Watch animation

They approach the following topics related to the neurobiology of drug addiction.

• Methamphetamine actions on dopamine vesicles.
• LSD action on serotonin receptors.
• Heroin effects on opioid receptors .
• How marijuana interacts with the cannabinoid system and its receptors.
• Activation of the GABA-A ionotropic receptor by alcohol.
• Cocaine action on dopamine reuptake.

This blog has a related post that explains nicotine addiction mechanism through a 3-D video animation.

Antipsychotics Review in Primary care. A PPT By Shomir Banerjee, M.D.

Dr. Banerjee discusses the topic from a Family Medicine specialist point of view. Some other resources related to Family Medicine by the same author can be found at Shomir.org.

Presentation outline:

• Differences between first and second generation antipsychotics.
• How do typical and atypical Antipsychotics work? Mechanisms of action.
• Classification by potency.
• Acute extrapyramidal symptoms with high potency agents ( Akathisia, Dystonia, Parkinsonism).
• Neuroleptic Malignant Syndrome.
• Tardive Dyskinesia.
• Atypical vs Typical Antipsychotics.
• Are atypicals “better?”
• Monitoring
• Analysis of agents: clozapine (Clozaril), olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify).

Download PPT file

Conventional Antipsychotics: Concise Review for  Non-Psychiatrists Treating Developmentally Disabled Population. A PPT by S. Christopher Shim, M.D.

Dr. Shim is an American Psychiatric Association Distinguished Fellow who shares his practical approach on conventional antipsychotics with non-psychiatrists.

Presentation outline:

• Equivalence between high potency agents: Haloperidol, fluphenazine, thiothixine, trifluoperazine, pimozide.
• Equivalence between low potency agents: thioridazine, chlorpromazine, mesoridazine.
• Benefits & risks of high and low potency agents.
• Safety and Tolerability –side effects profile-.
• EPS (Extra Pyramidal Symptoms): features and treatment.
• Cardiovascular effects: Malignant Arrhythmias (torsade de pointes), Sudden Cardiac Death
• Cautions: Reduction or Discontinuation of Conventional Antipsychotic Medications

Download PPT file

Treatment of Schizophrenia (and Related Psychotic Disorders). A PPT by Scott Stroup, MD, MPH.

This presentation explores some of the most relevant clinical features of schizophrenia as well as other psychoses. It also reviews in chronological order of approval some of the most important neuroleptics (both first and second generation). As the presentations shown above, it highlights the most important side effects related to the use of antipsychotic medications. It also focuses on non-pharmacological therapies and other type of interventions .

Download PPT file

It is oriented to a general audience. However, it’s useful to review the brain reward system and some important dopamine pathways.

You may also be interested in other posts such as:

• EMEA’s recommendations on Methylphenidate.
• Methadone for chronic pain.

Further reading

Addiction, Dopamine, and the Molecular Mechanisms of Memory. Neuron, Vol. 25, 515–532, March, 2000. Free Full Text – PDF -

Is there a common molecular pathway for addiction? EJ Nestler – Nature neuroscience, 2005.  Free Full Text – PDF -

According to the SMC, the manufacturer did not present a sufficiently robust economic analysis to gain acceptance.

Psychiatrist Daniel Carlat from “The Carlat Psychiatry  Blog” refers to aripiprazole as “ the antipsychotic most likely to cause akathisia”.

The video below is the US TV ad for Abilify. As you can see, there is an aggressive marketing campaign to promote aripiprazole as a medication in bipolar disorder, targeted both to prescribers and patients.

As related information,  SMC previously reviewed aripiprazole for agitation control in patients with schizophrenia and accepted the IM formulation use only if oral therapy is not appropriate.

Mechanism of action

Agomelatine acts as an agonist on melatonin MT1 and MT2 receptors. Additionally, it blocks serotonin 2C (5-HT2C) receptors.

Efficacy and place in therapy

On November 2008, EMEA issued a positive opinion for granting a Marketing Authorization to Valdoxan, after a resubmission by the applicant.  Agomelatine was launched in the UK in June 2009 for the treatment of major depressive episodes in adults.

Few trials have compared agomelatine with  ‘established’ antidepressants like venlafaxine and sertraline. Most clinical trials compared agomelatine to placebo. As with most new drugs, time and experience from experts will tell which place it has on the therapeutic options for the treatment of depression.

The following document is a drug specific review for agomelatine by the London New Drugs Group.

Download review (PDF file)

References and further reading

Agomelatine for depression – horizon scanning review. Centre for Reviews and Dissemination. 2003.

J Pierre Olié, S Kasper.  Efficacy of agomelatine, a MT1/MT2 receptor agonist with 5-HT2C antagonistic properties, in major depressive disorder (abstract). The International Journal of Neuropsychopharmacology, 2007. Cambridge Univ Press.

S.H. Kennedy , R. Emsley. Placebo-controlled trial of agomelatine in the treatment of major depressive disorder. (PDF Free Full text). European Neuropsychopharmacology, 2006.

This post will focus on the classification of serotonin receptors, as well as drug classes that act on serotonergic transmission. This includes 5-HT agonists, antagonists and medications that modulate 5-HT at the presynaptic level, all of them of very high clinical relevance. Overdose of a combitation of serotonergic agents can lead to serotonin syndrome.

Outline:

• Serotonin receptors
• Drugs acting on serotonergic transmission: MAO inhibitors, SNRIs, SSRIs
• Serotonin agonists
• Serotonin antagonists

Serotonin receptors classification

Based on biochemical and pharmacological criteria, serotonin receptors are classified into seven main receptor subtypes, 5-HT1–7. Of major pharmacotherapeutic importance are those designated 5-HT1, 5-HT2, 5-HT4, and 5-HT7, all of which are G-protein-coupled, whereas the 5-HT3 subtype represents a ligand-gated ion channel.

5-HT1 receptors are subdivided into 5-HT1A, 5-HT1B, and 5-HT1D receptors; while 5-HT2 subtypes include 5-HT2A, 5-HT2B, and 5-HT2C.

Drugs acting on serotonergic transmission

The figure above depicts how serotonin neurotransmission may be modified at the presynaptic level by inhibiting degradation, storage or reuptake.

MAO inhibitors

Monoamine oxidase is a key enzyme for serotonin, dopamine and norepinephrine inactivation. MAO inhibitors prevent inactivation of monoamines within a neuron, causing excess neurotransmitter to diffuse into the synaptic space. This class of agents is used in the treatment of depression (phenelzine, tranylcypromine, selegiline) and Parkinson’s disease (selegiline). Dietary restrictions (because of tyramine toxicity) limit their widespread use.

Inhibitors of serotonin storage

They interfere withe the ability of synaptic vesicles to store monoamines; displace serotonin, dopamine and norepinephrine from their storage in presynaptic nerve terminals. Agents that share this mechanism of action include amphetamine, methylphenidate and modafinil.

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs mechanism involves blockade of 5-HT and norepinephrine reuptake in a concentration-dependent manner. Agents in this class include venlafaxine and duloxetine, they may be effective for the treatment of depression in patients in whom SSRIs are ineffective.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs block the reuptake of serotonin, leading to increased concentrations of the neurotransmitter in the synaptic cleft and to an enhanced postsynaptic neuronal activity.

Tricyclic-antidepressants (TCAs)

Tricyclic antidepressants act by inhibiting reuptake of 5-HT and norepinephrine from the synaptic cleft by respectively blocking 5-HT and norepinephrine reuptake transporters, thereby causing enhancement of postsynaptic response.

Serotonin receptor agonists

Serotonin receptors agonists have wide clinical applications, from treatment of depression to abortive medications for migraine headache. According to the receptor they activate, they can be divided into:

5-HT1A agonists

Buspirone is a partial 5-HT1A agonist used clinically for the treatment of anxiety and depression.

5-HT1B and 5-HT1D agonists

The “triptans” are a drug class useful as abortive medication for the treatment of  acute migraine headaches. They are very effective medications that bind to 5-HT1B and 5-HT1D receptors in cranial vessels, which leads to vasoconstriction and decreased release of neuropeptides involved in “sterile inflammation”.

5-HT2C agonist

Trazodone was previously believed to be a 5-HT2C receptor antagonist. However,  recent publications report that trazodone would behave as a 5-HT2C agonist. This drug is used generally as somnorific.

5-HT4 agonists

Cisapride is a serotonin and cholinergic agonist used as a prokinetic drug, it was withdrawn from the U.S. market because of cardiovascular toxicity.

Non-selective agonists

Ergotamine activates a more than one subtype of 5-HT receptor, it binds to  5-HT1A, 5-HT1D, 5-HT1B, D2 and norepinephrine receptors. Its vasoconstrictor effect makes it a suitable treatment for migraine attacks.

LSD is a 5-HT1A, 5-HT2A, 5-HT2C, 5-HT5A, 5-HT5, 5-HT6 agonist that has psychedelic properties.

Serotonin receptor antagonists

5-HT2 antagonists

Ketanserin is a 5-HT2A/2C antagonist used for the treatment of hypertension. In addition to its serotonin antagonism, it has affinity for alpha-1 receptors, which may contribute to its antihypertensive effect.

Clozapine is an atypical antipsychotic drug that acts as 5-HT2A/2C receptor antagonist with high affinity for dopamine receptors.  It represents a class of atypical antipsychotic drugs, one key advantage of this group is its reduced incidence of extrapyramidal side effects compared to the classical antipsychotics, and possibly a greater efficacy for reducing negative symptoms of schizophrenia.

Agomelatine is a new antidepressant with agonist action at the melatonin receptor and antagonism at the 5-HT2C receptor.

5-HT3 antagonists

This class includes drugs such as ondansetron, palonosetron and others. These agents are particularly useful in the treatment of chemotherapy induced nausea and vomiting (CINV).

The figures used in this post were created using the Bubble.us application for online mind mapping.

References and further reading

Golan, David E (editor). “Principles of Pharmacology: The Pathophysiologic Basis of Drug Therapy”, 2nd edition. LWW: 2008.

Harvey, R; Champe, P (series editors). “Lippincott illustrated reviews: Pharmacology”, 4th edition. LWW: 2009.

Brunton, L.B., Lazo, J.S., & Parker, K.L. (Eds.). “Goodman & Gilman’s the pharmacological basis of therapeutics“,  11th edition. New York: McGraw-Hill:2005.

Essential Evidence Plus

In this podcast Dr. Ebell and Dr. Wilkes (National Public Radio) discuss the POEM titled:

“Antidepressants only modestly effective for adolescent depression”

Listen to the podcast on antidepressants for adolescent depression.

Summary:

• Desvenlafaxine is the active metabolite of venlafaxine.
• There is no evidence that desvenlafaxine is more effective, safer or better tolerated than venlafaxine or other antidepressants.
• Doses above 50 mg/day are unlikely to provide further clinical benefit and are associated with a higher incidence of adverse effects.
• Common adverse effects include nausea, headache, dizziness, dry mouth and diarrhoea.
• Desvenlafaxine should not be used in children and adolescents.
• Reduce the dose slowly to avoid discontinuation symptoms.

In an article published in Annals of Pharmacotherapy.  Desvenlafaxine: Another "Me Too" Drug?, the authors conclude:

“With the overall similarity between these 2 drugs and the potential lack of cost savings, the need for desvenlafaxine and its ultimate utility in treating major depressive disorder appears to be insignificant.”

Advice for healthcare professionals:
• At normal doses, atomoxetine can be associated with treatment-emergent psychotic or manic symptoms (eg, hallucinations, delusional thinking, mania, or agitation) in children and adolescents without a history of psychotic illness or mania.
• If such symptoms occur , consideration should be given to a possible causal role of atomoxetine and discontinuation of treatment.
• It remains possible that atomoxetine might exacerbate pre-existing psychotic or manic symptoms.

The Midlands Therapeutics Review and Advisory Committee stated in a May 2006 verdict and summary of atomoxetine:

“Initiation of atomoxetine treatment and stabilisation of the dose should be the responsibility of a specialist. It is then appropiate to prescribe atomoxetine in primary care with the guidance of an ESCA”.

Recently (January 2009), the FDA reminded about the risk of serious hepatic damage with atomoxetine.

Psychotropics
Item Number: 11667 correct answer: 4 category: Psychotropics
1. The symptoms of tardive dyskinesia will acutely improve with:
1. administration of diphenhydramine
2. administration of amantadine
3. administration of bromocriptine
4. increase of neuroleptic dose
5. All of the above

Item Number: 8777 correct answer: 5 category: Psychotropics
2. Psychopharmacology includes the judicious of all the following EXCEPT:
1. haloperidol
2. lithium carbonate
3. imipramine
4. chlordiazepoxide
5. selegiline

Item Number: 11641 correct answer: 2 category: Psychotropics
3. Major tranquilizers of the phenothiazine group produce all of the following
EXCEPT:
1. autonomic effects
2. anesthesia
3. extrapyramidal effects
4. control of psychotic behavior
5. prevention of vomiting

Item Number: 11652 correct answer: 4 category: Psychotropics
4. Neuroleptic malignant syndrome is characterized by all of the following
EXCEPT:
1. hyperpyrexia
2. increase in serum creatine phosphokinase
3. catatonia
4. akathisia
5. All of the above

Item Number: 10533 correct answer: 5 category: Psychotropics
5. Pigment deposits in the anterior lens capsule and posterior surface of the
cornea can be seen by slit-lamp examination in one third to one half of some
groups receiving certain phenothiazine tranquilizers. Phenothiazine
tranquilizers which have caused this state include:
1. chlorpromazine
2. promazine
3. thioridazine
4. All of the above
5. 1,3

Item Number: 11754 correct answer: 4 category: Psychotropics
6. Pharmacologic effects of thioridazine include all of the following EXCEPT:
1. control of psychotic behavior
2. orthostatic hypotension
3. antiemesis
4. hypoprolactinemia
5. All of the above

Item Number: 10699 correct answer: 2 category: Psychotropics
7. A substance which decreases or inhibits the metabolism of benzodiazepines
metabolized to active metabolites in the liver is:
1. ranitidine
2. cimetidine
3. rifampin
4. carbamazepine
5. phenytoin

Item Number: 10484 correct answer: 5 category: Psychotropics
8. Systems on which antipsychotic agents exhibit pharmacologic action include all
of the following EXCEPT:
1. central nervous system
2. autonomic nervous system
3. cardiovascular
4. endocrine system
5. pulmonary

Item Number: 10645 correct answer: 5 category: Psychotropics
9. Pharmacologic effects of cyclic antidepressants include all of the following
EXCEPT:
1. sedation
2. flattened or inverted T waves on EKG
3. urinary retention and mydriasis
4. mood elevation
5. raise the seizure threshold

Item Number: 10486 correct answer: 4 category: Psychotropics
10. Uses for antipsychotics include all of the following EXCEPT:
1. Gilles de la Tourette syndrome
2. hiccups
3. schizophrenia
4. Parkinson’s disease
5. manic phase of manic depression

Item Number: 5262 correct answer: 5 category: Psychotropics
11. The pharmacological agent which is useful as an antiemetic is:
1. tetracycline
2. naloxone
3. caffeine
4. epinephrine
5. chlorpromazine

Item Number: 10663 correct answer: 4 category: Psychotropics
12. All of the following are monoamine oxidase inhibitors EXCEPT:
1. phenelzine
2. isocarboxazid
3. tranylcypromine
4. maprotiline
5. All of the above

Item Number: 10666 correct answer: 2 category: Psychotropics
13. The pharmacologic action of monoamine oxidase inhibitors is:
1. block the reuptake of monoamine neurotransmitter into the presynaptic cleft
2. blocks the metabolism of monoamine neurotransmitters
3. decreases 5HT and NE monoamines
4. enhances REM sleep
5. selective MAO-B inhibitors may be useful in psychosis

Item Number: 10687 correct answer: 5 category: Psychotropics
14. Effects of benzodiazepines include all of the following EXCEPT:
1. paradoxical stimulation
2. tolerance
3. dependence and withdrawal
4. respiratory depression in patients with obstructive lung disease
5. lower seizure threshold

Item Number: 10681 correct answer: 1 category: Psychotropics
15. Pharmacologic effects of lorazepam include:
A. sedation/hypnosis
B. anterograde amnesia
C. increased seizure threshold
D. inhibition of prolactin secretion
1. A,B,C
2. A,C
3. B,D
4. D only
5. All of the above

Item Number: 10682 correct answer: 4 category: Psychotropics
16. The elimination of all of the following benzodiazepines are influenced by
liver disease or advanced aging EXCEPT:
1. alprazolam
2. midazolam
3. chlordiazepoxide
4. lorazepam
5. diazepam

Item Number: 10648 correct answer: 4 category: Psychotropics
17. The appropriately matched tricyclic antidepressant and metabolite is:
1. amitriptyline – desipramine
2. imipramine – nortriptyline
3. imipramine – trimipramine
4. imipramine – desipramine
5. fluoxetine – protriptyline

Item Number: 6702 correct answer: 2 category: Psychotropics
18. A recognized side effect of  lithium carbonate is:
1. hypermagnesemia
2. polyuria and polydipsia
3. transient fall in BUN and serum creatinine
4. hypochloremia
5. proximal tubular degeneration

Item Number: 11648 correct answer: 5 category: Psychotropics
19. Endocrine effects of chlorpromazine include all of the following EXCEPT:
1. decrease in adrenocorticotropins
2. decrease in gonadotropins
3. decrease in release of pituitary growth hormone
4. increase in prolactin secretion
5. decrease in thyroid hormone production

Item Number: 3750 correct answer: 1 category: Psychotropics
20. Cholestasis is the principle derangement observed in hepatotoxicity
associated with:
1. phenothiazines
2. monoamine oxidase inhibitors
3. para-aminosalicylic acid
4. carbon tetrachloride
5. None of the above

Item Number: 11758 correct answer: 4 category: Psychotropics
21. Phenelzine can result in a hypertensive crisis when coadministered with all of
the following EXCEPT:
1. pickled herring (tyramine)
2. amphetamines
3. phenylpropanolamine
4. diazepam
5. ephedrine

Item Number: 10680 correct answer: 4 category: Psychotropics
22. The neurotransmitter through which benzodiazepines exert their action is:
1. norepinephrine
2. epinephrine
3. dopamine
4. gamma amino butyric acid
5. serotonin

Item Number: 10612 correct answer: 1 category: Psychotropics
23. The neuroleptic available as ester salts for intramuscular injection with slow
absorption characteristics is:
1. haloperidol
2. prochlorperazine
3. thioridazine
4. perphenazine
5. All of the above

Item Number: 10500 correct answer: 2 category: Psychotropics
24. Anticholinergic side effects are most common with:
1. haloperidol
2. thioridazine
3. fluphenazine
4. trifluoperazine
5. All of the above

Item Number: 11642 correct answer: 5 category: Psychotropics
25. Reserpine normally has a tranquilizing effect. However, prior administration
of some drugs can produce excitement in a patient taking reserpine. Classes
of drugs which will produce this paradoxical effect include:
1. anticholinesterases
2. antihistamines
3. atropine-type muscarinic blockers
4. alpha-adrenergic blockers
5. monoamine oxidase inhibitors

Item Number: 11697 correct answer: 4 category: Psychotropics
26. Fluoxetine is FDA-approved to treat:
1. schizophrenia
2. mania
3. anxiety
4. depression
5. obesity

Item Number: 11659 correct answer: 2 category: Psychotropics
27. Compliance with neuroleptics medications can be increased by the
administration of depot injections of:
1. loxapine hydrochloride
2. fluphenazine enanthate
3. molindone hydrochloride
4. chlorpromazine hydrochloride
5. All of the above

Item Number: 11766 correct answer: 5 category: Psychotropics
28. Drugs that reduce the renal clearance of lithium include all of the following
EXCEPT:
1. ibuprofen
2. hydrochlorothiazide
3. indomethacin
4. chlorothiazide
5. theophylline

Item Number: 11617 correct answer: 2 category: Psychotropics
29. The potential central nervous system effects of haloperidol is:
1. monoamine oxidase inhibition
2. blockade of dopamine in the chemoreceptor trigger zone
3. cholinesterase inhibition
4. blockade of serotonin in the basal ganglia
5. blockade of dopamine reuptake

Item Number: 10497 correct answer: 2 category: Psychotropics
30. The correct statements regarding extrapyramidal effects of antipsychotics is:
1. acute dystonic reactions occur most commonly with low potency agents
2. excess dopaminergic activity is hypothesized to be a mechanism of
tardive dyskinesia
3. akathisia is characterized by oral facial dyskinesia
4. cholinergic agents are useful in the management of neuroleptic-induced
Parkinsonism
5. tardive dyskinesia occurs early on in therapy and is reversible upon
discontinuation of therapy

Item Number: 10625 correct answer: 1 category: Psychotropics
31. Agents which are tricyclic or atypical cyclic antidepressants include all of
the following EXCEPT:
1. imipramine
2. fluoxetine
3. trazodone
4. bupropion
5. All of the above

Item Number: 1362 correct answer: 1 category: Psychotropics
32. You treat a 40-year-old female for neurotic depression. After a few visits
you prescribe amitriptyline to relieve her depression. After 4 days she calls
you to say the pills are having no effect and she still feels depressed. The
best course of action would be to advise her to:
1. continue on the medication as prescribed, as the drug often takes up to
2-6 weeks to have its antidepressant, effect
2. double the dose
3. stop the pills and you will order other treatment from the pharmacist
4. continue on the same dose and you will call in an order for a second
drug to use in combination with it
5. take the pills with an alcoholic drink to increase their effect

Item Number: 11709 correct answer: 4 category: Psychotropics
33. All of the following benzodiazepines are metabolized to active products
EXCEPT:
1. alprazolam
2. chlordiazepoxide
3. midazolam
4. lorazepam
5. diazepam

Item Number: 11705 correct answer: 4 category: Psychotropics
34. The cyclic antidepressants which selectively block serotonin reuptake is:
1. imipramine
2. doxepin
3. amoxapine
4. fluoxetine
5. maprotiline

Item Number: 10669 correct answer: 5 category: Psychotropics
35. Adverse effects of monoamine oxidase inhibitors include all of the following
EXCEPT:
1. dry mouth, constipation, urinary retention
2. hyperreflexia, fatigue, muscle twitching
3. hypertensive reactions if administered with tyramine containing substances
4. orthostatic hypotension
5. raise seizure threshold

Item Number: 10499 correct answer: 5 category: Psychotropics
36. Adverse effects of antipsychotic agents include all of the following EXCEPT:
1. orthostatic hypotension
2. mydriasis
3. gynecomastia
4. jaundice
5. hypothyroidism

Item Number: 10639 correct answer: 3 category: Psychotropics
37. A patient on medication develops severe hypertension after eating some cheese.
The combination of substances found in the cheese and medication,
respectively, which is the most likely cause of this reaction is:
1. ergotamine and amphetamine
2. acetylcholine and reserpine
3. tyramine and phenelzine
4. angiotensin and propranolol
5. dopamine and phentolamine

Item Number: 10622 correct answer: 4 category: Psychotropics
38. The correct statement which describes the dopamine theory of schizophrenia is:
1. schizophrenia is due to a relative lack of the neurotransmitter dopamine
2. schizophrenia is due to a relative decrease in sensitivity of
postsynaptic CNS dopamine receptors
3. schizophrenia is a result of a deficiency in the decarboxylase enzyme
necessary for dopamine synthesis
4. schizophrenia is due to a functional excess of the neurotransmitter
dopamine or to a hypersensitivity of dopamine receptors or a global
imbalance in dopaminergic function within the area A-10 of the brain
5. All of the above

Item Number: 10657 correct answer: 5 category: Psychotropics
39. Indications for and/or uses of cyclic antidepressants include all of the
following EXCEPT:
1. major depression
2. eating disorders
3. chronic pain
4. obsessive-compulsive disorders
5. epilepsy

Item Number: 10483 correct answer: 2 category: Psychotropics
40. Correct pairs of pharmacologic action with CNS region of dopamine blockade
include:
A. extrapyramidal effects – basal ganglia
B. increase prolactin secretion – limbic
C. antiemetic – chemoreceptor trigger zone
D. antipsychotic – basal ganglia
1. A,B,C
2. A,C
3. B,D
4. D only
5. All of the above

Item Number: 11749 correct answer: 4 category: Psychotropics
41. The predominant action of the demethylated biotransformation product of
imipramine is inhibition of:
1. serotonin synthesis
2. serotonin uptake
3. dopamine release
4. norepinephrine uptake
5. dopamine reuptake

Item Number: 10076 correct answer: 2 category: Psychotropics
42. Lithium carbonate is used as an alternative to the major tranquilizers in
the control of manic-depressive illness. After the drug is started, how many days
elapse before the antimanic effect is reached?
1. 1-5 days
2. 7-10 days
3. 11-15 days
4. 16-20 days
5. 21-25 days

Item Number: 10621 correct answer: 5 category: Psychotropics
43. Drug interactions with neuroleptics include all of the following EXCEPT:
1. opioids
2. guanethidine
3. phenobarbital
4. levodopa
5. furosemide

Item Number: 6923 correct answer: 3 category: Psychotropics
44. An attempted suicide with chlorpromazine is admitted to the hospital in a
semi-comatose state. Blood pressure is low. An injection of epinephrine is
given to restore the cardiovascular system and the patient immediately goes
into shock. Blood pressure is now unobtainable. The responsible factor is:
1. chlorpromazine depresses the respiratory center
2. epinephrine has a positive inotropic effect on the heart
3. chlorpromazine is an alpha-adrenergic blocking agent
4. chlorpromazine causes hypertension in toxic doses
5. epinephrine slows the heart rate

Item Number: 8220 correct answer: 3 category: Psychotropics
45. Compared to other major tranquilizers, thioridazine appears to produce
significantly fewer instances of:
1. ventricular dysrhythmias
2. retinopathy
3. Parkinsonism
4. All of the above
5. 1,3

Item Number: 11761 correct answer: 1 category: Psychotropics
46. Adverse effects of lithium that may persist with chronic therapy include all
of the following EXCEPT:
1. severe nausea and vomiting
2. fine tremor
3. leukopenia
4. polyuria
5. hypothyroidism

Item Number: 10673 correct answer: 4 category: Psychotropics
47. Adverse effects of lithium include all of the following EXCEPT:
1. tremors
2. polyuria
3. sedation
4. tardive dyskinesia
5. hypothyroidism

Item Number: 10489 correct answer: 4 category: Psychotropics
48. Extrapyramidal side effects is most common with which of the following
neuroleptics?
1. thioridazine
2. triflupromazine
3. mesoridazine
4. haloperidol
5. All of the above

Item Number: 11651 correct answer: 2 category: Psychotropics
49. Cholestatic jaundice is a rare hypersensitivity reaction which reportedly
occurs with:
1. amitriptyline
2. chlorpromazine
3. lithium
4. chlordiazepoxide
5. alprazolam

Item Number: 5700 correct answer: 5 category: Psychotropics
50. Overdosage of lithium carbonate prescribed for psychiatric disorders may be
serious. Correct statements include:
1. hemodialysis is an effective means of lithium removal and is helpful in
severe overdoses
2. activated charcoal binds lithium in the GI tract and prevents absorption
3. symptoms include edema, tremor, polyuria, and disturbed consciousness
4. All of the above
5. 1,3

Send comments to willoughby@cctr.umkc.edu.