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List 4 MOA of commonly used antidepressants.

1. Inhibition of serotonin re-uptake
2. Inhibition of the re-uptake of both serotonin and norepinephrine
3. Stimulation of nor-adrenergic and dopaminergic activity
4. Alpha 2 antagonism of nor-adrenergic and serotonergic neuron


List 7 ADRs associated with the use of SSRIs.

1. Insomnia
2. Sedation
3. Appetite change
4. Nausea
5. Dry mouth
6. Headache
7. Sexual Dysfunction


List 6 ADRs associated with the use of anticholinergic Tricyclics

1. Dry eye
2. Dry mouth
3. Constipation
4. Urinary retention
5. Blurred vision
6. AMS


List 2 histaminic ADRs associated with Tricyclics

1. Sedation
2. Weight gain


What 2 things can occur as a result of an alpha 1 adrenergic blockade secondary to the use of Tricyclics?

1. Orthostatic hypertension
2. Falls


List 4 side effects that should be monitored for in patients taking Tricyclics (TCAs).

1. Possible EKG changes, arrhythmias (prolonged QT and PR, AV block) * In OVERDOSE=widened QRS
2. Require diet modification to avoid HTN crisis (avoid tyramine containing foods)
3. Cannot be combined with other antidepressants (risk of serotonin syndrome) or sympathomimetic drugs; avoid with cough syrup or Demerol
4. SERIOUS RISK OF OD- even one week’s supply can be lethal!


What is Serotonin Syndrome?

A group of symptoms that may occur following use of certain serotonergic medications or drugs.


List 8 symptoms associated with Serotonin Syndrome.

1. Mydriasis (dilation of the pupils)
2. Diaphoresis
3. Agitation
4. Autonomic instability (hypertension)
5. Increased bowel sounds (diarrhea)
6. Clonus
7. Tremor
8. Hyperreflexia (unique sxs used to distinguish from other syndromes)


What is lithium indicated for?

Mood stabilization (bipolar disorder)


List 14 ADRs associated with the use of lithium.

1. Dyspepsia
2. Nausea
3. Vomiting
4. Diarrhea
5. Weight gain
6. Hair loss
7. Acne
8. Tremor
9. Sedation
10. Decreased cognition
11. Incoordination
12. Nephrogenic DI
13. Hypothyroidism
14. Epstein’s anomaly in pregnancy


List 7 signs of serious lithium toxicity.

1. Altered mental status
2. Muscle fasciculations
3. Stupor
4. Seizures
5. Coma
6. Hyperreflexia
7. Cardiovascular collapse


Lithium toxicity must be monitored every _____ because it can be toxic to the kidneys and thyroid.

6 months


________ and ______ drugs can also be used as mood stabilizers.

2nd generation antipsychotic drugs


Explain the dopamine hypothesis regarding the neurobiology of schizophrenia.

Postulates that dopamine hyperactivity in the mesolimbic pathway causes the positive symptoms of psychosis.


______ is the neurotransmitter referred to as the ‘master switch’ of the brain.



Explain the glutamate hypothesis regarding the neurobiology of schizophrenia.

Faulty NMDA synapses on GABA interneurons in the PFC leading to overstimulation of glutamatergic cortico-brainstem neurons and downstream over activation of mesolimbic dopaminergic neurons = negative symptoms of schizophrenia


List 2 side effects associated with D2 receptor blockers (1st generation receptor blockers).

1. Movement Problems
2. Hyperprolactinemia


1st generation antipsychotic drugs target _____ receptors, while 2nd generation antipsychotic drugs target _____ receptors.

1st generation = TYPICAL receptors
2nd generation = ATYPICAL receptors


1st generation antipsychotic are ____ drugs that target the _____ and ______ tracts. What positive and negative symptoms may occur when these tracts are affected?

D2 Blockade drugs

MESOLIMBIC = positive symptoms (hallucinations)

MESOCORTICAL: negative symptoms (impaired speech, motor function, depression)

Rigidity and Dyskinesia also possible


2nd generation antipsychotics work at ____ and _____ receptors and are less likely to cause movement problems and hyperprolactinemia than 1st generation antipsychotics.

1. D2 receptors
2. Serotonergic receptors


True or False: There was no significant differences in effectiveness between 1st and 2nd generation antipsychotics.



List 4 ADRs associated with 2nd generation antipsychotic drugs.

1. HTN
2. Metabolic Syndrome
3. Diabetes
4. Weight gain


What is Neuroleptic Malignant syndrome? List the 4 cardinal features of this syndrome.

Rare but life threatening reaction to neuroleptic medications

1. Severe muscular rigidity
2. Hyperthermia (temperature >38°C)
3. Autonomic instability
4. Changes in the level of consciousness


List 6 signs and symptoms of Neuroleptic Malignant Syndrome. (FALTER)

1. Fever
2. AMS
3. Leukocytosis
4. Tremors
5. Elevated CPK
6. Rigidity


What is Tardive Dyskinesia?

Unwanted and involuntary movements of the mouth, jaw and face


Tardive Dyskinesia may be a side effect of using _____ drugs.

Antipsychotic drugs


List 4 MOAs of Baclofen.

1. Binds to GABAa receptor to block influx of Ca++ into presynaptic terminal
2. Reduce neurotransmitter release and membrane hyperpolarization
3. Reduce gamma motor neuron activity
4. Reduce muscle spindle sensitivity


List 1 indications for the use of Baclofen.

Spasticity in SCI and MS adults


Baclofen shows no clear improvements in ____ or _____.



What is the MOA of Botox? How long does it take for Botox to start working?

1. Prevents the release of Ach from presynaptic vessels
2. 48-72 hours


List 5 indications for the use of Botox.

1. Spasticity
2. Migraines
3. Dystonia
4. Eye movement abnormalities
5. Cosmetic


What is the pathophysiology of Alzheimer’s disease? (4 steps)

1. Overproduction/impaired clearance of beta-amyloid
2. Tau hyperphosphorylation
3. Neuronal toxicity
4. Neuronal death


List 3 categories of drugs used to treat Alzheimer’s disease.

1. Acetylcholinesterase inhibitors
2. Glutamate modulators
3. Behavioral treatments


List 3 behavioral treatments used to treat Alzheimer’s disease.

1. Environment: quite, familiar with labels on doors and good lighting
2. Depression: use SSRIs
3. Agitation: use neuroleptics


Alzheimer’s disease is characterized by progressive ______ and ______ deficits with _____ changes.

Progressive COGNITIVE and FUNCTIONAL deficits with BEHAVIORAL changes


What are the 5 major categories of drugs used to treat Parkinson’s Disease?

1. Dopamine agonist
2. Dopamine replacement (L-dopa/carbidopa)
3. Supplements to dopamine replacement
4. Amantadine
5. Anticholinergics


What is the MOA of dopamine agonists?

Activate dopamine receptors in the brain to produce more dopamine


What are 2 MOAs of dopamine replacement drugs (L-dopa and carbidopa)?

1. Replace dopamine in the CNS with dopa decardoxylase inhibitor which doesn’t cross the BBB
2. Inhibit conversion of levodopa to dopamine outside the brain


What is the MOA of amantadine?

Not fully known, works on the dopamine/glutamate brain pathways


Anticholinergic drugs decreases ____ Ach and restore the balance between _____ and _____.

1. Decrease CNS Ach
2. Restore balance between DOPAMINE and ACETYLCHOLINE


What is the difference between L-dopa and dopamine?

L-dopa can cross the BBB but dopamine cannot


Why is carbidopa added to L-dopa?

Carbidopa prevents the breakdown of levodopa in the bloodstream so more levodopa can enter the brain


List 5 common side effects of anti-epileptic drugs (AEDs).

1. Drowsiness
2. Sedation
3. ‘Brain fog’
4. Depression
5. Dizziness


Aside from seizures, list 9 indications for the use of anti-epileptic drugs (AEDs).

1. Trigeminal neuralgia
2. DM neuropathy
3. Parkinson’s Disease
4. Tardive dyskinesia
5. Migraines
6. Bipolar disorder
7. Schizophrenia
8. Anxiety
9. Weight loss


What is a positive screening test for intrathecal baclofen?

Positive if the test dose significantly reduced spasticity and improved ROM

Patient must show at least a drop of 1 point on the Ashworth scale to pass the screening test.


Describe the screening test for intrathecal baclofen. (2)

1. An initial dose of 50 ug of intrathecal baclofen is given on day one followed by frequent monitoring using the Ashworth scale for the next eight hours.
2. If spasiticity fails to improve, a dose of 75 ug may be given on day two, and then a dose of 100 ug may be given on day three.