most significant adverse effects of antipsychotic medications comes from which class? Typical First Generation Antipsychotics, prevent by sticking to an atypical antipsychotics for long-term Medications that induce Mania -Steroids -Disulfiram (Antabuse) -Isoniazid (INH) Medication that can induce depression Beta blockers Benzodiazepines Antineoplastic drugs Isotretinoin (accutane) Steroids Interferon Some retroviral drugs Progesterone What is Acute Dystonia? Acute sustained contraction of muscles, usually of the head and neck. What are some symptoms of Acute Dystonia? Oculogyric crisis, torticollis, and widespread muscular spasm. When does Acute Dystonia typically occur after treatment initiation? Within hours to days after initiating treatment. What is the treatment for Acute Dystonia? Anticholinergic medications such as Diphenhydramine and Benztropine. What type of symptom is Acute Dystonia classified as? An Extrapyramidal Symptom. What is akathisia? Inability to remain still; characterized by tremor, tapping, motor restlessness, pacing, and anxiety. What is a common treatment for akathisia? Beta blockers. When does akathisia typically come on after treatment is started? It can come on months after treatment is started. What should be monitored closely when treating akathisia? Dosage of the medication. What should be done if akathisia occurs? Lower the dose or change to an atypical medication if possible. What category of symptoms does akathisia fall under? Extrapyramidal symptoms (EPS). What is tardive dyskinesia (TD)? A late-onset, irreversible neurologic side effect of antipsychotic medications. What are the characteristic movements associated with tardive dyskinesia? Abnormal, involuntary movements especially of the facial muscles and jaw, such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet. What is the treatment for tardive dyskinesia? Stop antipsychotic medication and consider clozapine; switch to atypical antipsychotic. What type of symptom is tardive dyskinesia classified as? An extrapyramidal symptom (EPS). What are common symptoms of Parkinsonism? Tremors, rigid movements, cogwheeling rigidity, mask facies, shuffling gait, resting tremor. Disulfiram (Antabuse) Used for alcohol aversion therapy. Unpleasant side effects, vomiting, and headaches Clients started on Disulfiram must avoid any form of alcohol or they would develop a severe reaction. Teach pt to avoid some over-the-counter cough preparations, mouthwash etc. Inhibits acetaldehyde dehydrogenase (acetaldehyde accumulates contributing to hangover symptoms) What is a common treatment for Parkinsonism symptoms? Anticholinergic medications. Acamprosate (Campral) GABA Agonist & Glutamate Antagonist [BG+], [GLU-} Helps patient abstain from alcohol Alcoholic Hallucinations 12-48h after last drink -visual, auditory, and/or tactile hallucinations -clear sensorium -normal vital signs No vital sign instability Resolves rapidly No high mortality rate Treatment of alcohol withdrawal Benzodiazepines -eg chlordiazepoxide (Librium); CNS depressants that will limit the effects of alcohol withdrawal hallucinations- haloperidol -thiamine, folate, multivitamin replacement **Give as many BENZOs as it takes to suppress Sx in the 1st 24 hrs and then taper 10 20% each day Benzodiazepines GABA Agonist, [GB+] Most common group of antianxiety drugs Schedule IV Drug What are the effects of Benzodiazepines? Sedation, Euphoria, Ataxia, Amnesia, Relaxation What are the withdrawal effects from Benzodiazepines? Panic, anxiety, insomnia, tachycardia, seizures What is used to treat a Benzodiazepine overdose? Flumazenil Diacetylmorphine, Heroin (H, Smak, Horse, Tar) [OP+], The hydrochloride salt of a diacetyl derivative of the opiate morphine, a naturally occurring alkaloid extracted from the seedpod of the Asian poppy (Papaver sp.). What type of drug is morphine? Opioid analgesic What are common physical signs of opiate use? Pinpoint pupils, CNS depression, Mitosis What is a potential risk associated with black tar heroin? Botulism What are withdrawal symptoms from opiates? Sweating, diarrhea, piloerections, mydriasis, dilated pupils Opioid receptor antagonists [OP-], Naloxone (Narcan), naltrexone (Vivitrol) What are the symptoms of Neuroleptic Malignant Syndrome (NMS)? Confusion, Muscle Rigidity, Fever, Tachycardia, myoglobinuria, autonomic instability, hyperpyrexia. What is the first step in treating Neuroleptic Malignant Syndrome (NMS)? Discontinue the antipsychotic medication. What medication can be given to treat Neuroleptic Malignant Syndrome (NMS)? Dantrolene. What type of agonists can be used in the treatment of Neuroleptic Malignant Syndrome (NMS)? Dopamine (D2) agonists, such as bromocriptine. What supportive measures are important in the management of Neuroleptic Malignant Syndrome (NMS)? Vital hydration, cooling, and benzodiazepines. What laboratory findings are associated with Neuroleptic Malignant Syndrome (NMS)? Increased CK, increased potassium, and elevated WBC. What serious condition can result from Neuroleptic Malignant Syndrome (NMS)? Rhabdomyolysis. Is Neuroleptic Malignant Syndrome (NMS) life-threatening? Yes, it can be life-threatening. False-Positive for Heroin or Morphine Quinolones, rifampin, codeine and poppy seeds False-Positive for Methadone or PCP OTC cough medicine, NyQuil (Dextromethorphan) Teratogenic Risk with Divalproex Sodium (Depakote) Neural Tube Defect, Spina Bifida, Atrial Septal Defect, and Cleft Plate, and possible long term developmental deficits Teratogenic Risk with Lithium (Eskalith) Epstein Anomaly Teratogenic Risk with Carbamazepine (Tegretol) Mood Stabilizer Nural Tube Deficits Symptoms of Acute Dystonia Painful "Stiff neck", Spasms of the tongue, face, neck, and back, "Thick tongue", Involuntary muscle spasms, abnormal posture, difficulty speaking, fatigue, tremors, anxiety, and distress, Opisthotonus, Oculogyric Crisis Treatment for of Acute Dystonia #1 Administer Benztropine (Cogent) or diphenhydramine IM immediately #2 Hold subsequent doses of medication like Risperidone until dystonia is completely resolved #3Resume mediations at a lower dose along with an oral anticholinergic CNS dopamine (DA) and Acetylcholine (ACH) have a reciprocal relationship as DA receptors are antagonized by antipsychotic medications , ACH increases giving rise to what? Extrapyramididial Side Effects What are extrapyramidal symptoms (EPS)? EPS are drug-induced movement disorders that can include symptoms like acute dystonia and akathisia. What is the first-line treatment for extrapyramidal symptoms (EPS)? Anticholinergics are the first-line treatment for EPS. Which medications are commonly used to treat EPS? Benztropine and trihexyphenidyl are commonly used to treat EPS. What is a common initial step in managing EPS? Dose reduction or switching to a different medication with a lower risk of EPS. How is acute dystonia managed? Immediate treatment with diphenhydramine or an anticholinergic injection may be needed. What medications can be effective for managing akathisia? Benzodiazepines or beta-blockers like propranolol may be effective for akathisia. Psychiatric Disorder related to decreased Opioid neuropeptides? Substance abuse Psychiatric Disorder related to decreased amounts of Glutamate? Memory and learning difficulties Negative Symptoms of Schizophrenia Psychiatric Disorder related to increased amounts of Glutamate? Bipolar affective disorder Psychosis from ischemic neurotoxicity or excessive pruning Psychiatric Disorder related to decreased amounts of (GABA) y-Aminobutync Acid? Anxiety Disorders Psychiatric Disorder related to decreased amounts of Serotonin? Depression, OCD, Anxiety disorders, Schizophrenia Psychiatric Disorder related to increased amounts of Norepinephrine ? Anxiety Psychiatric Disorder related to decreased amounts of Norepinephrine ? Depression Psychiatric Disorder related to decreased amounts of Dopamine ? Substance abuse Anhedonia Parkinson's disease Psychiatric Disorder related to increased amounts of Dopamine ? Schizophrenia and Psychosis Psychiatric Disorder related to increased amounts of Acetylcholine? Parkinsonian symptoms Psychiatric Disorder related to decreased amounts of Acetylcholine? Alzheimer's disease Impaired memory Excessive amounts of Dopamine Mild: Improved creativity, ability, executive functioning, spatiality, abstract thinking Sever: Disorganized thinkers, loose associations, TICS, Stereotypical behavior Too Little Dopamine Mild: Poor impulse control, poor spatiality, lack of abstractive thought Severe: Parkinson's disease, Endocrine Alterations, Movement Disorder Excessive amounts of Serotonin Sedation Increased Aggression Hallucinations (rare) Too little amount of Serotonin Irritability Hostility Depression Sleep Dysregulation Loss of Appetite Loss of Libido Too Little Norepinephrine Dullness, Low energy, depressive affect Excessive Levels of Norepinephrine Anxiety Hyperalertness Increased Startle Paranoia Decreased Appetite Remound Black tongue, hairy tongue What medications work on the serotonin reuptake transporter? Esatalopram (Lexapro) Sertraline (Zoloft) Fluvoxamine (Luvox) Major Depressive Disorder or Bipolar Disorder II as adjunctive therapy to SSRI? Aripiprazole (Abilify) How does Bupropion (Wellbutrin) for major depressive disorder treatment work? Dopamine and norepinephrine reuptake blockade is mechanism of action. What medication do you use to treat Neuroleptic Malignant Syndrome? Dantrolene, Dan never missed a step:) What medications do you use to treat movement disorders involving basal ganglia dopaminergic system, i.e. Huntington's disease, Tourette's Syndrome Antipsychotic Drugs What medication can be given for pts that are having tardive dyskinesia? Medications used to treat tardive dyskinesia (TD) include dopamine-depleting drugs, botulinum toxin injections, and other medications. Dopamine-depleting drugs Tetrabenazine (Xenazine): A dopamine-depleting drug that decreases the severity of TD symptoms Deutetrabenazine (Austedo): A dopamine-depleting drug that can treat TD Valbenazine (Ingrezza): A dopamine-depleting drug that treats TD by reducing dopamine, serotonin, and norepinephrine in the brain Botulinum toxin injections A small amount of the toxin is injected into a specific muscle to temporarily weaken or paralyze it This can help prevent involuntary movements in one area, like the face Other medications Clonazepam: A benzodiazepine that may help treat TD Amantadine: An off-label medication that may help treat TD Levetiracetam: An off-label medication that may help treat TD Piracetam: An off-label medication that may help treat TD Propranolol: An off-label medication that may help treat TD What long-term side effect can Chlorpromazine (Thorazine) Chloreneal sediment deposits in the eye What long-term side effect can Thioridazine (Mellaril) ? Retinal sediment deposits in the eye What is the effects of NSAID, kidney disease, and other drugs that reduce renal clearance on the body with medications? May increase serum concentration of drugs that are excreted by the kidneys such as lithium. Testing is required for the presents of HLA-B gene for people of Asian descent prior to prescribing ___________ due to risk of ________& ___________. Carbamazepine, Steven Johnson Syndrome, (TEN) Toxic Epidermal Necrolysis. Why are older adults more sensitive to psychotropics? Because of their decreased intracellular water, protein binding, low muscle mass, decreased metabolism, and increased body fat concentration. Why are older adults more likely to develop toxicity due to accumulation and erratic blood levels of drugs? Because most psychotics are lipophilic and highly protein-bound What medication can be used in addition (adjust therapy) to Zoloft Sertraline for major depressive disorder? Modafinil (Prodigal) Medications that can induce depression beta blockers, steroids, interferon, Accutane, benzodiazepines, progesterone, some antivirals, and antineoplasmics. Medications that can induce Mania Steroids, Antabuse (disulfiram), INH, antidepressants in people with bipolar disorder Bipolar disorder patient in mania should be treated with Lithium Bipolar disorder patient with rapid cycling between mixed bipolar and mania should be treated with Valproic Acid Bipolar disorder patient in depression should be treated with (Lamictal) Lamotrigine Acute agitation at any time, Tic Disorders, Tourette Syndrome should be treated with Antipsychotic 1st Generation, Haloperidol, (Haldol), Ziprasidone (Geodan) Black Box, Dementia related psychosis What pharmacokinetics should you keep in mind when treating older adults? Higher body fat content, decreased gastric hepatic and renal functioning all predispose an older adult to the potential toxic effects of medication. Anticholinergic effects and orthostasis. Patients with Bipolar taking Lithium (Lithobid) develops hand tremors & blurred vision. What should the PMHNP do? Discontinue immediately and call patient into the office to access for medical concerns. Huffing glue Central nervous system depression, peri oral dermatitis, unsteady gait, tremor What is the side effect of Donepezil (Aricept) a medication for memory loss in neurodeneration Loss of appetite, trouble sleeping, and unusual dreams Gout No alcohol HTN Low sodium diet, weight loss Drug Reaction with Eosinophilia & Systemic Sx (DRESS) General weakness Fatigue Fever Lymphadenopathy PAINFUL AND PRUITIC ERTHEMATUS RASH ABDOMINLA PAIN HEMATOCHEZIA BLOOD IN STOOL HEMATEMESIA VOMITING BLOOD Erythropoietic Protoporphyria )EPP) EPP is a rare, inherited disorder that causes an abnormal accumulation of a substance called protoporphyrin in the body. This accumulation leads to sensitivity to light, causing pain, redness, swelling, and blisters Syndrome of Inappropriate Antidiuretic Hormone (SIADH) SIADH is a condition where the body produces too much antidiuretic hormone (ADH), also known as vasopressin. Medications: Some medications, such as chlorpropamide, cyclophosphamide, and vincristine, can stimulate ADH release. Serotonin Syndrome A potentially life-threatening condition that occurs when there is an excessive amount of serotonin in the body. But too much serotonin causes signs and symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever and seizures). Serotonin syndrome treatment 1. Discontinuation of Serotonergic Medications:The first step is to discontinue all medications that increase serotonin levels, such as antidepressants (e.g., selective serotonin reuptake inhibitors, monoamine oxidase inhibitors), antipsychotics, and supplements (e.g., 5-HTP). 2. Supportive Care: Intravenous fluids to maintain hydration, Oxygen therapy to ensure adequate oxygenation, and Cooling measures to manage fever. 3. Medications: Benzodiazepines: These medications help calm agitation, seizures, and muscle stiffness. Serotonin Antagonists: Cyproheptadine can block the effects of serotonin in the body. Muscle Relaxants: In severe cases, muscle relaxants may be used to control rigidity. Medications to Control Heart Rate and Blood Pressure: These may include beta blockers or alpha-blockers. Toxic Epidermal Necrolysis (TEN) -Drug induced 30% of skin sloughs off, TEN is a rare, life-threatening skin condition characterized by widespread blistering and peeling of the skin. It is a severe form of Stevens-Johnson syndrome (SJS). TEN is typically caused by an immune reaction to certain medications, such as: Anticonvulsants (e.g., phenytoin, valproic acid) The symptoms of TEN Typically develop within 1-3 weeks after exposure to the trigger. They may include: Fever Flu-like symptoms Widespread, painful blisters and skin detachment Involvement of the mucous membranes (e.g., mouth, eyes, nose) Dehydration Sepsis Treatment for PTSD SSRIs, EMDR, desensitization and reprocessing What medications can be used for nightmares? Prozosin (Minipres) Clonidine (Catapres) Intuniv (Guanfacine) MDMA (methylenedioxymethamphetamine/ecstasy) toxicity Complications of MDMA toxicity include the following: Neurologic complications include delirium and seizures [23] Cardiovascular complications include cardiac dysrhythmias, myocardial infarction, aortic dissection, and intracranial hemorrhages [8][20][21] Gastrointestinal complications include severe hepatotoxicity, which can lead to fulminant liver failure [22] Renal complications include rhabdomyolysis and acute renal failure [25] Endocrine complications include the development of a syndrome of inappropriate diuretic hormone (SIADH), resulting in life-threatening hyponatremia and seizures Patients can also present with life-threatening hyperthermia mimicking heat stroke [25][26][27] Other complications include increased psychomotor agitation or muscle activity (such as bruxism, restless legs, and jaw clenching), hyperactivity, insomnia, difficulty concentrating, and feelings of restlessnes Medications used to treat mood stabilizers & bipolar affective disorders Mood stabilizers: medications that treat bipolar disorder, such as lithium carbonate (Eskalith, Litholad, Lithonate, Lithotolos, , valproic acid (Depakene) Divalporex sodium (Depakote), Lamotrigine (Lamiatal), Carbamazepine (Tegretol), Carbamazepine ER (Equator) Oxcarbazepine (Trilepital) Off label What is Valproic acid also known as? Depakene What condition is Valproic acid used to treat off-label? Bipolar disorder (Acute Manic) What is one mechanism of action of Valproic acid? Increases Na Channel inactivation What is another mechanism of action of Valproic acid? Increases GABA concentration What is a caution associated with Valproic acid? Elevated Liver Enzymes What blood condition can Valproic acid cause? Thrombocytopenia (low platelets) What is a potential fetal risk associated with Valproic acid? Neuro Tube Defects What pancreatic condition can be increased by Valproic acid? Pancreatitis What are two serious risks associated with valproic acid (Depake) ? Hepatotoxicity and Fetal Risk What Labs should you do with Valproate (Depakote)? Serum LFT levels What is Valproate (Depakote) used for ? Mood Stabilizer/ Anticonvulsant [Na-], [GB+] Used to treat Bipolar disorder (Acute Manic), and seizures disorders Good for rapid cycling or if Lithium is ineffective adverse effects are sedation, hepatic toxicity, cognitive dulling, Neuro-Tube Deficit, Teratogenic in pregnancy What is Lithium used to treat? Bipolar Disorder What is the mechanism of action for Lithium? Modulation of the phosphoinositol pathway In which conditions should Lithium be used cautiously? Nephrogenic Diabetic Insipidus, Hyperthyroidism, Hypothyroidism, and Chronic Kidney Disease What congenital anomaly is associated with Lithium use? Ebstein Anomaly What mnemonic can help remember Lithium's association with Ebstein Anomaly? LIT What labs should be monitored for a patient on Lithium? Lithium level, electrolytes, Creatinine, BUN, CBC, Pregnancy test, TSH, and thyroid panel What are signs and symptoms of Lithium toxicity? Severe hand tremors, blurred vision, polyuria, polydipsia What is the normal therapeutic level of Lithium? 0.6-1.2 mEq/L When should Lithium levels be checked after increasing the dose? 7 days after increasing the dose How is Lithium metabolized? In the kidneys How does reduced salt intake affect Lithium levels? It increases Lithium levels How does increased salt intake affect Lithium levels? It decreases Lithium levels When should Lithium not be taken during pregnancy? In the later part of the first trimester What are early signs of Lithium toxicity? GI disturbances, nausea, vomiting, diarrhea, and persistent GI upset What are some adverse effects of Lithium? Serotonin syndrome, Raynaud phenomenon, diabetes insipidus, hypothyroidism, bradycardia, and seizures Lithium Carbonate (Lithobid) and Indomethacin (Indocin) Can cause lithium toxicity because NSAID cause reduction of the renal clearance of lithium and can result in levels of lithium increased Lithium Carbonate (Lithobid) and hydrochlorothiazide (HCTZ) Diuretics can produce toxicity What are the discharge instructions for a person taking Lithium? Maintain a high fluid intake If intake of sodium increases the lithium level will decrease, limit the amount of aerobic activity in hot weather, NSAID should be avoided because they interfere with lithium What is Lamotrigine commonly known as? Lamictal What type of drug is Lamotrigine? Mood stabilizer/Anticonvulsant What is Lamotrigine used for in bipolar disorder? Maintenance treatment, not for acute mania Why is Lamotrigine better for bipolar disorder in depressive episodes? It does not affect GABA What is the mechanism of action of Lamotrigine? Glutamine inhibition and voltage-gated Na channel inhibition What serious condition is associated with Lamotrigine? Stevens-Johnson syndrome Do patients taking Lamotrigine need serum level monitoring? No, they do not need serum levels Is Lamotrigine safe for pregnant patients? Yes, it is good for pregnant patients What mnemonic can help remember the side effect of rash associated with Lamotrigine? LAM - ITCH - TAL = rash, Stevens-Johnson syndrome What is the mechanism of action (MOA) of Carbamazepine (Tegretol)? Blocks Na channels and decreases seizure spread. What condition is Carbamazepine (Tegretol) commonly used to treat? [Na-], ]GB+] Mood Stabilizers, Second line treatment, Bipolar Disorder. Neuropathy, and seizure disorders What serious side effect is associated with Carbamazepine (Tegretol)? Agranulocytosis./ aplastic anemia What syndrome is a potential adverse effect of taking Carbamazepine (Tegretol)? Stevens-Johnson syndrome. Who may not be able to take Carbamazepine (Tegretol)? People with a history of allergic reactions to it, heart conditions, porphyria, bone marrow problems, or those who are pregnant or breastfeeding. What is a long-term side effect of Carbamazepine (Tegretol)? Osteoporosis and osteopenia. What should be monitored when a patient is taking Carbamazepine (Tegretol)? Draw levels to monitor drug concentration. What is a significant drug interaction concern with Carbamazepine (Tegretol)? It is a potent P450 inducer. In which populations is Stevens-Johnson syndrome more common when taking Carbamazepine (Tegretol)? Children, those with a previous rash from another epilepsy medicine, those allergic to trimethoprim, and those taking sodium valproate. Oral contraceptives and Carbamazepine (Tegretol) Can result in false-positive pregnancy test Oxcarbazepine (Trileptal) Anticonvulsant, Used as a Mood Stabilizer, Bipolar Disorder [Na-] [GB+] Warnings: inc risk of serious skin reactions, hyponatremia GOOD FOR AGITATION/ INTERMITTENT EXPLOSIVE, has not been demonstrated to reduce mood cycling in bipolar disorder Non-hormonal OC rec Gabapentin (Neurontin) Anticonvulsant/Antineuralgic, [Ca_] [GB+] used off label for Mood Stabilizers, neuropathic pain, diabetic peripheral neuropathy What is Topiramate commonly known as? Topamax What is the primary use of Topiramate? Anticonvulsant Is Topiramate FDA approved for use as a mood stabilizer? No Is Topiramate considered safe for pregnant patients? Yes What is a potential benefit of using Topiramate? Weight loss What is a potential risk associated with Topiramate? Increased risk of kidney stones What metabolic condition can Topiramate cause? Metabolic acidosis What cognitive issue may arise from using Topiramate? Cognitive decline (word finding difficulty) What are first-generation antipsychotics also known as? Conventional or typical antipsychotics What is the primary mechanism of action of first-generation antipsychotics? They primarily block dopamine D2 receptors in the brain. What are some common first-generation antipsychotics? Chlorpromazine (Thorazine), Haloperidol (Haldol), Fluphenazine (Prolixin), Perphenazine (Trilafon), and Thioridazine (Navane). What are extrapyramidal symptoms (EPS)? Movement disorders such as tremors, rigidity, and restlessness. What is tardive dyskinesia? Involuntary movements that can develop with long-term use of antipsychotics. What are some side effects of first-generation antipsychotics? Sedation, anticholinergic effects (dry mouth, constipation, blurred vision), and neuroleptic malignant syndrome. What is neuroleptic malignant syndrome? A rare but serious condition that can cause fever, muscle rigidity, and altered consciousness. When are first-generation antipsychotics typically used? When other treatments have failed or when the patient has a history of poor response to second-generation antipsychotics. What symptoms do first-generation antipsychotics help alleviate? Hallucinations, delusions, and agitation. Haloperidol (Haldol) Used for Schizophrenia, Other psychotic disorders, and Sudden movements and sounds, also called tics, that are caused by Tourette syndrome, Certain severe behavioral problems in children, Haloperidol belongs to a group of medicines called first generation (typical) antipsychotics., Side Effects Constipation, Dizziness, Drowsiness, Inability to empty your bladder, High or low blood pressure, Restlessness, Parkinson-like Symptoms. Haloperidol may cause involuntary movement problems, including shakiness, stiffness, or jerkiness. It can also cause drooling, falling, or walking or balance problems. These are called Parkinson-like symptoms, or parkinsonism., Side Effects What are the most common side effects of haloperidol? What is Haloperidol commonly known as? Haldol What is Haloperidol decanoate commonly known as? Haldol Decanoate What uncontrolled movement condition can Haloperidol cause? Tardive dyskinesia (TD) What are some symptoms of tardive dyskinesia? Jerky movements of the face, tongue, or body. What serious condition can Haloperidol cause that may lead to death? Neuroleptic malignant syndrome (NMS) What are some symptoms of neuroleptic malignant syndrome? High fever, muscle stiffness, changes in breathing or heart rate, increased sweating, confusion. What dangerous heart rhythm problem can Haloperidol cause? QT prolongation and torsade de pointes Who is at higher risk for heart rhythm problems when taking Haloperidol? Older individuals, those with a family history of heart conditions, and those with low potassium or magnesium levels. What blood disorders can Haloperidol cause? Agranulocytosis, neutropenia, and leukopenia. What symptoms indicate a potential blood disorder from Haloperidol? Fever, chills, sore throat, frequent infections, unusual weakness, sores in the mouth, swollen lymph nodes. What hormone level may increase due to Haloperidol? Prolactin Haloperidol (Haldol) Haloperidol decanoate (Haldol Decanoate) side effects of haloperidol are described below, along with what to do if they happen. Severe Allergic Reactions. Haloperidol may cause allergic reactions, which can be serious. Stop taking haloperidol and get help right away if you have any of the following symptoms of a serious allergic reaction. Breathing problems or wheezing, Racing heart, Fever or general ill feeling, Swollen lymph nodes,Swelling of the face, lips, mouth, tongue, or throat Trouble swallowing or throat tightness Itching, skin rash, or pale red bumps on the skin called hives Nausea or vomiting Dizziness, feeling lightheaded, or fainting Stomach cramps Joint pain Parkinson-like Symptoms. Haloperidol may cause involuntary movement problems, including shakiness, stiffness, or jerkiness. It can also cause drooling, falling, or walking or balance problems. These are called Parkinson-like symptoms, or parkinsonism. Call your healthcare provider right away if you develop any Parkinson-like symptoms. The most common side effects of haloperidol are listed below. Tell your healthcare provider if you have any of these side effects that bother you. Constipation, Dizziness, Drowsiness, Inability to empty your bladder, High or low blood pressure, Restlessness What is Thioridazine also known as? Mellaril What class of medication does Thioridazine belong to? First Generation Antipsychotics What is the primary mechanism of action of Thioridazine? D2 receptor inhibition Which receptors does Thioridazine have an effect on? Histamine-1, Alpha-1, Muscarinic-1 What are some common side effects of Thioridazine? Weight gain, sedation, orthostasis, hypotension, sexual dysfunction, priapism, dry mouth What life-threatening conditions can Thioridazine cause? Extrapyramidal symptoms (EPS) and Neuroleptic Malignant Syndrome (NMS) Loxapine (Loxitane) Typical Antipsychotics, 1st Generation Antipsychotics Thiothixene (Navone) Typical Antipsychotics, 1st Generation Antipsychotics Fluphenazine (Prolix) Typical Antipsychotics, 1st Generation Antipsychotics , side effects, Can cause EPS, and NMS, Weight gain, sedation, orthostasis, hypotension, sexual dysfunction, priapism, dry mouth, Black box warning dementia related psychosis Mesoridazine (senentil) Typical Antipsychotics, 1st Generation Antipsychotics , Trifluoperazine (Stelline) Typical Antipsychotics, 1st Generation Antipsychotics , Chlorpromazine (Thorazine) Typical Antipsychotics, 1st Generation Antipsychotics , Low protency, side effects, Can cause EPS, and NMS, Weight gain, sedation, orthostasis, hypotension, sexual dysfunction, priapism, dry mouth, Black box warning dementia related psychosis Perphenazine (Trilafen) Typical Antipsychotics, 1st Generation Antipsychotics Mechanism: D2+ 5HT2a Inhibitor Atypical Antipsychotics, 2st Generation Antipsychotics , Atypical Antipsychotics, 2st Generation Antipsychotics Best used for Long-term therapy, Tuberoinfidibular pathway, brain function affected by a dopamine blockade cause side effects What class of medication is Clozapine (Clozaril)? Atypical Antipsychotics What generation of antipsychotics does Clozapine belong to? 2nd Generation Antipsychotics What should be monitored when a patient is on Clozapine? Agranulocytosis with CBC Is Clozapine used as a first-line treatment? No, it should not be used as first-line treatment For what condition is Clozapine primarily used? Treatment-resistant bipolar disorder What type of monitoring is required for patients on Clozapine? Regular monitoring of labs What is a significant warning associated with Clozapine? Black box warning What severe risk is associated with Clozapine? Severe neutropenia risk What cardiovascular side effects can Clozapine cause? Orthostatic hypotension, bradycardia, and syncope What class of medication is Ziprasidone (Geodon)? Atypical Antipsychotics What generation of antipsychotics does Ziprasidone (Geodon) belong to? 2nd Generation Antipsychotics What conditions is Ziprasidone (Geodon) used to treat? Bipolar disorder, TIC, and Tourette's syndrome Is Ziprasidone (Geodon) approved for dementia-related psychosis? No, it is not approved for dementia-related psychosis. What is the mechanism of action of Ziprasidone (Geodon)? D2 and 5HT2a Inhibition What is the increased risk associated with Ziprasidone (Geodon) in elderly patients? Increased mortality risk What caution should be taken when prescribing Ziprasidone (Geodon)? Prolongation of the QT Interval What class of medication is Risperidone? Atypical Antipsychotics What generation of antipsychotics does Risperidone belong to? 2nd Generation Antipsychotics What is a common side effect associated with Risperidone? Hyperprolactinemia Is Risperidone considered good for elderly patients? Yes Does Risperidone cause a high level of sedation? No, it causes less sedation Quetiapine (Seroquel) Atypical Antipsychotics, 2st Generation Antipsychotics, D2 and 5HT2a Inhibition, Can be used for Anxiety resistant , Black Box warning, Dementia related psychosis, and Suicidality What class of medication is Olanzapine? Atypical Antipsychotics What generation of antipsychotics does Olanzapine belong to? 2nd Generation Antipsychotics What receptors does Olanzapine inhibit? D2 and 5HT2a What conditions is Olanzapine used to treat? Schizophrenia and bipolar disorder What serious side effect may Olanzapine cause in elderly patients with dementia? Increased risk of death or stroke What is a potential risk when taking Olanzapine with fluoxetine? Higher risk of suicide What metabolic side effects can Olanzapine cause? Metabolic changes What movement disorder can be a side effect of Olanzapine? Tardive dyskinesia What cardiovascular effect can Olanzapine have? Low blood pressure What type of blood disorders can Olanzapine cause? Blood cell disorders What is Aripiprazole commonly known as? Abilify What type of medication is Aripiprazole? Antipsychotic 2nd Generation What mental condition is Aripiprazole used to treat in adults? Bipolar I disorder What is one use of Aripiprazole in children? Irritability associated with autistic disorder What disorder can Aripiprazole treat in children besides autism? Tourette syndrome What is a potential use of Aripiprazole besides bipolar disorder? Treatment-resistant depression What combination can be effective for treating manic episodes of bipolar I disorder? Aripiprazole and Lithium What is another medication that can be combined with Aripiprazole for bipolar I disorder? Lamotrigine (Lamictal) What other mental health condition can Aripiprazole be used to treat? Schizophrenia Can Aripiprazole be used for anxiety disorders? Possibly Can Aripiprazole be used for depressive symptomss? yes, Aripiprazole is good for use of pts with depressive symptoms Paliperidone (Invega) 2nd Generation Antipsychotics Asenapine (Saphris) 2nd Generation Antipsychotics Illoperidone (Fanapt) 2nd Generation Antipsychotics Lurasidone (Latuda) 2nd Generation Antipsychotics, used to treat schizophrenia or bipolar disorder. Can be monotherapy, and as combination therapy with lithium or valproate. What is the primary mechanism of action for antipsychotics? Decrease Dopamine What type of dopamine receptors do first-generation antipsychotics primarily block? D2 only What types of receptors do second-generation antipsychotics block? D2, D4, and 5HT2 Which generation of antipsychotics is more likely to cause extrapyramidal symptoms? First-generation antipsychotics (FGAs) What condition is associated with long-term use of first-generation antipsychotics? Tardive dyskinesia (TD) What side effects are more commonly associated with second-generation antipsychotics? Weight gain and metabolic syndrome Discharge teaching for antipsychotics avoid excessive exposure What do Tricyclic Antidepressants (TCA) inhibit? Serotonin and norepinephrine reuptake What is a significant risk associated with Tricyclic Antidepressants (TCA)? High mortality of overdose What are some common side effects of Tricyclic Antidepressants (TCA)? Orthostatic hypotension, anti-cholinergic effects, dry eyes, constipation, bradycardia, dry mouth, suicide What are the two different classes of Tricyclic Antidepressants (TCA)? Tertiary amines and secondary amines Which Tricyclic Antidepressants are classified as tertiary amines? Amitriptyline, Clomipramine, Doxepin, Imipramine, Trimipramine Which Tricyclic Antidepressants are classified as secondary amines? Desipramine, Nortriptyline, Protriptyline How do tertiary amines and secondary amines differ in their action? Tertiary amines work on both serotonin and norepinephrine, while secondary amines focus more on norepinephrine. Amitriptyline (Elavil) Tricyclic Antidepressant What type of medication is Clomipramine (Anafranil)? Tricyclic Antidepressant What conditions is Clomipramine (Anafranil) used to treat? Antidepressant, Mood disorders, unipolar, affective disorders, and depressive disorder, nerve pain, and obsessive-compulsive disorder (OCD) What does DRESS stand for in medical terms? Drug Reaction with Eosinophilia and Systemic Symptoms What is a common name for DRESS? Multi-organ hypersensitivity What are some symptoms of a serious allergic reaction to Clomipramine? Breathing problems or wheezing What is a symptom of a serious allergic reaction involving the heart? Racing heart What skin reactions can occur as a serious allergic reaction to Clomipramine? Itching, skin rash, or hives What general symptoms may indicate a serious allergic reaction? Fever or general ill feeling What lymphatic symptom may indicate a serious allergic reaction? Swollen lymph nodes What facial symptoms may indicate a serious allergic reaction? Swelling of the face, lips, mouth, tongue, or throat What respiratory symptoms may indicate a serious allergic reaction? Shortness of breath, trouble swallowing, or throat tightness What symptoms related to extremities may indicate a serious allergic reaction? Swelling in your feet, ankles, or legs What gastrointestinal symptoms may indicate a serious allergic reaction? Nausea or vomiting What neurological symptoms may indicate a serious allergic reaction? Dizziness, feeling lightheaded, or fainting What abdominal symptom may indicate a serious allergic reaction? Stomach cramps What joint symptom may indicate a serious allergic reaction? Joint pain What urinary symptom may indicate a serious allergic reaction? Dark-colored pee What skin condition may indicate a serious allergic reaction? Jaundice (yellowish skin or whites of the eyes) Imipramine (Tofranil) Tricyclic Antidepressant, TCA Antidepressant, Mood disorders, unipolar, affective disorders, and depressive disorder, symptoms of serotonin syndrome agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea. Amoxapine (Asendin) TCA Antidepressant, Mood disorders, unipolar, affective disorders, and depressive disorder, What is an off label medication to treat Insomnia Amitriptyline (Elavil) TCA Antidepressant Amitriptyline (Elavil) Good to treat insomnia, chronic pain, migraines, anxiety, and effective for depression, but it is rarely used as a first-line antidepressant, sedating Desipramine (Norpramin) TCA Antidepressant, Mood disorders, unipolar, affective disorders, and depressive disorder, Nortriptyline (Pamelor) TCA Antidepressant, Mood disorders, unipolar, affective disorders, and depressive disorder, Doxepin (Sinequan, Silenor) TCA Antidepressant, Mood disorders, unipolar, affective disorders, and depressive disorder, sedating properties, treatment of chronic insomnia or pre Protriptyline (Vivacity) TCA Antidepressant, Mood disorders, unipolar, affective disorders, and depressive disorder, Trimipramine (Surmontil) TCA Antidepressant, Mood disorders, unipolar, affective disorders, and depressive disorder, Mitazine (Remeron) * GOOD FOR ELDERLY, good for underweight patients, good for severely depressed patients, GOOD FOR ANXIETY, ELDERLY, AND SLEEP, TCA Antidepressant, Mood disorders, unipolar, affective disorders, and depressive disorder, MAY CAUSE WEIGHT GAIN, increased appetite, Used to treat chronic INSOMNIA, and PRN use Adverse Effects of TCA Antidepressant Cardiac, QT prolongation, Chubby, Convulsion's, Anti-cholinergic with OVERDOSE administer sodium bicarbonate , treat of cardiac toxicity List the Selective Serotonin Reuptake Inhibitors (SSRI) Citalopram (Celexa) Escitalopram (Lexopro) Fluxetine (Prozac) Fluvoxamine (Luvax) Paroextine (Paxil) Sertraline (Zoloft) Selective Serotonin Reuptake Inhibitors (SSRI) 1st line treatment and well tolerated, Used to treat GAD, Panic disorder, Premenstrual syndrome OCD, Bulima Nervosa Fluoxetine SSRI used to treat Bulima Nervosa Side effects of Selective Serotonin Reuptake Inhibitors (SSRI) side effects are trouble sleeping, nervousness, sexual problems, sedation, reduction in appetite, occasional diarrhea Adverse effects of Selective Serotonin Reuptake Inhibitors (SSRI) Suicidiality, QT prolongation, sexual dysfunction, Serotonin syndrome Hypoatremia, weight changes, weight gain Which two Selective Serotonin Reuptake Inhibitors (SSRI) can cause QT prolongation (City and Escape) Citalopram & Escitalopram Citalopram SSRI, QT prolongation Fluvoxamine (Luvox) SSRI, good for OCD Paroxetine (Paxil) SSRI, Mood disorder, unipolar affective disorder and depressive disorders, Good for anxiety and sleep, cheap, most common SSRI to weight gain risk Fluoxetine (Prozac) SSRI, Mood disorder, unipolar affective disorder and depressive disorder, major depressive disorder, anxiety, obsessive-compulsive disorder (OCD), panic disorder, premenstrual dysphoric disorder, and bulimia nervosa. LONG T1/2 LIFE GOOD FOR NONCOMPLIANT PATIENTS Sertraline (Zoloft) Zoloft is used to treat some types of depression, premenstrual dysphoric disorder (PMDD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), panic disorder (PD), and post traumatic stress disorder (PTSD) Best for liver patients, pregnancy, and patients with cardiac issues Escitalopram (Lexapro) SSRI, QT prolongation GOOD for ANXIETY What do Monamine Oxidase Inhibitors (MAOIs) inhibit? The enzyme monoamine oxidase (MAO) What is Tranylcypromine sulfate also known as? Partite What is Isocarboxazid used for? It is a type of Monamine Oxidase Inhibitor (MAOI) What is Phenelzine commonly known as? Nardil What is Selegiline transdermal also known as? EMSAM What is a primary use of MAOIs? Treatment of treatment-resistant major depression What other conditions can MAOIs be used to treat? Social anxiety disorder and panic disorder What happens to tyramine levels when MAOIs are taken? Tyramine levels can increase significantly What dangerous condition can result from increased tyramine levels due to MAOIs? A hypertensive crisis Foods High in Tyramine Aged cheeses (e.g., cheddar, blue cheese, Parmesan) Cured meats (e.g., salami, pepperoni, bacon) Fermented foods (e.g., sauerkraut, kimchi, soy sauce) Overripe fruits (e.g., avocados, bananas) Chocolate Yeast extracts What are common side effects of