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Psychopharmacology Study Guide
1. Serotonin regulates: Mood, emotion, feeding, and reproductive behavior
2. This class of antidepressants binds to presynaptic SERT and inhibits them from
reuptake of serotonin to increase levels in the synaptic cleft to bind with postsysnaptic 5HT2 receptors: SSRIs
3. First line therapy for MDD due to milder side effect profiles: SSRIs
4. Six Common SSRIs: citalopram, escitalopram, fluoxetine, fluvoxamine, sertraline, paroxetine
5. Onset of therapeutic benefit from SSRIs: 4-6 weeks
6. In addition to MDD, SSRIs also treat: Chronic Anxiety, PTSD, OCD, and eating disorders (bulimia)
7. Five Common side effects of SSRIs include: Anxiety, insomnia, GI distress, sexual dysfunction (ED), SIADH
8. Severe side effect of SSRIs in children/adolescents under age 25 years old: -
suicidal ideation
9. Life threatening adverse effect of SSRIs, especially when used in combination with other
serotonergic drugs (SNRIs, TCAs, MAOIs, etc.): Serotonin Syndrome
10. Excess accumulation of serotonin resulting in overstimulation of the nervous
system: Serotonin Syndrome
11. Seven symptoms of Serotonin Syndrome: Flushing, hyperthermia, agitation, muscle rigidity, seizure,
coma, HYPERreflexia
12. The treatment for serotonin syndrome: Cyproheptadine (5-HT2 receptor antagonist)
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13. Cyproheptadine treats serotonin syndrome by: blocking 5-HT2 receptors (serotonin antag- onist)
14. When SSRIs or SNRIs are stopped abruptly, common symptoms of withdraw- al include:
Irritability, headaches, and insomnia
15. Medicine specific side effect of citalopram: Prolonged QT interval (normal=0.4.-0.44 seconds)
16. This SSRI is pregnancy category D due to associations with congenital heart
defects: Paroxetine
17. All SSRIs but paroxetine (D) are pregnancy category: C
18. Three SSRIs that are inhibitors of Cytochrome P450 enzymes: fluoxetine, fluvoxam- ine, and
paroxetine
19. Five common SNRIs include: duloxetine, venlafaxine, desvenlafaxine, milnacipran, levomilnacipran
20. This antidepressant class of medications works by binding to presynaptic SERT
and NET to inhibit them from reuptake of serotonin and norepinephrine to increase their levels in the synaptic cleft: SNRIs
21. In addition to MDD SNRIs treat: Anxiety and neuropathic pain (peripheral neuropathy)
22. Medication specific indications of duloxetine:: urinary incontinence and Fibromyalgia
23. Medication specific indications of venlafaxine:: social anxiety, panic disorders, PTSD, OCD,
postmenopausal hot flashes
24. Six common side effects of SNRIs include:: Insomnia, nausea, sexual dysfunction, hyperten- sion,
sweating, headaches
25. Severe side effect of SNRIs in children/adolescents under age 25 years old:-
: suicidal ideation
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41. Selective MAOIs increase the level of this neurotransmitter:: Dopamine
42. These selective MAOIs are more commonly prescribed to treat Parkinson's Disease
(a neurodegenerative disorder that effects the dopaminergic neurons in the substantia nigra region of the brain):: selegeline, rasagiline
43. Adverse effects of MAOIs include:: Serotonin syndrome and hypertensive crisis
44. Before starting another antidepressant MAOIs should be stopped for at least::
Two weeks (to allow for the body to replace MAO enzymes so that serotonin syndrome does not occur)
45. Five main symptoms of hypertensive crisis:: hyperthermia, hypertension, tachycardia, ar- rhythmias,
agitation
46. Hypertensive crisis commonly occurs when people taking MAOIs consume foods or
drinks high in:: tyramine (cheese, wine, beer, cured/smoked meats)
47. Foods and drinks rich in tyramine:: cheese, wine, beer, cured/smoked meats
48. When uninhibited, these two enzymes are responsible for breaking down
tyramine:: MAO-A and MAO-B
49. When tyramine is not broken down, it increases the release of this neuro-
transmitter, which causes hypertensive crisis:: Norepinephrine
50. Due to its action as an adrenergic antagonist this drug is the treatment of
hypertensive crisis:: Phentolamine
51. TCAs are subdivided into these two groups:: Tertiary TCAs and Secondary TCAs
52. Three Tertiary TCAs:: amitriptyline, imipramine, clomipramine
53. Two Secondary TCAs:: desipramine, nortriptyline
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54. Tertiary TCAs are non-selective and act on:: Serotonin and Norephinephrine transporters (increase
5HT and NE)
55. Secondary TCAs are selective and act only on:: Norepinephrine transporters (increase NE)
56. Therapeutic benefits from TCAs typically take approximately:: 2-4 weeks
57. In addition to treatment of depression, other indications for TCAs include:: -
Phobic disorders, chronic neuropathic pain, migraine prophylaxis
58. Medication specific indication for clomipramine:: OCD
59. Medication specific indication for imipramine:: Nocturnal enuresis
60. In addition to SERTs and NETs, TCAs block (causes side effects):: Histamine (H1)
receptors, Muscarinic receptors, and Alpha 1 receptors
61. TCAs inhibitory effects on Histamine (H1) receptors results in this side effect:-
: sedation
62. TCAs inhibitory effects on Muscarinic receptors results in this side effect profile::
anticholinergic side ettects
63. These TCAs more commonly cause anticholinergic side effects:: amitriptyline,
imipramine, clomipramine (Tertiary TCAs)
64. These are five main anticholinergic side effects:: dry mouth, tachycardia, urinary retention, confusion,
hallucinations (common with Tertiary TCAs, amitriptyline, imipramine, clomipramine)
65. TCAs inhibitory effects on Alpha 1 receptors results in this side effect:: orthostatic
hypotension
66. This class of antidepressants is especially cardiotoxic and may cause arrhyth- mias
and prolonged QT interval:: TCAs
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79. For depressed individuals with anorexia, increased appetite and weight gain, are
possibly beneficial side effects of this Atypical Antidepressant:: mirtazapine
80. As Serotonin Antagonists, these two Atypical Antidepressants block 5-HT2A
receptors so that more Serotonin is available to bind to 5-HT1A receptors which are more strongly linked to depression:: trazodone and nefazodone
81. In addition to inhibition of 5-HT2A receptors, these two Atypical Antidepres- sants
increase levels of Serotonin in the synaptic cleft through weak inhibition of Serotonin reuptake transporters:: trazodone and nefazodone
82. These two Atypical Antidepressants are strong H1 receptor inhibitors, and
therefore commonly used to treat insomnia:: trazodone and nefazodone
83. These two Atypical Antidepressants may cause orthostatic hypotension and
priapism through Alpha-1 receptor inhibition:: trazodone and nefazodone
84. In rare cases, this Atypical Antidepressant is known to cause severe liver
damage:: nefazodone
85. Similar to SSRIs, these two Atypical Antidepressants are strong inhibitors of
Serotonin reuptake transporters on the presynaptic neuron:: vilazodone and vortioxe- tine
86. These two Atypical Antidepressants bind to and stimulate 5-HT1A receptors:-
: vilazodone (partial agonist) and vortioxetine (full agonist)
87. Vilazodone or Vortioxetine, which of these Atypical Antidepressants is a partial
agonist?:: vilazodone
88. Vilazodone or Vortioxetine, which of these Atypical Antidepressants is a full
agonist?:: vortioxetine
89. Since they enhance the effects of Serotonin through two different mecha- nisms,
8 / 15 these two Atypical Antidepressants can cause serotonin syndrome:: vila- zodone and vortioxetine
90. Six common side effects of vilazodone (primarily anticholinergic, **unique to
vilazodone**):: sedation, blurred vision, orthostatic hypotension, urinary retention, tachycardia, weight gain
91. Six common side effects of vortioxetine (primarily anticholinergic, **unique to
vortioxetine**):: sedation, blurred vision, orthostatic hypotension, urinary retention, tachycardia, abnor- mal dreams
92. This Atypical Antidepressant does not have a serotonergic effect:: bupropion
93. This Atypical Antidepressant binds to Norepinephrine and Dopamine reup- take
transporters and inhibits them, leading to increased levels of 5HT and DA in their synaptic clefts:: bupropion
94. In addition to SERT and DAT inhibition this Atypical Antidepressant blocks
nicotinic (acetylcholine) receptors:: bupropion
95. Due to inhibition of nicotinic (acetylcholine) receptors, this Atypical antide-
pressant is useful in smoking cessation:: bupropion
96. This Atypical Antidepressant has the least sexual side effects of all the anti-
depressants:: bupropion
97. Due to its noradrenergic (excitatory) effects, this Atypical Antidepressant may
cause tachycardia, insomnia, and a lower seizure threshold:: bupropion
98. Due to it's noradrenergic (excitatory) effects, this Atypical Antidepressant may
cause tachycardia, insomnia, and a lower seizure threshold:: bupropion
99. Schizophrenia is suspected to be related to altered levels of this neurotrans-
mitters:: Dopamine
100. These are the two categories of Antipsychotics:: first generation (typical) and second
10 / 15 receptors in the Mesolimbic pathway, but also block Dopamine receptors in the Mesocortical pathway which might worsen negative symptoms (lack of motivation, social withdrawal, flat affect):: First Generation (Typical) Antipsychotics
113. Six psychiatric indications for First Generation (Typical) Antipsychotics:: Psy- chosis,
Delirium, Bipolar Disorder, OCD, Tourette Syndrome, Huntington Disease
114. Three side effects of Typical Antipsychotics associated with the Tuberoin-
fundibular pathways include:: Oligomennorhea, Galactorrhea, Gynecomastia
115. Side effects of Typical Antipsychotics associated with the Nigrostriatal path- way can
cause extrapyramidal symptoms such as:: acute dyskinesias and dystonic reactions, tardive dyskinesia, pseudoparkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome
116. One possible extrapyramidal symptom of typical antipsychotics, that can occur
within a few hours or days of treatment, that involves uncontrollable muscle spasms, frequently of the tongue, face, neck, back, or extraocular muscles (olygogyric crisis):: Dystonia
117. A spasm of the extraocular muscles causing an upward and outward po- sition of
the eyes (possible extrapyramidal symptom associated with typical antipscyhotics can occur within hours to days of treatment):: Oculogyric Crisis
118. This extrapyramidal symptom involves a feeling of restlessness and an urge
to move the limbs. It can occur within a few days to a month of Typical Antipsychotic use:: Akathisia
119. This extrapyramidal symptom is characterized by muscle rigidity (usually in the
facial muscles, giving the face a wooden mask-like appearance), bradyki- nesia, and tremors. It can occur within a few days to a month of Typical Antipsychotic use::
11 / 15 Pseudoparkinsonism
120. This extrapyramidal symptom is characterized by constant, involuntary,
rhythmic movements. usually of the perioral muscles, causing a person to involuntarily smack or purse their lips. It can occur within a few months to years of Typical Antipsychotic use:: Tardive Dyskinesia
121. Unlike more acute extrapyramidal symptoms, this one can be irreversible and so
the antipscyhotic should be discontinued at the first sign:: Tardive Dyskinesia
122. The most dangerous and severe extrapyramidal symptom that typically occurs
within days or weeks of starting a Typical Antipsychotic:: Neuroleptic Malignant Syndrome
123. Seven symptoms associated with Neuroleptic Malignant Syndrome:: confusion, coma,
agitation, muscle rigidity, seizures, hyperthermia, and hyporeflexia
124. This syndrome consists of confusion, coma, agitation, muscle rigidity, seizures,
hyperthermia, and HYPOreflexia:: Neuroleptic Malignant Syndrome (caused by antipsy- chotics)
125. The two distinctions between Neuroleptic Malignant Syndrome and Sero- tonin
Syndrome:: HYPOreflexia and NORMAL pupils vs HYPERreflexia and DILATED pupils
126. Advanced Neuroleptic Malignant Syndrome can cause:: Rhabdomyolysis
127. Treatment of Neuroleptic Malignant Syndrome consists of:: Dantrolene (muscle relaxant)
and Dopamine agonists (bromocriptine)
128. Less severe neurotransmitter side effects of Typical Antipsychotics include:-
: ORTHOSTATIC HYPOTENSION (Alpha-1 receptor inhibition), ANTICHOLINERGIC SIDE EFFECTS (muscarinic receptor inhibition), and SEDATION (H1 receptor inhibition).
129. Which Typical Antipsychotics have a stronger sedating effect but less ex-
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140. Because they also block D2 receptors in the tuberoinfundibular pathway Atypical
Antipsychotics can cause:: Hyperprolactinemia
141. Hyperprolactinemia caused by Atypical Antipsychotics blocking D2 recep- tors in
the tuberoinfundibular pathway can result in these three side effects:: - Oligomenorrhea, Galactorrhea, and Gynecomastia
142. Because of its effect on blocking dopamine receptors in the tuberoin-
fundibular pathway, this Atypical Antipsychotic is the most likely to cause Hyperprolactinemia (oligomennorhea, galactorrhea, and gynecomastia):: risperi- done
143. Atypical Antipsychotics also block Dopamine receptors in the Nigrostriatal pathway and
can cause these symptoms:: Extrapyramidal symptoms (dyskinesias and dystonic reactions, tardive dyskinesia, pseudoparkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome)
144. Acute extrapyramidal symptoms include:: Dystonia, Akathisia, and Pseudoparkinsonism
145. Tardive (delayed) extrapyramidal symptoms include:: Tardive Dyskinesia and Neurolep- tic
Malignant Syndrome
146. This generation of Antipsychotics binds more loosely to D2 receptors and can get
"kicked off' if there is a lot of Dopamine around resulting in less extrapyramidal symptoms:: Second-Generation Antipsychotics (Atypical)
147. 14. First generation Antipsychotics (Typical) bind more tightly to D2 recep- tors
and are not "kicked off" when excess Dopamine is around. This charac- teristic makes them more likely to cause:: Extrapyramidal Symptoms (dyskinesias and dystonic reactions, tardive dyskinesia, pseudoparkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome)
148. Less severe neurotransmitter side effects of Atypical Antipsychotics in- clude::
14 / 15 ORTHOSTATIC HYPOTENSION (Alpha-1 receptor inhibition), ANTICHOLINERGIC SIDE EFFECTS (muscarinic receptor inhibition), and SEDATION (H1 receptor inhibition).
149. Metabolic side effects of Atypical Antipsychotics include:: Weight gain, dyslipidemia,
hyperglycemia, and increased cardiovascular risk
150. These two Atypical Antipsychotics tend to cause the most weight gain:: cloza- pine and
olanzapine
151. This Atypical Antipsychotic has the least impact on weight gain:: aripiprazole
152. Two serious medication specific side effects of clozapine include:: Seizures and
Agranulocytosis (leading to frequent and overwhelming infections)
153. These two labs must be monitored regularly with use of clozapine:: WBC and ANC
154. Due to this medications possible side effects of Agranulocytosis and subse- quent
risk for infections, this Atypical Antipsychotic is only used if a client has not responded to other Antipsychotics:: clozapine
155. Cardiac side effects of Atypical Antipsychotics (especially ziprasidone) in- clude::
Prolongation of the QT interval (normal = 0.4-0.44 seconds)
156. This Atypical Antipsychotic has the greatest effect on QT interval prolonga- tion and
should not be prescribed for people with arrhythmias:: ziprasidone
157. Lithium is primarily used in the treatment of:: Bipolar Disorder
158. The mechanism of action for this medication is unknown but it acts as a mood
stabilizer that can smooth out the "highs and lows":: Lithium
159. Symptoms of Manic episodes:: energetic, overly happy/optimistic, high self-esteem, reckless behavior,
pressured speech, racing thoughts, delusions of grandeur
