Psychopharmacology: MAOIs and Antipsychotics
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Questions and Answers

What dietary restriction must be observed when using MAOIs?

  • Diet must be low in carbohydrates
  • Diet must include high protein
  • Diet should avoid dairy products
  • Diet must be free of tyramine (correct)

Which neurotransmitter's metabolism is NOT inhibited by MAOIs?

  • Dopamine
  • Glutamate (correct)
  • Norepinephrine
  • Serotonin

Which of the following is a serious adverse effect associated with MAOIs?

  • Bloating
  • Fatigue
  • Severe hypertension (correct)
  • Headache

What condition can occur if tyramine-containing foods are consumed while on MAOIs?

<p>Hypertensive crisis (A)</p> Signup and view all the answers

What is a potential serious reaction resulting from excessive serotonin levels?

<p>Serotonin syndrome (D)</p> Signup and view all the answers

Which class of antipsychotic drugs has the lowest potency and is characterized by the suffix 'azine' in the generic name?

<p>Phenothiazines (B)</p> Signup and view all the answers

What is a common mechanism of action for first-generation antipsychotics?

<p>Block dopamine receptors (B)</p> Signup and view all the answers

Which drug is an example of a thioxanthene?

<p>Thiothixene (A)</p> Signup and view all the answers

Which of the following antipsychotics is strongly associated with extrapyramidal symptoms (EPS)?

<p>Haloperidol (D)</p> Signup and view all the answers

Which class of antipsychotic is structurally different from both thioxanthenes and phenothiazines yet shares similar antipsychotic properties?

<p>Phenylbutylpiperidines (C)</p> Signup and view all the answers

In addition to its antipsychotic effects, what is Haloperidol commonly used for?

<p>Management of nausea in palliative patients (D)</p> Signup and view all the answers

Which of the following antipsychotics is NOT categorized under Phenothiazines?

<p>Risperidone (B)</p> Signup and view all the answers

What is a significant risk associated with clozapine during long-term treatment?

<p>Agranulocytosis (B)</p> Signup and view all the answers

Which of the following characteristics best describes the second generation antipsychotic drugs?

<p>They block both serotonin and dopamine receptors. (B)</p> Signup and view all the answers

What must be done when withdrawing a patient from pimozide?

<p>Gradually taper the dosage (C)</p> Signup and view all the answers

Which second generation antipsychotic is specifically indicated for treating irritability associated with autistic disorder?

<p>Risperidone (A)</p> Signup and view all the answers

What type of symptoms do extrapyramidal symptoms (EPS) resemble?

<p>Motor symptoms associated with Parkinson's disease (B)</p> Signup and view all the answers

What is the primary use for antipsychotic drugs based on their current shift in application?

<p>Sedation and antiemetic effects (D)</p> Signup and view all the answers

Which of the following is a notable effect of aripiprazole compared to risperidone?

<p>Lower risk of extrapyramidal symptoms (B)</p> Signup and view all the answers

What are the characteristics associated with tardive dyskinesia?

<p>Uncontrollable facial movements (A)</p> Signup and view all the answers

Which medication is indicated as an adjunct treatment to increase effects for certain conditions?

<p>Clozapine (A)</p> Signup and view all the answers

What is the main concern associated with the use of antidepressants in adolescents and young adults?

<p>Increased risk of suicidal thoughts (A)</p> Signup and view all the answers

When is the risk of suicide highest during antidepressant treatment?

<p>At the beginning of treatment (A)</p> Signup and view all the answers

Which generation of antidepressants includes MAOIs?

<p>First Generation (A)</p> Signup and view all the answers

Which class of antidepressants is NOT included in the second generation category?

<p>Tricyclic antidepressants (B)</p> Signup and view all the answers

What is the suggested monitoring approach during the first weeks of antidepressant treatment?

<p>Close monitoring is essential (A)</p> Signup and view all the answers

Which of the following statements about antidepressants is correct?

<p>The risk of suicide decreases with older age. (D)</p> Signup and view all the answers

Which type of antidepressants are commonly classified as SSRIs?

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

Which group does NOT belong under first generation antidepressants?

<p>SSRIs (A)</p> Signup and view all the answers

What is an important factor for clinicians to consider when treating depression with antidepressants?

<p>Screening and treating depression attentively (B)</p> Signup and view all the answers

What is a characteristic of tetracyclic antidepressants?

<p>They are part of the first generation group. (A)</p> Signup and view all the answers

Which of the following conditions is a contraindication for the use of thiazide diuretics?

<p>Dehydration (B)</p> Signup and view all the answers

What serum lithium level range is considered the acceptable maintenance range?

<p>0.6-1.2 mEq/L (B)</p> Signup and view all the answers

What is a potential adverse effect of long-term lithium use?

<p>Hypothyroidism (A)</p> Signup and view all the answers

Which of the following drugs is NOT indicated for adjunct therapy with lithium in managing mania?

<p>Sertraline (B)</p> Signup and view all the answers

What is an early sign of lithium toxicity?

<p>Tremors (C)</p> Signup and view all the answers

Which mental health disorder is commonly treated with antidepressant drugs?

<p>Major depression (A)</p> Signup and view all the answers

Which electrolyte levels should be monitored for a patient on lithium?

<p>Sodium (B)</p> Signup and view all the answers

Which of these classes of drugs is NOT typically a first-line treatment for major depression?

<p>Benzodiazepines (A)</p> Signup and view all the answers

What is considered a severe level of lithium intoxication?

<blockquote> <p>3.5 mEq/L (D)</p> </blockquote> Signup and view all the answers

Which condition is one of the non-mental health medical uses for antidepressant drugs?

<p>Chronic pain (A)</p> Signup and view all the answers

Flashcards

First-generation antipsychotics (conventional)

A class of antipsychotic drugs that primarily work by blocking dopamine receptors in the brain.

Dopamine receptor blockade

The primary mechanism of action of conventional antipsychotics, inhibiting dopamine signaling in the brain.

Phenothiazines

A large group of first-generation antipsychotics that often end in "azine".

Thioxanthenes

First-generation antipsychotics with similar mechanisms to phenothiazines, but potentially fewer side effects.

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Phenylbutylpiperidines

First-generation antipsychotics having different structures from phenothiazines and thioxanthenes but similar antipsychotic actions.

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Extrapyramidal side effects (EPS)

Common side effects of first-generation antipsychotics, affecting movement and coordination.

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Haloperidol (Haldol)

A potent first-generation antipsychotic, commonly used to treat nausea.

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Pimozide (Orap®) Contraindications

Pimozide should not be used with antibiotics that affect the QT interval, like Clarithromycin and Erythromycin

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Antipsychotic Drug Withdrawal

Withdrawal from antipsychotic drugs must be gradual and tapered, not abruptly stopped.

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Antipsychotic Drug Addiction (Physical)

Antipsychotic drugs can be physically addictive, requiring a monitored tapering of dosage to avoid withdrawal.

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2nd Generation Antipsychotics

More effective in treating psychosis symptoms with less Extrapyramidal side effects (EPS) than 1st generation drugs.

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Mechanism of Action (2nd Gen antipsychotics)

Block both dopamine and serotonin receptors, leading to a tranquilizing effect, and greater impact on psychotic symptoms.

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Clozapine (Clozaril®) use

A 2nd generation antipsychotic primarily used as an adjunct to increase the effectiveness of other medications, but with the risk of agranulocytosis.

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Extrapyramidal Symptoms (EPS)

Involuntary motor symptoms similar to Parkinson's disease, potentially impacting mental health treatment.

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Akathisia

A distressing motor restlessness, a potential side effect of certain medications.

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Tardive Dyskinesia

Uncontrollable facial movements (e.g., lip smacking, chewing).

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MAOIs Mechanism of Action

MAOIs block the enzyme monoamine oxidase (MAO), preventing the breakdown of neurotransmitters like epinephrine, dopamine, norepinephrine, serotonin, and tyramine, leading to their accumulation in synapses.

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MAOI Adverse Effects - Hypertensive Crisis

A dangerous increase in blood pressure that can occur when eating foods containing tyramine while taking MAOIs. Tyramine usually gets broken down by MAO, but MAOIs block this, leading to an excess of tyramine. This triggers a surge of other neurotransmitters causing potentially fatal hypertension.

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Tyramine-Rich Foods

Foods high in tyramine, such as aged cheeses, cured meats, and fermented foods, should be avoided when taking MAOIs to prevent dangerously high blood pressure.

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Serotonin Syndrome

A potentially life-threatening reaction to too much serotonin in the body, often triggered by MAOIs or other drugs that affect serotonin levels. It is characterized by a triad of symptoms.

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MAOIs - Parkinson's Disease

Selegiline (a type of MAOI) is used to treat Parkinson's Disease but needs to be mindful in its consumption in order to prevent toxicity, as the diet needs to be free from Tyramine.

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Antidepressant Risk

Antidepressants may increase suicidal thoughts, especially in young people.

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Depression & Suicide

Depression is strongly linked to suicidal thoughts and behaviors.

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Antidepressant Types

Antidepressants are categorized into first and second generations.

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First-Generation Antidepressants

Older types, including tricyclics and MAOIs.

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Second-Generation Antidepressants

More recent types, like SSRIs and SNRIs.

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SSRIs

Selective serotonin reuptake inhibitors.

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SNRIs

Serotonin-norepinephrine reuptake inhibitors.

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Tricyclic antidepressants

Medication class for depression.

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MAOIs

Monoamine oxidase inhibitors.

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Monitoring during treatment

Close monitoring is critical in the first few weeks of treatment.

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Thiazide Diuretics Contraindications

Conditions where thiazide diuretics should not be used, including dehydration, sodium imbalances, kidney disease, cardiac disease, pregnancy, and age under 6.

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ACE Inhibitor Contraindications

Conditions where ACE inhibitors shouldn't be used (not listed in the provided text).

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NSAID Contraindications

Conditions where NSAIDs shouldn't be used (not listed in the provided text).

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Lithium Serum Levels

The ideal range of lithium in the blood for treatment of mania, ranging from 0.6-1.2 mEq/L.

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Lithium Toxicity Levels

Serum lithium levels above 1.5 mEq/L indicate potential toxicity. Severity increases with higher levels.

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Lithium Toxicity Symptoms (Mild)

Symptoms of mild lithium intoxication include nausea, vomiting, lethargy, tremor, and fatigue.

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Lithium Toxicity Symptoms (Moderate)

Symptoms of moderate lithium intoxication include confusion, agitation, delirium, tachycardia, and hypertonia.

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Lithium Toxicity Symptoms (Severe)

Symptoms of severe lithium intoxication include coma, seizures, hyperthermia, and hypotension.

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Lithium Long-Term Side Effect (Hypothyroidism)

Long-term lithium use can lead to hypothyroidism.

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Lithium Adjunct Therapy

Lithium can be used together with other medications (e.g., valproic acid, lamotrigine, topiramate, oxcarbazepine) to treat mania.

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Study Notes

Psychotherapeutic Drugs

  • Psychotherapeutic drugs, also called psychotropics, alter mental and emotional processes.
  • Current theories suggest neurotransmitter imbalances are a key factor in many mental health disorders.
  • Mental health drugs aim to correct imbalances by blocking or stimulating neurotransmitter release.
  • Combining drugs with non-pharmacological treatments (e.g., counseling) is needed for optimal results.
  • The goal of treatment is to improve quality of life, daily living skills, social and occupational functioning.
  • Some drugs initially approved for one condition may be later approved for others.
  • Response to medication varies significantly among patients.
  • Children and the elderly are more vulnerable to adverse effects.
  • A trial-and-error approach might be necessary to find the most effective drug for an individual.
  • Stigma and fear of adverse effects hinder individuals from accepting and adhering to treatment.

Antipsychotic Drugs (Neuroleptics)

  • Antipsychotics are used to treat psychoses, particularly those associated with schizophrenia but do not cure the illness.
  • They are also used for extreme mania, bipolar disorder and other medical conditions.
  • Antipsychotics aim to stabilize mood and reduce symptoms like hallucinations, delusions, and disorganized behavior.
  • Two generations of antipsychotics exist: first-generation (conventional) and second-generation (atypical).

First-generation Antipsychotics

  • Includes phenothiazines, thioxanthenes, and phenylbutylpiperidines.
  • Significant side effects, including extrapyramidal symptoms (EPS).
  • Specific examples of 1st Gen drugs include: chlorpromazine, fluphenazine, haloperidol, and pimozide.
  • Used for sedation and antiemetic (reduces nausea) purposes.

Second-generation Antipsychotics

  • Includes dibenzodiazepines and benzisoxazoles.
  • Generally, a newer class than first generation, they are more effective.
  • Generally fewer extrapyramidal side effects (EPS).
  • Examples include: clozapine, olanzapine, quetiapine, risperidone, and aripiprazole.
  • Treatment is more effective, but higher risk of certain side effects.

Mechanism of Action of First-generation Antipsychotics

  • Reduces overall dopamine concentration in areas of the brain involved in mental illness.
  • Blocks dopamine in other areas that lead to lower blood pressure (hypotension)

Mechanism of Action of Second-generation Antipsychotics

  • Works on dopamine receptors
  • Works on serotonin receptors to reduce symptoms

Extrapyramidal Symptoms (EPS) and Neuroleptic Malignant Syndrome (NMS)

  • EPS are involuntary movements similar to Parkinson's disease.
  • Symptoms include akathisia, tardive dyskinesia, and acute dystonia.
  • NMS is a life-threatening adverse effect.
  • Symptoms include muscle rigidity, high fever, autonomic instability, and altered mental status.
  • Treatment for both involves discontinuation of medication, administration of anticholinergics, and supportive measures for NMS.

Antipsychotic Drugs - Adverse Effects

  • Some common side effects include low white blood cell count, anaemia, hyperlipidemia, orthostatic hypotension, ECG changes (QT), insulin resistance, weight gain, exfoliative dermatitis, constipation, urinary retention, sexual dysfunction, and gynecomastia.

Anxiolytic Drugs (Anti-anxiety Drugs)

  • Two types exist: benzodiazepines and buspirone hydrochloride.

Benzodiazepines

  • Used for short-term symptom management.
  • Comes in short, intermediate, and long-acting forms.
  • Mechanism: Enhances the action of GABA, which reduces overactivity in the brainstem and limbic system.
  • Examples: Diazepam (Valium), Lorazepam (Ativan), Clonazepam (Klonopin), Alprazolam (Xanax), and Oxazepam (Serax)

Buspirone Hydrochloride

  • Used for anxiety without sedative, or dependence-forming properties.

Mood Stabilizer Drugs (Lithium)

  • Lithium is used to treat bipolar disorder, specifically for acute mania and maintenance treatment.
  • Mechanism is not fully understood but may involve shifts in sodium ion transport and action of GABA, as well as inhibiting certain neurotransmitters in the brain.
  • Use in combination with other medical treatments like benzodiazepines or antipsychotics is common
  • Narrow therapeutic index; requires strict monitoring and careful diet
  • Careful monitoring of blood levels and sodium is crucial due to its possible toxicity. It is excreted unchanged in the urine.

Antidepressant Drugs

  • Two generations exist: first- and second-generation.

First-generation Antidepressants

  • Includes tricyclic antidepressants, MAOIs, and tetracyclic antidepressants.
  • Tricyclic antidepressants are named for their chemical structure comprising three rings.
  • They correct imbalances by blocking reuptake of norepinephrine and serotonin, making more available for neural transmission
  • Common first-generations: Amitriptyline, Nortriptyline, and Clomipramine

Second-generation Antidepressants

  • Includes SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors).

  • SSRIs work by reducing serotonin reabsorption.

  • Some SSRIs and SNRIs include: Fluoxetine, Sertraline, Paroxetine, Fluvoxamine, Citalopram, Venlafaxine, Duloxetine, Levomilnacipran, and Desvenlafaxine

  • A large list of potential side effects, potential drug interactions, and contraindications exists for this class of drugs.

  • Drug interactions are also possible for second-generations with first-generation drugs, and MAOIs.

  • Treatment for overdose cases differs from one generation to another.

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Psychotherapeutic Drugs PHAR1059 2024-2025 PDF

Description

Test your knowledge on the dietary restrictions associated with MAOIs and explore the various classes of antipsychotic medications. This quiz covers key concepts, including neurotransmitter metabolism and serious adverse effects linked to these drugs. Perfect for students of pharmacology or those interested in mental health treatments.

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