Psychopharmacology

Question 1

The movement of the drug into the bloodstream. With oral agents this typically occurs in the small intestines.

Answer 1

Absorption

Question 2

The transformation or breakdown of the drug in preparation for elimination from the body.

Answer 2

Metabolism

Question 3

Unintended and undesired effects that occur when the medication is administered correctly. The severity of the impact may be dose dependent.

Answer 3

Adverse effects

Question 4

The process by which substances (drugs, substrates, toxins) leave the body (feces, urine, skin).

Answer 4

Excretion

Question 5

The pre-circulation process (uptake and conversion) by which the substrates (changed drug) are significantly reduced by the cytochrome P450 (CYP450) enzyme in the liver after enteric absorption. Non-enteric routes of medication bypass first pass effect.

Answer 5

First Pass Effect

Question 6

Disorganized behavior with accompanying (one of three of the following): delusions, hallucinations, and/or disorganized speech (marked by frequent derailment or incoherence) lasting <1 day.

Answer 6

Psychosis

Question 7

The PMHNP is monitoring a serum drug level for a med with a 24-hour half-life. How many hours will it take to reach steady state?A. 48B. 72C. 96D. 120

Answer 7

D. 120 hours. Steady state is achieved in five half-lives of the medication. (5 x 24 = 120)

Question 8

Rapidly diminishing responsiveness to increasing doses of the medication; aka “poop-out” effect.

Answer 8

Tachyphylaxis

Question 9

Rare life-threatening condition that can occur at any time in a patient receiving antipsychotic medication. It most commonly occurs with typical versus atypical antipsychotics within the first 2 weeks of starting treatment.

Answer 9

Neuroleptic Malignant Syndrome

Question 10

Absent movement; difficulty standing; flat affect; avolition. Often mistaken for disinterest.

Answer 10

Akinesia

Question 11

A drug that blocks receptors, inhibiting a biological response, is known as a(n): A. Partial agonistB. Inverse agonist C. AntagonistD. Agonist

Answer 11

C. An antagonist is a medication that blocks a receptor to inhibit a biological response even from endogenous agnists.

Question 12

Shuffling gait, motor slowing, masked flat facial expression, tremor, and cogwheel rigidity.

Answer 12

Pseudo-Parkinson’s

Question 13

A usually undesired but foreseeable effect that occurs regardless of dose, and often resolves after continued therapy without intervention.

Answer 13

Side effect

Question 14

Involuntary muscle spasms.

Answer 14

Dystonia

Question 15

When target symptoms cease to be acceptably controlled or mitigated.

Answer 15

Treatment failure

Question 16

Dietary (tyramine) restrictions (for this drug class):- Aged cheese- Cured meat- Smoked meat- Fermented foods- Fish sauce- Alcohol- Soy products

Answer 16

MAOIs (Mono-amine Oxidase Inhibitors)

Question 17

Which antipsychotic is associated with agranulocytosis?

Answer 17

Clozapine (Clozaril)

Question 18

The time needed to clear 50% of the drug from the plasma.

Answer 18

Half-life

Question 19

The movement of the drug through the bloodstream and to target receptors. The chemicals (substrates) bind to the protein for transport. The unbound (free) portion of the drug is considered active.

Answer 19

Distribution

Question 20

The process of becoming desensitized and therefore less responsive to a particular dose of medication over time, necessitating increases; may eventually lead to “poop-out” effect.

Answer 20

Tolerance

Question 21

A medication that works by receptor activation to produce a biological effect.

Answer 21

Agonist

Question 22

Binds to a receptor but does not fully activate it, and produces a muted biological response

Answer 22

Partial agonist

Question 23

The study of what the body does to a drug concerning absorption, distribution, metabolism, and excretion (ADME).

Answer 23

Pharmacokinetics

Question 24

Inability to remain still; motor restlessness; often mistaken for anxiety.

Answer 24

Akathisia

Question 25

The study of drug action on the body, specifically the relationship between drug concentration and effect (dose and response).

Answer 25

Pharmacodynamics

Question 26

This drug class is known to prolong the QTc (except for aripiprazole).

Answer 26

Antipsychotics

Question 27

Which of the following is an indication for monitoring of serum drug levels?A. Smoking cessationB. New diagnosis of diabetesC. Resolution of symptomsD. New diagnosis of hyperlipidemia

Answer 27

A. Smoking is a known inducer of the CYP450 pathway.

Question 28

Syndrome associated with a rise in eosinophils, liver enzymes, renal insufficiency, and positive cardiac enzymes.

Answer 28

(DRESS) Syndrome

Drug rash with eosinophilia and systemic symptoms

Question 29

Specific, life-threatening drug rash characterized by blisters giving way to dermis and hives on the lining of the mucous membranes.

Answer 29

Steven-Johnson Syndrome

Question 30

It is essential to check the _______ level before treating the patient that is taking valproic acid.

Answer 30

Ammonia

Question 31

Check these things before initiating any psychopharmacological intervention (particularly those known to affect these parameters).

Answer 31

• Hepatic and renal function
• Lipids
• Hemoglobin A1C
• Thyroid Function (TSH)
• 12-lead EKG for QTc prolongation

Question 32

These 3 drug classes can precipitate SIADH. Also intermittently monitor sodium levels.

Answer 32

• SSRIs: Selective Serotonin Reuptake Inhibitors
• SNRIs: Serotonin-Norepinephrine Reuptake Inhibitors
• MAOIs: Monoamine Oxidase Inhibitors

Question 33

Refusing to believe a painful reality.

EXAMPLE: A partner denies the evidence of a love affair.

Answer 33

Denial

Question 34

Shifting an impulse toward a more acceptable object.

EXAMPLE: Kicking the dog in response to being disciplined.

Answer 34

Displacement

Question 35

Self-justifying explanation instead of reality which is perceived as threatening.

EXAMPLE: An alcoholic who says she only drinks socially.

Answer 35

Rationalization

Question 36

Disguising one’s impulse by attributing to others.

EXAMPLE: “All guys do this.”

Answer 36

Projection

Question 37

Switching unacceptable impulses into the opposite impulse.

EXAMPLE: Displacing angry feelings with extreme friendliness.

Answer 37

Reaction formation

Question 38

Retreating to a previously mastered developmental stage.

EXAMPLE: A child reverts to thumb-sucking or bed-wetting in response to a new stressor (new baby, new school, etc).

Answer 38

Regression

Question 39

Psychological angst manifested as a physical symptom.

EXAMPLE: Abdominal pain with no organic etiology.

Answer 39

Conversion

Question 40

Outer body experience, disconnected from the physical world.

EXAMPLE: Becoming inattentive or day-dreaming or freezing during an acute stress.

Answer 40

Dissociation

Question 41

Seeking a funny aspect in a stressful situation to reduce associated anxiety.

EXAMPLE: No example needed.

Answer 41

Humor