NR546 / NR 546 Midterm Exam V2 | 2026/2027 Edition | Advanced Pharmacology | PMHNP | Chamberlain | Practice Questions & Accurate Solutions

NR546 / NR 546 Midterm Exam V2 | 2026/2027 Edition | Advanced Pharmacology | PMHNP | Chamberlain | Practice Questions & Accurate Solutions Q: How does the orbitofrontal cortex (OFC) affect the amygdala? Answers inhibits and activates the amygdala Q: Wernicke's area is associated with which of the following? Answers speech comprehension Q: The limbic system is associated with which of the following Answers emotion and learning Q: Which brain structure is most associated with long term memory? Answers hippocampus Q: When prescribing psychotropic medications, the PMHNP knows that these medications work within which specific areas? Answers mood Q: Which of the following are involved in regulating neurotransmission via excitation secretion coupling? Answers voltage-sensitive sodium channels and voltage-sensitive calcium channels Q: What system influences the length of time for a drug to achieve efficacy? Answers signal transduction cascades Q: One of the signal transduction cascades, pass the message from a first receptor to a second messenger. Answers G protein linked systems Q: Human central nervous system communication at synapses is which of the following? Answers chemical Q: Which of the following is an excitatory neurotransmitter? Answers glutamate Q: Which statement correctly pairs the pharmacodynamic effect with its definition? Answers antagonist effect - drug binds to receptor, but does not activate a response Q: A major current hypothesis for the cause of schizophrenia proposes that N-methyl-d aspartate (NMDA) receptors may be which of the following? Correct! Answers hypofunctional Q: Which medication is least associated with weight gain? Answers aripiprazole Q: Which dopamine pathway is associated with positive symptoms of schizophrenia? Answers mesolimbic pathway Q: Which pathway is associated with negative symptoms? Answers The mesocortical pathway Q: Is part of the extrapyramidal nervous system and associated with extrapyramidal symptoms (EPS) Answers nigrostriatal pathway Q: This pathway is associated with hyperprolactinemia. Answers The tuberoinfundibular pathway Q: A 34-year old male recently began experiencing breast secretions while receiving risperidone . Which dopamine pathway is associated with this side effect? Answers tuberoinfundibular pathway Q: A 44-year-old woman is initiated on an atypical antipsychotic for the treatment of schizophrenia. Regarding affinity, atypical antipsychotics demonstrate which of the following most often? Answers Atypical antipsychotics have equal positive symptom antipsychotic actions and low extrapyramidal symptoms. Q: is a syndrome that can be associated with several different psychiatric disorders. Symptoms include hallucinations, delusions, disorganized speech, disorganized behavior, and distortions of reality. This syndrome can affect a person's cognition, affective response, communication, capacity to recognize reality, and ability to relate to others. Answers psychosis Q: What Diagnosis require the presence of psychosis? Answers schizophrenia substance-induced psychotic disorders schizophreniform disorder schizoaffecive disorder delusional disorder brief psychotic disorder psychotic disorder due to a medical condition Q: What diagnosis has a diagnosis of psychosis as a feature? Answers mania depression cognitive disorders dementia Q: What are some positive symptoms? Answers Hallucinations Delusions Thought disorder Hostility Excitability Q: What are some Negative symptoms? Answers Affective flattening Alogia Anhedonia Amotivation Asociality Q: What area of the brain is associated with negative and affective symptoms? Answers Mesocortical and ventromedial prefrontal cortex: Q: What area of the brain is associated with cognitive symptoms? Answers Dorsolateral Q: What area of the brain is associated with aggressive, impulsive symptoms? Answers Orbitofrontal and connections to the amygdala Q: Non-selectively blocks dopamine D2 receptors, specifically in mesolimbic pathway. Improves Positive Symptoms Answers Use: Acute & Chronic Schizophrenia & Psychosis First generation antipsychotics Q: are associated with movement, intelligence, abstract thinking, the ability to organize, personality, behavior, and emotional control. Traumatic brain injuries can result in personality changes, difficulty controlling emotions, and other cognitive functions Answers Frontal Lobes responsible for proprioception, is the home of the somatic senses. This part of the brain helps a person to identify spatial relationships, interpret pain and touch in the body, and identify and give meaning to objects Answers Parietal Lobe (Middle Brain) Damage to the anterior portion may cause asterogenesis, the loss of ability to recognize objects via the sense of touch. This may be experienced by patients with post cerebral vascular accidents Answers parietal Lobe and involved in short-term memory, speech, auditory signals, and smell recognition. It identifies "what" things are - object identification. It contains the limbic system, amygdala, and hippocampus. Answers Temporal Lobe Disorders from this lobe include dementia, affective disorders, and attention deficit hyperactivity disorders (ADHD). Answers Temporal Lobe controls visual processing. Damage to this lobe results in the inability to form visual memories. Bilateral lobe damage results in the inability to recognize items by sight even though vision is normal. Occipital Lobe This separates the frontal lobe from the parietal lobe. Central sulcus This controls the communication between the two brain hemispheres. Is involved in attention, impulse control, and emotion regulation. It integrates impulses from both sides of the brain. corpus callosum This is located deep in the temporal lobes and is involved in anxiety and memory, and shifting short-term to long-term memory. Hippocampus This is located deep in the temporal lobes and involved in emotional regulation and perception of odors. All smells travel directly to this structure. Cooking smells can elicit memories of childhood events and holidays. A traumatic event can result in the formation of the fear response, causing the fight or flight reflex within the autonomic nervous system and affects the hypothalamic-pituitary-adrenal (HPA) axis causing the release of stress hormones Amygdala This is an egg-shaped structure involved in sensory organ and motor command processing. All sensory systems except for the olfaction process through the thalamus, which is responsible for processing all external information Thalamus A group of structures involved in voluntary motor movements, cognition, and emotion. Movement disorders include Parkinson's disease, obsessive-compulsive disorder (OCD), and Tourette syndrome. Basal ganglia This is involved in complex motor actions and linkage of cognition to motor actions. It is the main input area for the basal ganglia and is activated when anticipating or engaging in pleasure Dorsal striatum This is involved in the reward circuit and reinforces addictive behaviors. Nucleus accumbens This is associated with pleasure, reward, and reinforcing behavior. Drug abuse affects the limbic system, disrupting emotions and feelings associated with normal behavior. Limbic system Associated with movement, intelligence, abstract thinking. etc. Frontal lobe Associated with speech Brocas area Involves object identification and auditory signals Temporal lobe Involved in Coordination cerebellum Involved in Speech comprehension Wernicke's area Primary visual area Occipital Lobe Keeps us alert to what is going on around us Parietal lobe Involved in the reward process. Nucleus accumbens Involved in sensory organ and motor command processing thalamus Involved in complex motor actions, also links cognition to motor actions Striatum This includes circuits that are associated with pleasure and reward, emotion and learning LIMBIC SYSTEM A group of structures involved in voluntary motor movements basal ganglia Controls the communication between the two brain hemispheres Corpus callosum Contains nerve fibers that connect neurons from different regions into functional circuits white matter enzyme system mediates how the body metabolizes many drugs, including antipsychotics. The enzyme in the gut wall or liver converts the drug into a biotransformed product in the bloodstream. After passing through the gut wall and liver (left), the drug will exist partly as unchanged drug and partly as biotransformed drug CYP450 system Which medication classes increases serotonin? SSRIs, Tricyclic, SNRIs bind more potently to the 5HT 2A receptor than the D2. Sedation is common and relates to a high affinity for histamine. These medications have the least risk of EPS but a high risk for weight gain and metabolic abnormalities. The "Pines" more potently to the 5HT 2A receptor than to D2 or bine equally between the 2 receptors. These medications are less sedating and cause less weight gain, but have a higher risk for hyperprolactinemia and EPS. Two dones and a rone bind more potently to D2 receptors than to 5HT-2A. They have low risk of metabolic side effects and weight gain, but they have a potential for EPS. The rip binds equally to both D2 and 5HT-2A receptors. The medications has low risk for metabolic disorders. 2 Pips and a Rip What medication has the highest risk for galactorrhea, due to hyperprolactinemia. risperidone Include other symptoms such as disorganized speech, disorganized behavior, gross distortions of reality testing, and as diminished emotional expression and decreased motivation. Negative symptoms If the functioning of this pathway is disrupted by lesions or drugs, prolactin levels can also rise. Elevated prolactin levels are associated with galactorrhea (breast secretions), gynecomastia (enlarged breasts especially in men), amenorrhea (loss of ovulation and menstrual periods), and possibly other problems such as sexual dysfunction. tuberoinfundibular DA neurons Projects from the midbrain VTA but sends its axons to areas of the prefrontal cortex, where they may have a role in mediating cognitive symptoms (dorsolateral prefrontal cortex or DLPFC) and affective symptoms (ventromedial prefrontal cortex or VMPFC) of schizophrenia. The mesocortical dopamine pathway which projects from the substantia nigra to the basal ganglia or striatum, is part of the extrapyramidal nervous system and controls motor function and movement. Nigrostriatal dopamine pathway projects from the midbrain ventral tegmental area (VTA) to the nucleus accumbens, a part of the limbic system of the brain thought to be involved in many behaviors such as pleasurable sensations,the powerful euphoria of drugs of abuse, and delusions and hallucinations of psychosis. mesolimbic dopamine pathway What are the three major hypotheses of pychosis? The Dopamine theory, the Glutamate theory, and the serotonin theory. Treat both positive and negative signs of psychosis. They are considered serotonin-dopamine antagonists, as they maintain D2 antagonism but also have simultaneous serotonin 5HT2A antagonism. Serotonin (5HT) can regulate DA release directly or indirectly, producing various effects on dopamine (DA) neurons. 5HT1A and 5HT2A receptors have opposite actions on dopamine release. Stimulation of 5HT1A receptors increases dopamine release (a DA accelerator). Once bound to 5HT1A receptors, 5HT causes inhibition of its release, which results in increased dopamine output. SGA 'atypical' What antipsychotics have a black box warning in childen? Aripiprazole and Quetiapine increases the risk of suicide Drugs citalopram (Celexa) escitalopram (Lexapro) fluoxetine (Prozac) fluvoxamine (Luvox, Luvox CR) paroxetine (Paxil, Paxil CR) sertraline (Zoloft) SSRI are used for the treatment of all anxiety disorders. They act by preventing the reuptake of 5-HT by synapses in the brain. SSRI Are used to treat all anxiety disorders except obsessive compulsive disorder. SNRIs work by preventing the reuptake of 5-HT and NE by synapses in the brain. Compared with venlafaxine and desvenlafaxine, which have SRI activity and dose-related affinity for norepinephrine reuptake inhibition (NRI) primarily, duloxetine has more balanced SRI and NRI activities. Levomilnacipran has higher activity at NRI than SRI. SNRI Drugs desvenlafaxine (Pristiq) duloxetine (Cymbalta) venlafaxine (Effexor, Effexor XR) levomilnacipran (Fetzima) SNRI are FDA approved for short-term anxiety treatment and are used alone or as an adjunct to antidepressants. They bind to serotonin and dopamine receptors in the brain and increase norepinephrine metabolism in the brain. Buspirone `Buspar' Non-selectively blocks dopamine D2 receptors, specifically in mesolimbic pathway amino acid that acts as the chief inhibitory neurotransmitter, and decrease neuroexcitability across the brain. This neurotransmitter help people relax, destress, and get some sleep Gaba When people dont have enough of this neurotransmitter, they may experience anxiety or even schizophrenia. Some meds use this neurotransmitters benefits to help people sleep for medical procedures. Gaba am also a monoamine neurotransmitter and I serve many functions in the human body. Do you remember learning about flight, fight, or fright? That's me, in excess. A little of me can get you up off the couch and have you alert, oriented, and ready to take on life's challenges. I can really help with focus and productivity which is why you see me with a cup of coffee. Norepinephrine too much can cause antsy, nervous, and affect your ability to focus Norepinephrine one of the key neurotransmitters that psychotropic drugs target. Within the central nervous system, I affect arousal, motivation, attention, learning, and REM sleep. I work within the parasympathetic nervous system too. I can make you sweat and salivate. acetylcholine Substances that block me can paralyze you because I am the link between the brain and muscles. When there's not enough of me, I can be involved in Alzheimer's and Parkinson's disease. Increase me, and I can help with symptoms, but be cautious, because I also have a role in addiction. Dr. Stahl refers to me as "the brain's own nicotine" when he talks about my role in addiction. acetylcholine I help to regulate mood. I've been called the "happy hormone," but actually I am not a hormone at all; I am a monoamine neurotransmitter. Your body synthesizes me naturally from tryptophan. I help to regulate sleep, arousal, libido, aggression, and pain perception. serotonin ( 5HT ) I am one of the key monamine neurotransmitters that regulate mood. I am associated with executive function, your ability to perform well, be organized, and all those good things including emotional intelligence. That's when I'm working hard in the prefrontal cortex. I'm also essential to your movement and coordination. Being balanced is very important to me; too much or too little can cause problems. Dopamine When my levels are low you'll lose pleasure, interest, alertness, and even self-confidence. Low levels are also found in clients who have Parkinson's disease. Dopamine Too much of me is not always a good thing. I can lead to the hallucinations you see in schizophrenia and psychosis. Another thing, do you know that great feeling you get when you win something? That's me, at work in your reward center. Dopamine Some people have trouble with me because my reward properties can lead to all types of addictions. Dopamine amino acid and THE excitatory neurotransmitter. I've been referred to as the workhorse of the brain because I can affect almost every neuron in the brain. I'm quite the firecracker. You'll find me working hard all over the brain affecting energy, memory, learning, and neural plasticity. I also work to relay sensory information and regulate spinal and motor reflexes. glutamate When my levels are too high, I've been associated with schizophrenia, epilepsy, and mania. glutamate In depression is acetylcholine increased or decrease? Increased In depression is norepinephrine increased or decreased? Decreased In depression is histamine increased or decreased? Decreased In depression is glutamate increased or decreased? Decreased This is located deep in the temporal lobes and is involved in anxiety and memory, and shifting short-term to long-term memory Hippocampus This structured is impaired in schizophrenia and dementia Hipocampus This is associated with pleasure, reward, and reinforcing behavior. Drug abuse affects this system, disrupting emotions and feelings associated with normal behavior. Limbic system This is located deep in the temporal lobes and involved in emotional regulation and perception of odors. All smells travel directly to this. Cooking smells can elicit memories of childhood events and holidays. A traumatic event can result in the formation of the fear response, causing the fight or flight reflex within the autonomic nervous system and affects the hypothalamic pituitary-adrenal (HPA) axis causing the release of stress hormones (e.g. cortisol). Also is involved in the interpretation of facial expressions and sexual stimuli. Amygdala This is involved in the reward circuit and reinforces addictive behaviors. Nucleus Accumbens A group of structures involved in voluntary motor movements, cognition, and emotion. movement disorders include Parkinson's disease, obsessive-compulsive disorder (OCD), and Tourette syndrome. The striatum is a group of structures that includes the caudate, putamen, and nucleus accumbens. The dorsal striatum contains the caudate nucleus and the putamen. The ventral striatum contains the nucleus accumbens. Both are involved in facilitating voluntary movement. Basal Ganglia This is an egg-shaped structure involved in sensory organ and motor command processing. All sensory systems except for the olfaction process through this, which is responsible for processing all external information. Has been associated with symptoms related to schizophrenia and post-traumatic stress disorder (PTSD). thalamus This is involved in complex motor actions and linkage of cognition to motor actions. It is the main input area for the basal ganglia and is activated when anticipating or engaging in pleasure. Dorsal Striatum This controls the communication between the two brain hemispheres. Is involved in attention, impulse control, and emotion regulation. It integrates impulses from both sides of the brain. Persons with an underdeveloped or missing _____ may have intellectual impairment. The corpus callosum Is located on the sides of the brain and involved in short-term memory, speech, auditory signals, and smell recognition. It identifies "what" things are - object identification. It contains the limbic system, amygdala, and hippocampus. There are multiple pathways within this which affect object identification and language comprehension, including the ability to understand semantics. A dominant __________ lesion can present as Wernicke's aphasia. Disorders of this structure include dementia, affective disorders, and attention deficit hyperactivity disorders (ADHD). temporal lobe This is the back part of the brain and controls visual processing. Damage to this lobe results in the inability to form visual memories. Bilateral lobe damage results in the inability to recognize items by sight even though vision is normal. seizures of this lobe can cause hallucinations, such as lines of color. Occipital lobe Are associated with movement, intelligence, abstract thinking. the ability to organize, personality, behavior, and emotional control. Traumatic brain injuries can result in personality changes, difficulty controlling emotions, and other cognitive functions. Frontal Lobes The middle part of the brain, responsible for proprioception, is the home of the somatic senses. This part of the brain helps a person to identify spatial relationships, interpret pain and touch in the body, and identify and give meaning to objects. Damage to the anterior portion of this lobe may cause asterogenesis, the loss of ability to recognize objects via the sense of touch. This may be experienced by patients with post cerebral vascular accidents. parietal lobe This separates the frontal lobe from the parietal lobe. Central Sulcus It is the working area of the brain and the focus of psychiatry and neurology. Is associated with learning. Changes in this matter are linked to psychiatric diagnoses including Alzheimer's disease, schizophrenia, and major depressive disorder. Gray matter are chemicals released by neurons to send communication across synaptic clefts to other neurons. Many psychiatric disorders and client symptoms occur from an excess, deficiency, or imbalance of this because it can impact human emotion and behavior. Neurotransmitters I serve many functions in the human body. Do you remember learning about flight, fight, or fright? That's me, in excess. A little can get you up off the couch and have you alert, oriented, and ready to take on life's challenges. I can really help with focus and productivity which is why you see me with a cup of coffee. Norepinephrine To much of this can make you feel antsy, nervous, and affect your ability to focus Norepinephrine one of the key neurotransmitters that psychotropic drugs target. Within the central nervous system, I affect arousal, motivation, attention, learning, and REM sleep. I work within the parasympathetic nervous system too. I can make you sweat and salivate. Did you see my muscles? Substances that block me can paralyze you because I am the link between the brain and muscles. Acetylcholine when there's not enough of me, I can be involved in Alzheimer's and Parkinson's disease. Increase me, and I can help with symptoms, but be cautious, because I also have a role in addiction. Dr. Stahl refers to me as "the brain's own nicotine" when he talks about my role in addiction. I've got lots of receptor friends; my best friends are nicotinic and muscarinic receptors. Acetylcholine I help to regulate mood. I've been called the "happy hormone," but actually I am not a hormone at all; I am a monoamine neurotransmitter. Your body synthesizes me naturally from tryptophan. You know that amino acid in turkey that makes you content and happy after a big turkey meal? That's me, helping you to feel relaxed, comfortable, and less stressed. I help to regulate sleep, arousal, libido, aggression, and pain perception too! That's how I work in medications too. Serotonin one of the key monamine neurotransmitters that regulate mood. First of all, I am associated with executive function, your ability to perform well, be organized, and all those good things including emotional intelligence. That's when I'm working hard in the prefrontal cortex. I'm also essential to your movement and coordination. Being balanced is very important to me; too much or too little can cause problems. When my levels are low you'll lose pleasure, interest, alertness, and even self-confidence. Low levels are also found in clients who have Parkinson's disease. Too much of me is not always a good thing. I can lead to the hallucinations you see in schizophrenia and psychosis. Dopamine I've been referred to as the workhorse of the brain because I can affect almost every neuron in the brain. I'm quite the firecracker. You'll find me working hard all over the brain affecting energy, memory, learning, and neural plasticity. I also work to relay sensory information and regulate spinal and motor reflexes. When my levels are too high, I've been associated with schizophrenia, epilepsy, and mania. My receptors, NMDA and AMPA, work with me across many regions of the brain. I can really make things happen. Glutamate Neuroscience matters Neuroscience is the foundation for mental health prescribing, especially as the future moves toward symptom-based prescribing rather than selecting a drug class based on a diagnosis. Know what area of the brain is associated with presenting symptoms AND how the medication works on that area of the brain to treat that symptom (the medication mechanism of action) Functional neuroanatomy Classifying how regions within the nervous system relate to psychology and behavior. If a particular area of the brain is affected, what is the expected response? What symptoms would you expect to see? Link the assessment to the affected brain area. Ethical Issues course Explore section and readings Epigenetics the study of influences on gene expression that occur without a DNA change Why is epigenetics important? Involved in switching genes on and off i.e. controlling transcription/translation How does epigenetics impact a person's mental health? Genetics The scientific study of heredity How does the CYP450 affect pharmacodynamics and pharmacokinetics? What are some very common/concerning interactions? Also see Stahl Ch 2. Incidence of mental illness what factors are increasing the incidence? This is covered in the course Explore section CYP450 -Enzyme family most important in metabolizing drugs -Always available in the liver -Evolved to eliminate toxic chemicals from plants -Function can be altered by alcohol & barbiturates CYP450 inducers Kenytoin Rides Shotgun in Barbie's Crazy Girly Motor Car phenytoin rifampin st. john's wart barbiturates chronic alcohol use griseofulvan modafinil carbamazepine How does an inhibitor or inducer affect medication efficacy? CYP450 inhibitors CRACK AMIGOS Cimetidine Ritonavir (protease inhibitor) Amiodarone Ciprofloxacin Ketocanazole (and other azoles) Acute alcohol use Macrolides Isoniazid Grapefruit Juice Omeprazole Sulfonamides Carbamazepine (Tegretol) INDUCER: anticonvulsant/mood stabilizer How does combining carbamazepine with another medication affect your prescribing? What happens if you prescribe an inducer or an inhibitor with a substrate? Full agonist Ability of a drug to produce 100% of the maximum response regardless of the potency partial agonist a drug that binds to a receptor and causes a response that is less than that caused by a full agonist Reverse agonist full antagonist a ligand that binds and produces no effect partial antagonist Drug that acts as an agonist to some receptors, but an antagonist to others. Some opioid drugs have this property. Reverse antagonist Competitive Antagonist: Competes for the same receptor as the endogenous ligand; blocks the endogenous ligand from binding; Always dissociates Non-competitive Antagonist: Binds to a site other than the endogenous ligand binding site; Poor clinical utility Neurotransmission the process of transferring information from one neuron to another at a synapse types of neurotransmission Retrograde transduction signal transduction A series of molecular changes that converts a signal on a target cell's surface to a specific response inside the cell. Why do some medications take weeks for the client to notice a response? Which neurotransmission process causes this? Dopamine pathways in the brain 1. Mesolimbic 2. nigrostriatal 3. mesocortical 4. tuberoinfundibular mesolimbic dopamine pathway plays a major role in the experience of pleasurable emotions associated with rewarding events Nigrostriatal pathway EPS DUE TO LOW DOPAMINE IN THIS AREA Communication from SnPC of the basal ganglia to the striatum (caudate + putamen) of the BG via DA; used to initiate movement mesocortical pathway VTA to prefrontal cortex negative symptoms; a path through which dopaminergic projections travel to reach the neocortex Tuberoinfundibular pathway Connects the hypothalamus and the pituitary gland Is responsible for dopamine-dependent prolactin inhibition. Antipsychotic action here cause an increase in prolactin, leading to galactorrhea, disruption of menstrual cycle, and sexual dysfunction. FGA (First generation antipsychotic) - risks and benefits - Affected neurotransmitters - adverse effects - Which medication class is first line? -Which medication is associated with higher incidence of EPS or metabolic side effects? SGA (Second generation antipsychotic) - risks and benefits - Affected neurotransmitters - adverse effects - Which medication class is first line? -Which medication is associated with higher incidence of EPS or metabolic side effects? How are FGAs and SGAs similar? How are FGAs and SGAs different? Which medications are noted for decreased risk of death by suicide? (There are 2.) Review your completed antipsychotic table for the next section. What medications are the first-line treatment for hallucinations? NMS (neuroleptic malignant syndrome) - signs - symptoms - treatment A life-threatening drug reaction characterized by fever, change in BP and pulse, sweating, seizures, and change in LOC Tardive dyskinesia (TD) - signs - symptoms - treatment potentially disabling motor disorder that may occur following regular use of antipsychotic drugs Akathisia - signs - symptoms - treatment restlessness acute dystonia - signs - symptoms - treatment acute sustained contraction of muscles, usually of the head and neck Benzodiazepines drugs that lower anxiety and reduce stress Benzodiazepines - risks and benefits of prescribing - Which benzodiazepine is safe in lactation? - Which benzodiazepine should not be prescribed in pregnancy? - Recommended length of treatment - How to wean. fight or flight response an emotional and physiological reaction to an emergency that increases readiness for action Pathophysiology of Fear and worry know what areas of the brain are associated with the fight or flight response and which neurotransmitters are affected. GAD treatment SSRIs, SNRIs, buspirone, cognitive behavioral therapy. PTSD (Post Traumatic Stress Disorder) - which medication is FDA approved? OCD approved treatments. Which medication is first line? OCD- Which medications are appropriate for the elderly? -Which medications should be avoided in the elderly? In lactation? anxiolytic table especially buspirone