Final Exam Part 2

Question 1

List 4 MOA of commonly used antidepressants.

Answer 1

1. Inhibition of serotonin re-uptake
2. Inhibition of the re-uptake of both serotonin and norepinephrine
3. Stimulation of nor-adrenergic and dopaminergic activity
4. Alpha 2 antagonism of nor-adrenergic and serotonergic neuron

Question 2

List 7 ADRs associated with the use of SSRIs.

Answer 2

1. Insomnia
2. Sedation
3. Appetite change
4. Nausea
5. Dry mouth
6. Headache
7. Sexual Dysfunction

Question 3

List 6 ADRs associated with the use of anticholinergic Tricyclics

Answer 3

1. Dry eye
2. Dry mouth
3. Constipation
4. Urinary retention
5. Blurred vision
6. AMS

Question 4

List 2 histaminic ADRs associated with Tricyclics

Answer 4

1. Sedation

2. Weight gain

Question 5

What 2 things can occur as a result of an alpha 1 adrenergic blockade secondary to the use of Tricyclics?

Answer 5

1. Orthostatic hypertension

2. Falls

Question 6

List 4 side effects that should be monitored for in patients taking Tricyclics (TCAs).

Answer 6

1. Possible EKG changes, arrhythmias (prolonged QT and PR, AV block) * In OVERDOSE=widened QRS
2. Require diet modification to avoid HTN crisis (avoid tyramine containing foods)
3. Cannot be combined with other antidepressants (risk of serotonin syndrome) or sympathomimetic drugs; avoid with cough syrup or Demerol
4. SERIOUS RISK OF OD- even one week’s supply can be lethal!

Question 7

What is Serotonin Syndrome?

Answer 7

A group of symptoms that may occur following use of certain serotonergic medications or drugs.

Question 8

List 8 symptoms associated with Serotonin Syndrome.

Answer 8

1. Mydriasis (dilation of the pupils)
2. Diaphoresis
3. Agitation
4. Autonomic instability (hypertension)
5. Increased bowel sounds (diarrhea)
6. Clonus
7. Tremor
8. Hyperreflexia (unique sxs used to distinguish from other syndromes)

Question 9

What is lithium indicated for?

Answer 9

Mood stabilization (bipolar disorder)

Question 10

List 14 ADRs associated with the use of lithium.

Answer 10

1. Dyspepsia
2. Nausea
3. Vomiting
4. Diarrhea
5. Weight gain
6. Hair loss
7. Acne
8. Tremor
9. Sedation
10. Decreased cognition
11. Incoordination
12. Nephrogenic DI
13. Hypothyroidism
14. Epstein’s anomaly in pregnancy

Question 11

List 7 signs of serious lithium toxicity.

Answer 11

1. Altered mental status
2. Muscle fasciculations
3. Stupor
4. Seizures
5. Coma
6. Hyperreflexia
7. Cardiovascular collapse

Question 12

Lithium toxicity must be monitored every _____ because it can be toxic to the kidneys and thyroid.

Answer 12

6 months

Question 13

________ and ______ drugs can also be used as mood stabilizers.

Answer 13

Anticonvulsants

2nd generation antipsychotic drugs

Question 14

Explain the dopamine hypothesis regarding the neurobiology of schizophrenia.

Answer 14

Postulates that dopamine hyperactivity in the mesolimbic pathway causes the positive symptoms of psychosis.

Question 15

______ is the neurotransmitter referred to as the ‘master switch’ of the brain.

Answer 15

GLUTAMATE

Question 16

Explain the glutamate hypothesis regarding the neurobiology of schizophrenia.

Answer 16

Faulty NMDA synapses on GABA interneurons in the PFC leading to overstimulation of glutamatergic cortico-brainstem neurons and downstream over activation of mesolimbic dopaminergic neurons = negative symptoms of schizophrenia

Question 17

List 2 side effects associated with D2 receptor blockers (1st generation receptor blockers).

Answer 17

1. Movement Problems

2. Hyperprolactinemia

Question 18

1st generation antipsychotic drugs target _____ receptors, while 2nd generation antipsychotic drugs target _____ receptors.

Answer 18

1st generation = TYPICAL receptors

2nd generation = ATYPICAL receptors

Question 19

1st generation antipsychotic are ____ drugs that target the _____ and ______ tracts. What positive and negative symptoms may occur when these tracts are affected?

Answer 19

D2 Blockade drugs

MESOLIMBIC = positive symptoms (hallucinations)

MESOCORTICAL: negative symptoms (impaired speech, motor function, depression)

Rigidity and Dyskinesia also possible

Question 20

2nd generation antipsychotics work at ____ and _____ receptors and are less likely to cause movement problems and hyperprolactinemia than 1st generation antipsychotics.

Answer 20

1. D2 receptors

2. Serotonergic receptors

Question 21

True or False: There was no significant differences in effectiveness between 1st and 2nd generation antipsychotics.

Answer 21

TRUE

Question 22

List 4 ADRs associated with 2nd generation antipsychotic drugs.

Answer 22

1. HTN
2. Metabolic Syndrome
3. Diabetes
4. Weight gain

Question 23

What is Neuroleptic Malignant syndrome? List the 4 cardinal features of this syndrome.

Answer 23

Rare but life threatening reaction to neuroleptic medications

1. Severe muscular rigidity
2. Hyperthermia (temperature >38°C)
3. Autonomic instability
4. Changes in the level of consciousness

Question 24

List 6 signs and symptoms of Neuroleptic Malignant Syndrome. (FALTER)

Answer 24

1. Fever
2. AMS
3. Leukocytosis
4. Tremors
5. Elevated CPK
6. Rigidity

Question 25

What is Tardive Dyskinesia?

Answer 25

Unwanted and involuntary movements of the mouth, jaw and face

Question 26

Tardive Dyskinesia may be a side effect of using _____ drugs.

Answer 26

Antipsychotic drugs

Question 27

List 4 MOAs of Baclofen.

Answer 27

1. Binds to GABAa receptor to block influx of Ca++ into presynaptic terminal 2. Reduce neurotransmitter release and membrane hyperpolarization 3. Reduce gamma motor neuron activity 4. Reduce muscle spindle sensitivity

Question 28

List 1 indications for the use of Baclofen.

Answer 28

Spasticity in SCI and MS adults

Question 29

Baclofen shows no clear improvements in ____ or _____.

Answer 29

Gait | ADLs

Question 30

What is the MOA of Botox? How long does it take for Botox to start working?

Answer 30

1. Prevents the release of Ach from presynaptic vessels | 2. 48-72 hours

Question 31

List 5 indications for the use of Botox.

Answer 31

1. Spasticity 2. Migraines 3. Dystonia 4. Eye movement abnormalities 5. Cosmetic

Question 32

What is the pathophysiology of Alzheimer’s disease? (4 steps)

Answer 32

1. Overproduction/impaired clearance of beta-amyloid 2. Tau hyperphosphorylation 3. Neuronal toxicity 4. Neuronal death

Question 33

List 3 categories of drugs used to treat Alzheimer’s disease.

Answer 33

1. Acetylcholinesterase inhibitors 2. Glutamate modulators 3. Behavioral treatments

Question 34

List 3 behavioral treatments used to treat Alzheimer’s disease.

Answer 34

1. Environment: quite, familiar with labels on doors and good lighting 2. Depression: use SSRIs 3. Agitation: use neuroleptics

Question 35

Alzheimer’s disease is characterized by progressive ______ and ______ deficits with _____ changes.

Answer 35

Progressive COGNITIVE and FUNCTIONAL deficits with BEHAVIORAL changes

Question 36

What are the 5 major categories of drugs used to treat Parkinson’s Disease?

Answer 36

1. Dopamine agonist 2. Dopamine replacement (L-dopa/carbidopa) 3. Supplements to dopamine replacement 4. Amantadine 5. Anticholinergics

Question 37

What is the MOA of dopamine agonists?

Answer 37

Activate dopamine receptors in the brain to produce more dopamine

Question 38

What are 2 MOAs of dopamine replacement drugs (L-dopa and carbidopa)?

Answer 38

1. Replace dopamine in the CNS with dopa decardoxylase inhibitor which doesn’t cross the BBB 2. Inhibit conversion of levodopa to dopamine outside the brain

Question 39

What is the MOA of amantadine?

Answer 39

Not fully known, works on the dopamine/glutamate brain pathways

Question 40

Anticholinergic drugs decreases ____ Ach and restore the balance between _____ and _____.

Answer 40

1. Decrease CNS Ach | 2. Restore balance between DOPAMINE and ACETYLCHOLINE

Question 41

What is the difference between L-dopa and dopamine?

Answer 41

L-dopa can cross the BBB but dopamine cannot

Question 42

Why is carbidopa added to L-dopa?

Answer 42

Carbidopa prevents the breakdown of levodopa in the bloodstream so more levodopa can enter the brain

Question 43

List 5 common side effects of anti-epileptic drugs (AEDs).

Answer 43

1. Drowsiness 2. Sedation 3. ‘Brain fog’ 4. Depression 5. Dizziness

Question 44

Aside from seizures, list 9 indications for the use of anti-epileptic drugs (AEDs).

Answer 44

1. Trigeminal neuralgia 2. DM neuropathy 3. Parkinson’s Disease 4. Tardive dyskinesia 5. Migraines 6. Bipolar disorder 7. Schizophrenia 8. Anxiety 9. Weight loss

Question 45

What is a positive screening test for intrathecal baclofen?

Answer 45

Positive if the test dose significantly reduced spasticity and improved ROM Patient must show at least a drop of 1 point on the Ashworth scale to pass the screening test.

Question 46

Describe the screening test for intrathecal baclofen. (2)

Answer 46

1. An initial dose of 50 ug of intrathecal baclofen is given on day one followed by frequent monitoring using the Ashworth scale for the next eight hours. 2. If spasiticity fails to improve, a dose of 75 ug may be given on day two, and then a dose of 100 ug may be given on day three.