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?

Hypertensive crisis Signup and view all the answers

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

Serotonin syndrome 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?

Phenothiazines Signup and view all the answers

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

Block dopamine receptors Signup and view all the answers

Which drug is an example of a thioxanthene?

Thiothixene Signup and view all the answers

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

Haloperidol Signup and view all the answers

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

Phenylbutylpiperidines Signup and view all the answers

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

Management of nausea in palliative patients Signup and view all the answers

Which of the following antipsychotics is NOT categorized under Phenothiazines?

Risperidone Signup and view all the answers

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

Agranulocytosis Signup and view all the answers

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

They block both serotonin and dopamine receptors. Signup and view all the answers

What must be done when withdrawing a patient from pimozide?

Gradually taper the dosage Signup and view all the answers

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

Risperidone Signup and view all the answers

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

Motor symptoms associated with Parkinson's disease Signup and view all the answers

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

Sedation and antiemetic effects Signup and view all the answers

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

Lower risk of extrapyramidal symptoms Signup and view all the answers

What are the characteristics associated with tardive dyskinesia?

Uncontrollable facial movements Signup and view all the answers

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

Clozapine Signup and view all the answers

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

Increased risk of suicidal thoughts Signup and view all the answers

When is the risk of suicide highest during antidepressant treatment?

At the beginning of treatment Signup and view all the answers

Which generation of antidepressants includes MAOIs?

First Generation Signup and view all the answers

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

Tricyclic antidepressants Signup and view all the answers

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

Close monitoring is essential Signup and view all the answers

Which of the following statements about antidepressants is correct?

The risk of suicide decreases with older age. Signup and view all the answers

Which type of antidepressants are commonly classified as SSRIs?

Serotonin Reuptake Inhibitors Signup and view all the answers

Which group does NOT belong under first generation antidepressants?

SSRIs Signup and view all the answers

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

Screening and treating depression attentively Signup and view all the answers

What is a characteristic of tetracyclic antidepressants?

They are part of the first generation group. Signup and view all the answers

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

Dehydration Signup and view all the answers

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

0.6-1.2 mEq/L Signup and view all the answers

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

Hypothyroidism Signup and view all the answers

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

Sertraline Signup and view all the answers

What is an early sign of lithium toxicity?

Tremors Signup and view all the answers

Which mental health disorder is commonly treated with antidepressant drugs?

Major depression Signup and view all the answers

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

Sodium Signup and view all the answers

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

Benzodiazepines Signup and view all the answers

What is considered a severe level of lithium intoxication?

<blockquote> 3.5 mEq/L </blockquote> Signup and view all the answers

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

Chronic pain Signup and view all the answers

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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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.