NSG552 Psychopharmacology Exam
1
1. What are the 6 general principles of psychopharmacological treatment?: -
Safety Tolerability
Efficacy Practicality
Treatment accessibility Treatment 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 receptors only, cause EPS symptoms faster due to prolonged receptor dissociation, have
more dangerous side effect profiles, have been around longer, more effective at treating positive symptoms, less
expensive. (Ex. Haloperidol, Chlorpromazine, Thioridazine, Fluphenazine)
5. Define Second-generation antipsychotics: Referred to as Atypical Antipsy- chotics. Most have a weak bond with
D2 receptors and block serotonin receptors leading to anti-depressive and anxiolytic effects. They cause less EPS due to
rapid receptor disassociation which leads to rapid dopamine neurotransmission. Have less dangerous side effect profiles
but can cause metabolic syndromes, have been around shorter time, more expensive, more effective at treating negative
symptoms but can treat positive symptoms as well, long-acting injections available for several of these. (Ex. Risperidone,
Clozapine, Quetiapine, Aripiprazole, Ziprasidone)
6. Extra Pyramidal Symptoms (EPS): Side effects caused by certain antipsychotic medications, which include:
involuntary or uncontrollable movements. tremors. mus- cle contractions.
7. Tardive dyskinesia: A neurological disorder characterize by involuntary move- ment of the face and jaw.
8. Upregulation: Occurs through chronic use of antagonists which causes an in- crease in the number of receptors,
externalization of receptors, and increased sen- sitivity 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
9. Down regulation: Occurs by chronic exposure of agonists which causes de- creased number of receptors,
internalization of receptors, and decreased sensitivity of the receptors. Prolonged use of agonist -> down-regulation of
receptors -> decreased effectiveness 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 affinity 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 different 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, ke- tamine, 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 an- ticancer drugs (2C19, two see 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 with this
one)
, NSG552 Psychopharmacology Exam
1
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
(6) Amiodarone
(7) All macrolides (think mycins) except azithromycin
1
1. What are the 6 general principles of psychopharmacological treatment?: -
Safety Tolerability
Efficacy Practicality
Treatment accessibility Treatment 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 receptors only, cause EPS symptoms faster due to prolonged receptor dissociation, have
more dangerous side effect profiles, have been around longer, more effective at treating positive symptoms, less
expensive. (Ex. Haloperidol, Chlorpromazine, Thioridazine, Fluphenazine)
5. Define Second-generation antipsychotics: Referred to as Atypical Antipsy- chotics. Most have a weak bond with
D2 receptors and block serotonin receptors leading to anti-depressive and anxiolytic effects. They cause less EPS due to
rapid receptor disassociation which leads to rapid dopamine neurotransmission. Have less dangerous side effect profiles
but can cause metabolic syndromes, have been around shorter time, more expensive, more effective at treating negative
symptoms but can treat positive symptoms as well, long-acting injections available for several of these. (Ex. Risperidone,
Clozapine, Quetiapine, Aripiprazole, Ziprasidone)
6. Extra Pyramidal Symptoms (EPS): Side effects caused by certain antipsychotic medications, which include:
involuntary or uncontrollable movements. tremors. mus- cle contractions.
7. Tardive dyskinesia: A neurological disorder characterize by involuntary move- ment of the face and jaw.
8. Upregulation: Occurs through chronic use of antagonists which causes an in- crease in the number of receptors,
externalization of receptors, and increased sen- sitivity 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
9. Down regulation: Occurs by chronic exposure of agonists which causes de- creased number of receptors,
internalization of receptors, and decreased sensitivity of the receptors. Prolonged use of agonist -> down-regulation of
receptors -> decreased effectiveness 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 affinity 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 different 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, ke- tamine, 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 an- ticancer drugs (2C19, two see 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 with this
one)
, NSG552 Psychopharmacology Exam
1
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
(6) Amiodarone
(7) All macrolides (think mycins) except azithromycin
