40 Questions
What is the primary function of acetylcholine in the hippocampus?
To aid in processing and storing memory
What happens to the neurotransmitter after it binds to the postsynaptic receptor?
It is neutralized
What is the name of the enzyme responsible for breaking down acetylcholine?
Cholinesterase
What is the term for the process by which neurotransmitters diffuse away from the synapse?
Fick's first law of diffusion
What is the motivation behind developing cholinesterase inhibitors?
To improve memory loss and cognitive impairment in Alzheimer's disease
What is the process by which a presynaptic neuron reclaims a neurotransmitter?
Re-uptake
What would happen if there was too much acetylcholine in the synapse?
We would never forget anything
What is the suffix commonly used in enzyme names to indicate their function?
ase
What is the primary concern when prescribing drugs that affect cardiac conduction in geriatric patients?
Age-related cardiac hyperexcitability
What is a common misconception about selective serotonin reuptake inhibitors (SSRIs)?
They are very benign and have no dangerous adverse effects
Which of the following SSRIs has a statistically significant prolongation of the QT interval?
Citalopram
What is the dose limit for citalopram in the geriatric population?
20 milligrams
Why might a provider still choose to prescribe citalopram despite the risks?
The patient has no insurance and must pay out of pocket
What is the primary reason to avoid using citalopram in geriatric patients?
It can cause a prolonged QT interval and increase the risk of dysrhythmia
What is a common misconception about antidepressants and anxiolytics?
They are completely safe and have no side effects
What is a key consideration when prescribing medications to geriatric patients?
The patient's age-related changes in the body
What is the primary function of the sympathetic nervous system?
To respond to stressors and prepare the body for 'fight or flight'
Which of the following is NOT a characteristic of the sympathetic nervous system?
Decreased blood pressure
What is the neurotransmitter of the parasympathetic nervous system?
Acetylcholine
Which of the following is a characteristic of a sympathetic discharge?
It happens suddenly and uncontrollably
What is the relationship between the sympathetic and parasympathetic nervous systems?
They have opposing functions and work antagonistically
What is the primary function of the parasympathetic nervous system?
To maintain day-to-day life functions
What is the primary symptom presentation in Alzheimer's disease patients?
Memory loss
What is a common side effect of medications that affect the parasympathetic nervous system?
Cholinergic adverse effects
What is the autonomic nervous system composed of?
The sympathetic and parasympathetic nervous systems
What was the brand name of the first cholinesterase inhibitor indicated for Alzheimer's disease?
Cognex
Why was the first cholinesterase inhibitor considered 'ludicrous'?
It had to be taken four times a day
What was a limitation of the first cholinesterase inhibitor in terms of its interaction with other drugs?
Cytochrome P450 interaction
What is the main consideration when selecting a cholinesterase inhibitor for a patient?
Which one best matches the patient's needs
What is a characteristic of the current cholinesterase inhibitors available in the market?
They are more user-friendly
What is a common assumption made by drug companies when developing new medications?
They want to be the first to get a new class of medication to market
What is a general principle to consider when prescribing medications to patients?
All medications have some adverse effect profile
What is the primary concern when treating psychosis in a patient with Parkinson's disease?
The treatment may worsen Parkinsonian motor symptoms
What is unique about Nuplazid compared to other antipsychotics?
It has no impact on dopamine, histamine, or muscarinic receptors
What is the theorized mechanism of action for Nuplazid's control of hallucinations and psychosis?
It acts as a serotonin 2A receptor antagonist and inverse agonist
What is the role of an agonist in a biological response?
It produces a biological response
Why is Nuplazid a better option for patients with Parkinson's disease than traditional antipsychotics?
It does not worsen Parkinsonian motor symptoms
What is the primary advantage of Nuplazid over other antipsychotics?
It does not impact dopamine receptors
What is the clinical conundrum when treating psychosis in a patient with Parkinson's disease?
Treating psychosis may worsen Parkinsonian motor symptoms
What is the consequence of using traditional antipsychotics to treat psychosis in a patient with Parkinson's disease?
The patient may experience worsened motor symptoms
Study Notes
Geriatric Psychopharmacology
- In geriatric psychopharmacology, it's essential to consider the potential impact of medications on cardiac conduction, especially in older adults with age-related cardiac hyperexcitability.
- Selective serotonin reuptake inhibitors (SSRIs) are generally considered safe, but they can still prolong the QT interval and increase the risk of dysrhythmia, particularly citalopram.
- Citalopram has an FDA Black Box warning for prolonged QT interval and risk of dysrhythmia and is dose-limited to 40mg for the general population and 20mg for geriatric patients.
Neurotransmission and Alzheimer's Disease
- Acetylcholine is a neurotransmitter that helps process and store memory in the hippocampus, and its loss contributes to memory loss in Alzheimer's disease.
- Cholinesterase inhibitors increase acetylcholine concentration by blocking its breakdown by the enzyme acetylcholinesterase.
- The three ways to neutralize neurotransmitters are:
- Diffusion away from the synapse
- Reuptake by the presynaptic neuron
- Enzymatic degradation
Cholinesterase Inhibitors
- The first cholinesterase inhibitor was tacrine, marketed under the brand name Cognex, but it had limitations, such as needing to be taken four times a day and interactions with cytochrome P450.
- Later formulations, such as Aricept, are more user-friendly but still have cholinergic adverse effects.
- Cholinergic adverse effects are common with cholinesterase inhibitors and are related to the parasympathetic nervous system.
Autonomic Nervous System
- The autonomic nervous system has two branches: sympathetic and parasympathetic.
- The sympathetic nervous system is responsible for the "fight or flight" response, increasing heart rate, blood pressure, and respiration.
- The parasympathetic nervous system, also known as the cholinergic system, maintains daily life functions, such as heart rate, digestion, and respiration.
Nuplazid
- Nuplazid is a medication that controls hallucinations and delusions without impacting dopamine, histamine, or muscarinic receptors.
- It has a unique mechanism of action, acting as a serotonin 2A receptor antagonist and inverse agonist to control psychosis.
- Nuplazid does not have anticholinergic or antihistamine-like side effects, making it a useful option for patients with Parkinson's disease or other dopamine-related conditions.
This quiz covers the key concepts and considerations in geriatric psychopharmacology, including prescribing for elderly patients. It focuses on important factors to think about early in the learning curve.
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