Pscyhopharm exam 1

Question 1

Pharmacology

Answer 1

• Study of drug actions and effects on living organisms
• Includes synthetic and natural substances

Question 2

Neuropharmacology

Answer 2

• Focused on drug-induced changes in cell functioning in nervous system

Question 3

Psychopharmacology

Answer 3

Drug-induced changes in mood, thinking, and behavior

Question 4

Neuropsychopharmacology

Answer 4

Focused on identification of chemical substances that alter nervous system and alter behaviors changed by injury, disease or environmental factors

Question 5

Drug

Answer 5

Any substance that brings about change in biologic function through its chemical actions

Question 6

Drug action

Answer 6

Specific molecular changes caused by a drug when it binds to specific target or receptor

Question 7

Drug effects

Answer 7

• Widespread alterations in physiological or psychological functioning.
• Site where these effects can be different

Question 8

Therapeutic effects

Answer 8

• Interaction between drug and receptor results in desired change, physical or behavioral
• Not all drugs have therapeutic effects

Question 9

Side Effects

Answer 9

• Unwanted and sometimes unintentional changes caused by interaction between drug and receptor
• All drugs have side effects

Question 10

Nonspecific drug effects

Answer 10

Changes that occur after drug-receptor interactions due to uniqueness of the person rather than drug-site interaction

Question 11

Liver (enzyme)

Answer 11

• Critical for metabolism of nutrients
• Increased serum levels of liver enzymes indicate
  
  • Alcoholic hepatitis
  • Active viral hepatitis (A, B, C)
  • Drug-induced hepatitis

Question 12

Cytochrome P450

Answer 12

• Proteins with a heme (taxi carrier blood brain barrier) group
• Involves various intracellular electron transfers
• Oxidation reactions
• In liver
• Involves in drug metabolism
• Leads to drug-drug interactions

Question 13

Pharmacodynamics

Answer 13

• Pharmacodynamics: Study of what the drug does to the body
  
  • Other drugs present
  • Chemical interactions
  • Disorders
    • Genetic mutation
    • Malnutrition
    • Parkinson’s disease
  • Affected by physiologic changes
  • Post-receptor effects
  • Aging
  • Receptor binding
• Up-regulation
  
  • Receptor numbers increase
  • Due to drug effects
• Down-regulations
  
  • Receptor numbers decrease
  • Due to drug effects
• Potency
  
  • Amount of drug necessary to achieve desired behavioral effect
• Tolerance
  
  • Diminished response to specific drug after repeated exposure
    
    • Cross-tolerance: drug interaction
    • Acute tolerance: single administration
    • Pharmacodynamic tolerance: changes in cell function compensate for presence of drug
    • Behavioral tolerance: Involves learning

Question 14

Pharmacokinetics

Answer 14

Pharmacokinetics: Study of what the body does to the drug

• Determines onset, duration and intensity of the drug’s effect

Four factors:

• Absorption: How body “takes in” the drug?
  
  • Determined by drug’s physiochemical properties, formulation and route of administration
  • Routes of administration:
    
    • Oral (pills, liquid): First-pass metabolism, Involves liver
    • Intramuscular (IM, shot): Slower then IV, faster than oral, Drugs can be suspended in oil
    • Subcutaneous (under the skin):
    • Inhalant (breathe in): Absorbed into blood via lungs, Very rapid, Get to brain quickly
    • Intravenously (IV, shot): Most rapid, Accurate, Quick onset of drug action can be dangerous
• Distribution: How body releases the drug?
• Biotransformation: What body does to the drug?
• Excretion: How body gets rid of the drug?

Question 15

Absorption

Answer 15

• Crossing the blood-brain barrier
  
  • Passive Transport:
    
    • Easily moves through membrane
    • Smaller chemical
    • More likely lipophilic
  • Active Transport:
    
    • Requires higher expenditure of energy
    • Drugs likely endogenous (vitamins, sugars, amino acids)

Question 16

Blood-Brain Barrier

Answer 16

• Dense network of blood vessels
• Supplies brain with nutrients
• Keeps out toxins
• Cerebrospinal fluid created by choroid plexus (lateral ventricle)

Question 17

Distribution

Answer 17

• How drug is distributed to body tissues
• Usually uneven
• Distribution is slow to muscles and lipids

Question 18

First-order kinetics

Half-life

Answer 18

• First-order kinetics
  
  • Drug clearance
  • How much gets through in the first pass
• Half-life
  
  • The amount of time required for 50% of a drug to be eliminated from the body

Question 19

Binding

Answer 19

• How the chemical “sticks” to proteins
• “free”drug: unbound (not stuck)
  
  • Can diffuse to tissue sites where drug effects occur
  • Free” drug amount causes drug effects
• Albumin
  
  • Critical plasma protein for mental health drugs
  • Acidic drugs bind to albumin

Question 20

Steady State plasma level

Zero-order kinetics

Answer 20

• Steady State plasma level:
  
  • Desired blood concentration of drug in order to have therapeutic effects
• Zero-order kinetics:
  
  • Drug molecules are cleared at constant rate regardless of drug concentration
  • Drug levels are high and receptors are bound
  • Zero clearance: receptors are busy

Question 21

Biotransformation

Answer 21

• Process by which any substance that enters body is changed
  
  • From hydrophobic or lipophilic
  • to hydrophilic or lipophobic
  • This is done to facilitate the elimination from the body.
• Metabolizing the chemical
• Occurs in the liver, primarily
  
  • Caused by enzymes
  • Produces by-products: metabolites
    
    • Helpful to reduce symptoms
• Toxicity
  
  • Can occur when biotransformation is not working correctly

Question 22

Excretion

Answer 22

• The process of elimination of drug
• Through the kidneys
  
  • If hydrophilic
• Other routes include:
  
  • GI tract
  • Lungs
  • Sweat
  • Saliva
  • Breast milk

Question 23

Half LIfe

Answer 23

• How long drug stays in body
• “amount of time required for the serum concentration to be reduced by 50%
• Used to determine dosage amount and intervals
• Steady State
  
  • When drug concentrations in the blood to reach a plateau so the amount administered is equal to the amount being eliminated

Question 24

Why Side Effects

Answer 24

• Symptoms occur because of chemical reactions
• Medications effect chemicals all over body
• Thus we have side effects
• The mechanisms:
  • Many molecules bind to more than one receptor
    
    • Antipsychotics can bind to DA receptor and Ach muscurinic receptors causing side effects
  • A molecule can bind to receptors in more than one system
    
    • DA receptors in limbic system and gut.

Question 25

Common Side Effects

Answer 25

* **Anticholinergic Effects** * Dry mouth * Urinary retention * Blurred vision * Headaches * **Orthostasis** * Especially problematic with elderly * **Akathesia** * restlessness

Question 26

Serious Side Effects

Answer 26

* **Dystonic reactions** * Painful muscle spasms * Young males most at risk * Larnygospasm (can’t breathe) is fatal type * **Pseudoparkinson symptoms** * Elderly more at risk * **Tardive Dyskinesia** * Tremors, tongue thrusting, facial movements * Must stop drug * Occurs more with typical antipsychotics * **Agranulocytosis** * Symptoms include fever, easy bruising, mouth sores, flu-like * Decrease in white blood cells * Must stop medica6on immediately * Clozaril has the highest risk

Question 27

Interactions

Answer 27

* Drugs interact with each other as well as foods * Charbroiled foods and cigareqe smoke * These interactions can increase or decrease drug levels * Many psychotropics are used for treating chronic pain * Can interact with each other as well as with medications used for treating mental disorders

Question 28

Medications used for Neuropathic Pain

Answer 28

* Anticonvulsants * Neurontin (gabapentin) * Valproate * Carbamazepine * Clonazepam * Topiramate * Antidepressants: lower doses used than for depression * Elavil (amitriptyline) * Despiramine * Nortriptyline * First choice for pain * Paxil (paroxetine) * Celexa (citalopram)