Psychopharmacology: Antipsychotics and Antidepressants
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Questions and Answers

What is the primary goal during the first 6-8 weeks of antidepressant therapy?

  • To obtain full recovery from depression
  • To obtain a response to drug therapy and improve the patient's symptoms (correct)
  • To define non-response to antidepressant drug therapy
  • To maintain the effective dose for 8-14 months

    • What is the recommended duration for maintaining antidepressant drug therapy after remission of depressive symptoms?

  • 8-14 months (correct)
  • 1-2 years
  • 6-12 months
  • 6-8 weeks

    • What is the definition of therapeutic non-response to antidepressant drug therapy?

  • Failure to respond to at least 12 weeks of therapy
  • Failure to respond to at least 6 weeks of therapy (correct)
  • Failure to respond to at least 3 weeks of therapy
  • Failure to respond to at least 3 months of therapy

    • What is the mechanism of action of selective serotonin reuptake inhibitors (SSRIs)?

    <p>Increasing the levels of serotonin, dopamine, and norepinephrine concentrations in the CNS</p> Signup and view all the answers

    What is the etiology of depression?

    <p>Unknown</p> Signup and view all the answers

    What is the role of dosage optimization in antidepressant therapy?

    <p>To carefully upward titrate the medication dose for several weeks</p> Signup and view all the answers

    What is the term for the first 6-8 weeks of antidepressant therapy?

    <p>Acute phase</p> Signup and view all the answers

    Which of the following is an example of an older generation antidepressant?

    <p>Tricyclic antidepressant (TCA) drugs</p> Signup and view all the answers

    What is the primary indication for newer-generation antidepressants?

    <p>Depression</p> Signup and view all the answers

    What is a characteristic of schizophrenia?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action for antipsychotic drugs?

    <p>Reducing dopaminergic activity in the brain</p> Signup and view all the answers

    Why do patients taking antidepressant drugs need to be patient and faithful with dosing?

    <p>Because they may not see immediate results</p> Signup and view all the answers

    What is a hallmark of psychosis?

    <p>Loss of contact with reality</p> Signup and view all the answers

    What type of disorder is often associated with excessive dopaminergic activity in the brain?

    <p>Psychotic illness</p> Signup and view all the answers

    What is the primary goal of drug therapy for psychotic illness?

    <p>To reduce dopaminergic activity in the brain</p> Signup and view all the answers

    Why is patient assessment and response carefully evaluated in psychotic illness?

    <p>Because there are no diagnostic laboratory tests available</p> Signup and view all the answers

    What is characteristic of manic depressive illness?

    <p>Periods of extreme overactivity and excitement</p> Signup and view all the answers

    What is the primary basis for selecting an antipsychotic for a patient?

    <p>The patient's tolerance and need to minimize adverse effects</p> Signup and view all the answers

    What is a key difference between atypical and conventional antipsychotics?

    <p>Adverse effects</p> Signup and view all the answers

    Which of the following is NOT an atypical antipsychotic?

    <p>Haloperidol</p> Signup and view all the answers

    What do all antipsychotics have in common?

    <p>Blockage of dopamine receptors in the brain</p> Signup and view all the answers

    What is the mechanism of action of older antipsychotics such as phenothiazines?

    <p>Blockage of dopamine receptors postsynaptically</p> Signup and view all the answers

    What is the advantage of atypical antipsychotics compared to conventional antipsychotics?

    <p>Improved efficacy and safety profiles</p> Signup and view all the answers

    What brain areas are associated with the mechanisms of action of antipsychotics?

    <p>Limbic system and basal ganglia</p> Signup and view all the answers

    What is a major disadvantage of using Monoamine Oxidase Inhibitors (MAOIs)?

    <p>Their ability to cause a hypertensive crisis with certain foods and beverages</p> Signup and view all the answers

    What is the primary mechanism of action of Tricyclic Antidepressants (TCAs)?

    <p>Blocking presynaptic reuptake of serotonin and norepinephrine</p> Signup and view all the answers

    What is a common indication for the use of Tricyclic Antidepressants (TCAs)?

    <p>Treating neuropathic pain syndromes</p> Signup and view all the answers

    What is a contraindication for the use of Tricyclic Antidepressants (TCAs)?

    <p>All of the above</p> Signup and view all the answers

    What is a common adverse effect of Tricyclic Antidepressants (TCAs)?

    <p>Constipation</p> Signup and view all the answers

    What is a characteristic of Mirtazapine, a Tetracyclic Antidepressant?

    <p>Associated with sedation due to histamine H1 receptor activity</p> Signup and view all the answers

    What is the class of antidepressants that includes Citalopram, Escitalopram, and Fluoxetine?

    <p>Selective Serotonin Reuptake Inhibitors (SSRIs)</p> Signup and view all the answers

    What is the class of antidepressants that includes Duloxetine and Venlafaxine?

    <p>Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)</p> Signup and view all the answers

    What is a possible explanation for lithium's effectiveness in treating bipolar disorder?

    <p>It potentiates serotonergic neurotransmission</p> Signup and view all the answers

    Which of the following medications may be used in conjunction with lithium to regulate mood or achieve stability in manic or hypomanic patients?

    <p>All of the above</p> Signup and view all the answers

    What is a common adverse effect of the medications used to treat mania and hypomania?

    <p>Postural hypotension</p> Signup and view all the answers

    Why is it important to advise patients to change positions slowly?

    <p>To prevent postural hypotension and possible injury</p> Signup and view all the answers

    What is the importance of providing simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected?

    <p>To increase patient adherence to medication</p> Signup and view all the answers

    Why should only small amounts of medications be dispensed at a time?

    <p>To minimize the risk of suicide attempts</p> Signup and view all the answers

    What is the consequence of simultaneous use of these drugs with alcohol or other CNS depressants?

    <p>It can lead to fatal consequences</p> Signup and view all the answers

    What is the importance of the combination of drug therapy and psychotherapy?

    <p>To help patients learn and acquire more effective coping skills</p> Signup and view all the answers

    Study Notes

    Depression

    • Affective disorder characterized by intense sadness and duration beyond what is warranted by the event that triggered it
    • Uncertain etiology, but evidence suggests a reduction in neurotransmitters like serotonin and norepinephrine at neuron junctions in the brain

    Antidepressants

    • Increase levels of serotonin, dopamine, and norepinephrine in the CNS
    • Early and aggressive treatment increases chances of full remission
    • Primary goals of the first 6-8 weeks of therapy: obtain a response to drug therapy and improve symptoms
    • Recommended to maintain effective dose for an additional 8-14 months after remission

    Types of Antidepressants

    • Older generation:
      • Tricyclic antidepressants (TCAs)
      • Monoamine oxidase inhibitors (MAOIs)
    • Newer generation:
      • Selective serotonin reuptake inhibitors (SSRIs)
      • Serotonin norepinephrine reuptake inhibitors (SNRIs)
      • Miscellaneous

    Monoamine Oxidase Inhibitors (MAOIs)

    • Isocarboxazid, phenelzine, and tranylcypromine
    • Rarely used due to newer, safer drugs being available
    • Disadvantages: potential to cause hypertensive crisis when taken with substances containing tyramine

    Tricyclic Antidepressants (TCAs)

    • Amitriptyline, clomipramine, and imipramine
    • Mechanism of action: correcting imbalance in neurotransmitter concentrations by blocking presynaptic reuptake
    • Indications: originally used to treat depression, now used to treat neuropathic pain syndromes and insomnia
    • Contraindications: known drug allergy, pregnancy, acute or chronic cardiac problems, and history of seizures
    • Adverse effects: constipation, urinary retention, disturbances in cardiac conduction, hypotension, and sexual dysfunction

    Tetracyclic Antidepressants

    • Maprotiline and mirtazapine
    • Mirtazapine: associated with sedation, dosed once daily at bedtime, and increases appetite

    Selective Serotonin Reuptake Inhibitors (SSRIs)

    • Citalopram, escitalopram, fluoxetine, paroxetine, and sertraline
    • Mechanism of action: increasing serotonin levels in the CNS
    • Indications: depression, bipolar disorder, eating disorders, and obsessive-compulsive disorder

    Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

    • Duloxetine and venlafaxine
    • Associated with fewer and less severe systemic adverse effects compared to older-generation antidepressants

    Antipsychotic Drugs

    • Mental disorders: caused by inherent dysfunction in the brain leading to abnormal thought processes and responses
    • Psychosis: severe mental disorder impairing mental function and daily activities
    • Dopamine hypothesis: psychotic illness grows out of excessive dopaminergic activity in the brain

    Types of Antipsychotics

    • Older generation (conventional antipsychotics):
      • Thioridazine, trifluoperazine, chlorpromazine, and haloperidol
    • Newer generation (atypical antipsychotics):
      • Clozapine, olanzapine, risperidone, and aripiprazole
    • Mechanism of action: blocking dopamine receptors in the brain, decreasing dopamine concentration in the CNS

    Adverse Effects of Antipsychotics

    • CNS effects: drowsiness, neuroleptic malignant syndrome, and extrapyramidal symptoms
    • Cardiovascular effects: postural hypotension and electrocardiogram changes

    Lithium

    • Effective in alleviating symptoms of acute mania and maintenance treatment of bipolar disorder
    • Mechanism of action: potentiates serotonergic neurotransmission
    • Requires blood level monitoring due to narrow therapeutic range
    • Often used in conjunction with other medications like benzodiazepines, antipsychotic drugs, antiepileptic drugs, and dopamine receptor agonists

    Nursing Implications

    • Provide simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected
    • Advise patients to avoid abrupt withdrawal, change positions slowly, and minimize the risk of suicide attempts
    • Emphasize the combination of drug therapy and psychotherapy to acquire effective coping skills

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    Description

    This quiz covers the basics of antipsychotics and antidepressants, including their effects on neurotransmitters and the etiology of depression.

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