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CMN 548 Exam 5 study guide
- Course
- CMN 5548
- Institution
- University Of South Alabama
This is a completed document of CMN 548 exam 5 study guide from Saddock 11th edition. As well as notes taken from the videos added for this exam.
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CMN 548 - Module 5Primary Study Guide
Psychopharmacology
Sadock Comprehensive Text, Chapter 33
Section 33.1a (General Principles of Psychopharmacology)
Receptor Pharmacology pp. 2995 - ion channels (ionotropic) and
metabotropic (G protein-coupled) acetylcholine, glutamate, gamma-
aminobutyric acid [GABA], and serotonin) act as agonists for receptors in
each class.
Integration of Neurotransmitter Signals pp. 3006
o Thousands of axons converge into a single dendrite
o A single transmitter can evoke multiple intracellular pathways
o Each pathway is interdependent
Pharmacokinetics pp. 3010 –
o pharmacokinetics are the effects of drugs on the plasma
concentrations of each other
o pharmacodynamic drug interactions are the effects of drugs on the
biological activities of each other
Treatment Outcomes: Response and Remission pp. 3012 Remission-
improvement below the syndromal threshold. Response- is usually defined
as a 50% of greater decrease from baseline on a standard rating scale such as
the HAMD or MADRS, remission is defined as an absolute score of 7 or
less on the HAMD scale or 10 or less on the MADRS.
Withdrawal pp.3013- withdrawal should technically be considered a side
effect. The more abruptly a drug is stopped and the shorter its elimination
half-life, the more likely it is that clinically significant withdrawal
symptoms. Sedative hypnotics and opiates are the agents most often
associated with mentally and physically distressing discontinuation
reactions. Barbiturate withdrawal can be fatal.
o Alprazolam- more immediate and intense withdrawal
symptoms than other benzos
o Paroxetine (Paxil)- more frequent and severe withdrawal than
other SSRIs
o Fluoxetine- may even produce withdrawal symptoms, but they
may be delayed due to long elimination half life
1
, o Venlafaxine- produces a severe SSRI-like withdrawal
syndrome
o Sustained release drugs does not reduce the severity of
withdrawal
Section 33.1b (Drug Development and Approval Process in the US)
Effect Size pp.3017- Effect sizes of compounds developed for psychiatric
disorders are not large, which makes signal detection more challenging.
Expectation bias pp. 3018- Subjects expect that a test drug will confer a
benefit or that it is unlikely to do so.
Regression to the Mean pp. 3018- variance- a way to capture the random
change in repeated meaurements of the same variable. The presence of an
extreme value (one far from the mean) on one measurement, and a value
much closer to the mean at another measurement = regression to the mean.
Extreme values tend to move closer (regress) to the mean on different
measurements.
Personalized Medicine pp.3020 – Treatment personalized to patients based
on genetics. An example is the use of HER2 screening in patients with
metastatic breast cancer. HER2 positive patients have a greater likelihood of
responding to trastuzumab (Herceptin).
Nonclinical Studies: Phase 1 pp. 3023 – Initial introduction of new drug to
human, usually conducted in healthy volunteers. Typically in closely
monitored (often inpatient) settings, serve to characterize the absorption,
distribution, metabolism, and excretion of the compound to identify
toxicities. (Example anti-HIV agents)
Nonclinical Studies: Phase 2 – the initial controlled clinical efficacy studies.
Typically include carefully selected patients with the disease or condition.
Exploratory work is done to help determine the optimal doses of the drug.
Nonclinical Studies: Phase 3 – Determines the overall risk to benefit
relationship of the drug and to provide an adequate basis for product
labeling.
Nonclinical Studies: Phase 4 – once the drug has been approved subsequent
postmarketing activities may be conducted. Determining if the drug can be
used in pediatrics.
Section 33.2a (Dopamine Antagonists)
2
, Akathisia pp. 3046 – “inability to sit still” this is the most common acute
manifestation of EPS. 41 % of patients treated with dopamine antagonist and
21% had moderate to severe akathisia. Presentation- shifting the weight from
foot to foot, walking on the spot, inability to keep the legs still, feeling of
inner restlessness, and shifting of body positions in a chair. Akathisia may
appear on the second or third day of antipsychotic treatment but more
frequently has its onset after five days.
Neuroleptic Malignant Syndrome pp.3047 – is an uncommon but potentially
fatal complication of dopamine-blocking agents. Its main clinical features
include (1) hyperthermia; (2) severe muscular rigidity; (3) autonomic
instability, including hyperthermia, tachycardia, increased blood pressure,
tachypnea, and diaphoresis; and (4) changing levels of consciousness. It is
twice as common in men as in women and is more likely to be present in
younger patients.
Management of NMS pp 3047- Dantrolene (Dantrium) may be effective for
treating severe NMS. Bromocriptine can be added. Amantadine may be
helpful if other agents are not sufficient.
Tardive Dyskinesia pp.3047 – Movement disorder that can follow chronic
treatment with antipsychotics. Abnormal movements may include : mouth
and tongue movements (lip smacking, sucking, and puckering), as well as
facial grimacing. Other movements may include irregular movements of the
limbs, particularly choreoathetoid-like movements of the fingers and toes,
and slow, writhing movements of the trunk. Dopamine blocking
medications, such as antipsychotics suppress TD whereas dopamine agonist
worsen the disorder. Older women are particularly at risk for TD
Management of TD pp. 3048 – Patients receiving dopamine blocker for
more than 6 months should have regular and systematic evaluations of TD
every 6 months. The abnormal involuntary movement scale (AIMS) provide
a structured system for evaluating and recording abnormal movements.
deutetrabenazine and valbenazine- these drugs are approved for the
treatment of TD
Section 33.2b (Dopamine-Serotonin Antagonists)
Comparison of DSAs pp. 3055 aside from clozapine—the selection of an
antipsychotic will be based on side-effect concerns rather than efficacy.
Olanzapine: Design and Interpretation of Clinical Drug Studies: Children
pp.3057 – In children and adolescents olanzapine was more effective than
placebo but associated with somnolence, liver enzyme elevations, prolactin
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