MH 701 Exam 1 Questions with 100% Correct Answers | Verified | Latest Update, Exams of Advanced Education

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MH 701 Exam 1 Questions with 100%

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What is the DSM5 - Correct Answer-Diagnostic and Statistical Manual of Mental Disorders Definitions of disorders based on clinical features. Diagnostic criteria is a list of clinical features That need to be present for diagnosis. Increases reliability for diagnostic process. Pharmacokinetics - Correct Answer-What the body does to a drug.(metabolism) Goal is to make is more water soluble so it can be excreted. Pharmacodynamics - Correct Answer-The study of what the drug does to the body. Interaction between the drug and the receptor. Pharmacogenetics - Correct Answer-Differences in how individuals metabolize drugs. (Ultra rapid metabolizers or extensive metabolizers of slow metabolizers)

Toxicity - Correct Answer-the degree to which a substance is biologically harmful. When a person has accumulated too much in the blood stream. Steady state - Correct Answer-The time which the concentration of the drug in the body stays consistent. (usually 4-5 half lives if the drug is given consistently) Half-Life - Correct Answer-Safe dosage interval. The amount of time it takes a drug to be reduced in the blood by 50%. What are the general classes of psychotropic medications? - Correct Answer-Antidepressants, antipsychotics, mood stabilizers, hypnotics, anxiolytics, cognitive enhancer and stimulants. What is meant by a drug causing an agonist type of reaction at the receptor site? - Correct Answer-A drug or medication that binds to a specific receptor producing an effect identical to that usually produced by the neurotransmitter affecting that receptor. (Drugs are often designed as receptor agonists to treat a variety of diseases in which the original neurotransmitter is missing or diminished.)

What is meant by a drug causing an antagonist type of reaction at the receptor site? - Correct Answer-A compound that binds to a receptor that blocks or reduces the action of another substance at the receptor site involved. Competitive antagonists: - Correct Answer-Compete with an agonist for a receptor. EX, drugs for schizophrenia block dopamine 2 receptors, naltrexone and naloxone are opioid antagonists. What is meant by a drug causing a partial agonist type of action at a receptor site? - Correct Answer-A compound that possess affinity for a receptor, but elicits a partial pharmacological response at the receptor involved. Partial agonists are often structural analogs of agonist molecules. If neurotransmitters a low, partial agonists may behave as agonists. What is meant by a drug causing an inverse agonist type of action at the receptor site? - Correct Answer-An inverse agonist is an agent that binds to the same receptors as an agonist for that receptor but produces the opposite pharmacological effect.

What is the significance of understanding about CYP 450 when prescribing various medications that may affect this? - Correct Answer-CYP 450 is an enzyme that helps break down drugs. There are some drugs that are either inhibitors or inducers of the CYP 450 enzyme. The inhibitors inhibit the enzyme from working, therefore decreasing drug metabolism and can cause toxicity. The inducers speed up the CYP 450 enzyme , therefore increases the drug metabolism and causes a sub-therapeutic affect. What medications are most affected to the CYP 450 enzyme? - Correct Answer-Mnemonic for inducers: CRAP GPS induces my rage: C: carbamazepine R: Rifampin A: Alcohol P: Phenytoin G:Grisofulvin P: Phenobarbital S: Sulfonylureas Inhibitors:

Valproate Ketoconazole Sulfonamides Chloramphenicol Amiodarone Erythromycin Quinidine Grapefruit juice Ultrametabolizers - Correct Answer-May need higher doses to have therapeutic affect. Poor metabolizers - Correct Answer-are at risk of toxicity & adverse drug event. What are the 4 tracts of the basal ganglia that can affect psychiatric or neurological disorders? - Correct Answer- Corpus-striatum: Globus pallidus: Substania nigra: Subthalamic nucleus

What is the function of the limbic system related to psychiatric disorders. - Correct Answer-Responsible for emotional expression & motivation, learning & memory (excessive reactions to situations or reduced emotional response = damage to this area). How would your know if someone's frontal lobe was damaged? - Correct Answer-Possibility for people who display disinhibition.(poos impulse control and inappropriate behavior), disorganized behavior (memory deficits and poor planning) and are apathetic (unmotivated). Would show gray matter loss. Monoamine neurotransmitters common in psychiatric disorders: - Correct Answer-Serotonin, norepinephrine and dopamine. Serotonin: MOA, Sx of deficiency, Sx of excess, drugs - Correct Answer-MOA: regulates mood, sleep, appetite, sex, pain and instincts. Symptoms of insufficiency: Depression, anxiety, pain sensitivity, carb craving, difficulty concentrating, poor sleep, constipation.

Symptoms of excess: Shivering, diarrhea, muscle rigidity, fever, seizures, irregular HB. Depression, apathy, passivity, insomnia, difficulty concentrating, learning, poor memory, decision making difficulty, sexual dysfunction. Drugs increase serotonin: SSRI's. sertraline, paroxetine, escitalopram, citalopram, fluoxetine. SNRI's increase serotonin: venlafaxine, duloxetine, desvenlafaxine, milnacipran, levomilnacipran. Dopamine: MOA:Sx insufficiency, SX of excess, drugs. - Correct Answer-MOA: movement, memory, pleasure/reward, behavior/cognition, attention, inhibition of prolactin production, sleep, mood, learning. Sx insufficiency: pain, Parkinson's, restless leg syndrome, ADHD, age related changes in cognitive flexibility, neurological sx (decreased arm swing, rigidity), Mood (lack of motivation, fatigue apathy, procrastination, low libido, sleep problems, mood wings, hopelessness, memory loss, inability to concentrate). Sx excess: unnecessary movements, tics, psychosis, hypersexuality, nausea. Most antipsychotics are dopamine antagonists which makes them very effective nausea meds). Meds: antipsychotics & parkinsons. levodopa-carbidopa is converted to dopamine.

Agonist: Parkinson's, RLS, negative sx. Mirapex, Requip, Antagonists: positive symptoms. Haldol, Zyprexa, Reglan, risperidone. Antipsychotics reduce dopamine in the brain. Norepinephrine: MOA: sx insufficiency; Sx excess, meds - Correct Answer-Affects arousal, attention, anxiety, autonomic nervous system. Meds: Used in treatment of ADHD, anxiety, cardiac failure GABA: MOA, sx insufficiency, meds. - Correct Answer-MOA: functions a inhibitory neurotransmitter, insufficiency: anxiety, depression, difficulty concentrating, insomnia, seizures. excess: sleepiness, shallow breathing, increased BP. Meds: gabapentin, benzodiazepines, barbiturates'. Glycine inhibitory. Histamine: MOA - Correct Answer-MOA: cortex depends on this neurotransmitter for activation. hay fever, sleepiness.

Glutamate - Correct Answer-Most excitatory neurotransmitter. Too little: insomnia, poor concentration, mental fatigue, low energy, depression, ADHD inattentive. Too much: anxiety restlessness, seizures, alzheimers, ADHD (impulsive). Agonists (increase): caffeine, d-amphetamine, D-cycloserine. Antagonist: (decrease): memantine, amantadine, lamotrigine, dexomethorphan, PCP, ketamine, Dizocipine. Aceylcholine: - Correct Answer-MOA: lower amount acts like stimulant, releases epinephrine and dopamine. Affects memory, higher order thought processes, motivation, sexual desire, activity and sleep. Meds: cholinergic (glaucoma, bladder control, severe muscle weakness), Alzheimer's, dementia. Anticholinergics: EPS treatments, muscle spasm, akathisia (internal feeling of restlessness, tension and anxiety), drug induced parkinsonism, TD. Can worsen GERD. Atropine, benztropine, (chlor-trimeton), diphenhydramine, Dramamine, hydroxyzine, bupropion, dextromethorphan. Anticholinergics: GI, urinary, respiratory disorders.

First line treatment for MDD? - Correct Answer-SSRI first line tx. medications and psychotherapy for severe depression. mild to moderate, psychotherapy alone or medication alone. Fear: - Correct Answer-short term stimulus, specific response. Anxiety: - Correct Answer-sustained response, influencing behavior after the stimulus is removed. Panic disorder: rx - Correct Answer-CBT, self--management techniques & medications, including antidepressants and anxiolytics. Alprazolam (Xanax), Paroxetine (Paxil) are the 2 drugs FDA approved for panic disorder. Superiority of SSRI & clomipramine (Anafranil) over benzos and MAOIs & TCAs. Effexor(venlafaxine) & Buspar (buspirone) are suggested additive ins some cases. Panic disorder: FDA approved meds. - Correct Answer- Alprazolam (Xanax), Clonazepam (Klonipin), Fluoxetine (Prozac), Paroxetine (Paxil), and sertraline (Zoloft). FDA approved.

Panic disorder: Rx: first line - Correct Answer-First line Rx: SSRI's, SNRI's, benzos and alpha2 ligands. Panic disorder: Rx - Correct Answer-Buspirone (Buspar) has been suggested as an additive medication in some cases. Alph2 ligands are approved for treatment of anxiety in Europe but not in the US. Panic disorder: Rx: 2nd line - Correct Answer-Trazadone and Mirtazapine. Can be used for augmentation. MAOIs, powerful use. OCD - Correct Answer-Abnormality lies mainly in the pathway that links the frontal lobes of the cerebral cortex with the basal ganglia. Loss of tissue in the caudate nuceli fails to dampen the obsessional thinking. Treatment is behavioral therapy and medications. Train the patient "thought stopping" therapy. Standard approach is SSRI or clomipramine. SRI's chiefly fluoxetine (Prozac), Luvox (fluvoxamine), sertraline (Zoloft), and Paroxetine (Paxil).

OCD: Rx: 1st line - Correct Answer-SSRI or clomipramine OCD" Rx" 2nd line - Correct Answer-TCAs, SNRIs or MAOIs OCD: Rx: other pearls - Correct Answer-Can consider augment with benzo o lithium or buspirone. OFF label: Citalopram, Venlafaxine, vilazodone. FDA approved: clomipramine, fluoxetine, fluvoxamine, paroxetine or sertraline. Experiment: deep brain stimulation. PTSD - Correct Answer-SSRIs such as Zoloft (sertraline), & Paxil (paroxetine) are first line. Buspirone (Buspar) can also be effective. Efficacy of imipramine (Tofranil) & amitriptyline (Elavil), (cyclic drugs) are supported in literature. Used same as depressive disorder for at least 8 weeks. Prazosin(minipress) is used to suppress nightmares, especially with PTSD. This blocks the adrenaline associated with the fear from the nightmare.

GAD Rx: 1st line - Correct Answer-SSRI's, SNRI's, benzos, buspirone, alpha 2 ligands (pregabalin (Lyrica)/ gabapentin). GAD: RX: alternatives - Correct Answer-Benzos not indicated with substance abuse. Alpha 2 ligands good alternative. Sedative hypnotics: - Correct Answer-Benzodiazepine, barbiturate's, miscellaneous agents. Benzodiazepines: action and med - Correct Answer-Short action: Triazolam Intermediate action: Alprazolam Long action: flurazepam Barbiturate's: action and meds - Correct Answer-Ultra-short action: thiopental Short-action: secobarbital Long action: phenobarbital

Miscellaneous sedatives and hypnotics: - Correct Answer- Buspirone, Chloral hydrate, Eszopiclone, Ramelteon, Zaleplon, Zolpidem Benzodiazepine's (action) - Correct Answer-Share a common effect on receptors that have been termed benzo receptors, which in turn modulates GABA activity. GABA binds to the GABAa receptor>increase the influx of Cl- ions (Chlorine)>hyperpolarization of neuronal cell membranes> decrease excitability. Benzos (pharmacological effects) - Correct Answer-* All benzos have anxiolytic effect.

• Can cause paradoxically hyperexcitability.
• Induction of sleep.
• Anterograde amnesia.
• Anticonvulsant effect (clonazepam as an anti-elliptic/ diazepam in acute seizures).
• Reduces muscle tone by central action on GABAa receptors primarily in the spinal cord.
• In pre-anesthetic doses, decrease BP and increase HR.
• Tolerance occurs with benzos.

• Benzos vary greatly in duration of action. *Short-acting: better hypnotic with reduced hang-over effects in terms of wakening.
• Long-acting: better anxiolytic & anti-convulsant drugs.
• Withdrawal symptoms typically mimic those of anxiety disorders. Benzos: contraindicated - Correct Answer-Pregnancy, lactation, hepatic or renal disease, children <6, hypersensitivity to benzos, acute narrow-angle glaucoma. Lactation: Lorazepam best, short half life. Geriatric: Lorazepam best. Z-compounds - Correct Answer-Zolpidem (Ambien) and Eszopiclone (Lunesta) Structurally related to benzos Tolerance & physical dependence are not as common as seen in benzos. Lunesta is approved for long-term use. Barbiturate and phenobarbital - Correct Answer-High abuse potential

Narrow therapeutic range with low therapeutic index & unfavorable side effects. Use has been significantly minimized by use of benzos and hypnotics. Chloral hydrate - Correct Answer-Rarely used due to numerous safer options such as benzos. Buspirone - Correct Answer-Anxiolytic medication Similar to that of benzos in anxiolytic effect. Act as partial agonist for serotonin- 5-HTa receptors No physical dependence/ withdrawal/ abuse potential. Less sedation nd psychomotor impairment. Lack of interaction with alcohol. Slow onset of action: 1-2 weeks. Requires BID, TID dosing due to t1/2. Buspirone: MOA - Correct Answer-anxiolytic effect Partially agonist for serotonin 5-HT receptors in the brain. Slow onset, 1-2 weeks. Requires BID or TID dosing.

Melatonin congeners ie ramelteon - Correct Answer- Melatonin 1&2 receptor agonists. Bind selectively to melatonin 1&2 receptors as a full agonist. Primary use is for insomnia-reduces time to sleep onset, increases total sleep time, & may improve quality of care. Clonidine - Correct Answer-Off label anxiety disorder including PTSD and social anxiety. Antihypertensive, centrally acting Alpha 2 agonist. Clonidine - Correct Answer-Alpha 2 agonist antihypertensive Off label ADHD kids Useful for opioid withdrawal. Vistaril - Correct Answer-Hydroxyzine, blockade of histamine receptor Propranolol - Correct Answer-Beta blocker Off label use for PTSD, GAD, violence/aggressive behavior.

Blockade of histamine receptor. Propranolol - Correct Answer-Off label PTSD, GAD, violence/aggression. Beta blocker Addiction - Correct Answer-The state of response to a drug whereby the drug taker feels compelled to use the drug an suffers anxiety when separated from it. Anesthesia - Correct Answer-Loss of consciousness associated with absence of response to pain. Anxiolytic - Correct Answer-A drug that reduces anxiety, a sedative. Dependence - Correct Answer-The state of response to a drug whereby removal of the drug evokes unpleasant, possible life- threatening symptoms, often the opposite of the drug effects. Hypnotic - Correct Answer-A drug that produces drowsiness and facilitates the onset & maintenance of a state of sleep that resembles natural sleep.

REM sleep - Correct Answer-Rapid eye movement sleep, a recurring sleep stage during which vivid dreams commonly occur. Also known as paradoxical sleep, because the muscles are relaxed (except for minor twitches) but other body systems are active. Sedation - Correct Answer-reduction of anxiety Tolerance - Correct Answer-reduction in drug effect requiring an increase in dosage to maintain the same response. Amygdala & fear. - Correct Answer-Center of brain near hippocampus. Determines whether there will be a fear response. Amygdala circuit has to do with fear. CSTC - Correct Answer-Cortico-striato-thalamo-cortical circuit has to do with worry. Endocrine output of fear - Correct Answer-fear response>endocrine/hypothalamus>increased cortisol, CAD, type 2 DM and stroke.

Breathing output of fear - Correct Answer-fear response> respiratory system> increased SOB, respirations and asthma. Autonomic output of fear - Correct Answer-fear response>CV/locus coerulus> increased atherosclerosis, cardiac ischemia, BP, MI, sudden death. Decreased HR variability. Hippocampus response to fear - Correct Answer-Where memories are stored, especially traumatic memories. This is called re-experiencing in PTSD. Associated symptoms with anxiety. - Correct Answer-fear: panic/phobia> amygdala centered circuit> 5-HT, GABA, glutamate, CFR (corticotropin releasing factor)/ HPA (hypothalamus pituitary axis), NE, voltge-gated ion channels. Contributions of biological science: - Correct Answer-Three neurotransmitters associated with anxiety: NE, 5-HT, GABA. CSTL - Correct Answer-cortico-striato-thalamo loo: (worry loop)

Worry/anxious> CST> 5-HT, GABA, DA, glutamate. Prefrontal cortex. GABA - Correct Answer-Key neurotransmitter in anxiety. Key in anxiolytic of meds. Major inhibitory neurotransmitter. Reduce activity of neurons in amygdala. Reduce activity to CSTC loop. GABA meds: Flumazenil - Correct Answer-Reverse action of benzos, antagonist GABA meds: benzos - Correct Answer-Enhance GABA at the first level o he amygdala. Enhance action at the level o the pre-frontal cortex with CSTC loops. Relieves anxiety Agonist action. GABAa receptors re targets of: - Correct Answer-Benzos Sedative

Hypnotics Barbiturate's Alcohol Anxiety treatment - Correct Answer-SSRI SNRI TCA MAOI benzos Non-benzo anxiolytics atypical antipsychotics/mood stabilizers Response and remission - Correct Answer-response is the preferred outcome of treatment. Treatment failure - Correct Answer-A next step strategy should be in place at th initiation of treatment. Treatment resilience - Correct Answer-Often refers to major depressive episodes that do not respond satisfactorily to at least 2 trials of antidepressant monotherapy.

For patients who do not respond, you can switch treatment, different anti-depressant, psychotherapy, ECT, repetitive transcranial magnetic stimulation, augmentation with a second generation antipsychotic, lithium or triiodothyronine. Treatment refractory depression - Correct Answer-typically refers to unipolar major depression episodes that do not respond satisfactorily to numerous sequential treatment regimens. Drugs most likely to lower the seizure threshold: - Correct Answer-bupropion, imipramine, clozapine, olanzapine, and Haldol. Seizure risk factors can be divided into: - Correct Answer-drug related or patient related. Seizure Risk factors that are drug related: - Correct Answer- polypharmacy, high dose, rapid titration, abrupt withdrawal, abrupt dose change, intrinsic epileptogenicity, prolonged treatment, high serum levels.

Seizure risk factors that are patient related: - Correct Answer- family hx of seizures, personal hx of seizures, brain injury, blood brain abnormality, cerebral arteriosclerosis, increased age, impaired kidney or liver function, psychiatric illness, substance abuse, HIV, CNS infections and alcohol abuse. Neurobiology PPT - Correct Answer-the study of the brain & nervous system which generates sensation, perception, movement, learning, emotion, and many of the functions that make us human. Dopamine: mechanisms of action - Correct Answer- Movement, memory, pleasurable reward, behavior & cognition, attention, inhibition of prolactin production, sleep, mood, learning,. Altered dopamine neurotransmitter is implicated in - Correct Answer-Cognitive control, racing thoughts, attentional control, impulse control, working memory. Where do we find dopamine? - Correct Answer-Precursor, L- dopa is found is synthesized in the brain and kidneys.

Dopamine functions in several parts of the peripheral nervous system. In the blood vessels: - Correct Answer-In the blood vessels, it inhibits norepinephrine release and acts as a vasodilator(relaxation). Dopamine function in the kidneys: - Correct Answer-increases sodium and urine excretion. Dopamine function in the pancreas: - Correct Answer-reduce insulin reduction. Dopamine function in the digestive system: - Correct Answer- reduces GI motility and protects intestinal mucosa. Dopamine function in the immune system - Correct Answer- reduces lymphocytic activity. Symptoms of excess dopamine: - Correct Answer-unnecessary movements, repetitory tics Psychosis hypersexuality nausea