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CHAPTER 27 PHARMACOLOGY IN PSYCHIATRIC CARE part two

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wipimebe's version from 2015-09-25 00:24

Section

1. Structure-activity relationship (SAR) indicates that if two drugs are chemically and structurally similar, a provider can predict:

 

a. they will probably produce similar effects
b. little or nothing about the effects of the drugs
c. activity differences based on the structural differences
d. the side effects with some precision

 

ANS: A
According to structure-activity relationship, two chemically and structurally similar drugs will most likely produce similar effects. However, in some cases one may have fewer or different side effects, or be more or less effective than another. As a result of this, a larger number of psychotropic medications have been produced that are structurally and chemically similar, but have differing side effects and effectiveness among clients.

 

PTS: 1 DIF: Comprehension
REF: History of Psychiatric Medication| Reflective Thinking| Serendipity and SAR

 

2. The half-life of a drug is the time it takes for

 

a. half of the drug to be excreted in the urine
b. plasma concentrations of the drug to drop to half the initial value
c. half of the drug to reach each and every cell of the human body
d. half of the drug to reach the liver and be metabolized

 

ANS: B
A drug's half-life is the time required for plasma concentrations of a drug to decrease to half of an initial value. For example, after one half-life, 50% of the medication remains in the plasma. After 2 half-lives, 25% of the medication remains in the plasma. After 7 half-lives, less than 1% of the medication remains in the plasma.

 

PTS: 1 DIF: Knowledge REF: How and Why Psychiatric Medications Work

 

3. In most cases, the goal of medication administration is to achieve a state in which the amount of drug absorbed is balanced with the competing processes of distribution, elimination, and metabolism. This is known as the:

 

a. homeostatic balance
b. recommended dose
c. steady state
d. therapeutic value

 

ANS: C
The steady state is the state in which the amount of drug absorbed is constantly balanced by the competing processes of distribution, elimination, and metabolism. It is also called the pharmokinetic state. The relationship between the absorption of a drug and the steady state may not be linearly related to the drug dosage given.

 

PTS: 1 DIF: Comprehension
REF: How and Why Psychiatric Medications Work

 

4. After seven half-lives of a drug, which of the following percentages of the medication or drug remains in the plasma of the person taking that drug?

 

a. less than 1%
b. 1.5%
c. 5%
d. 50%

 

ANS: A
After seven half-lives, less than 1% of the medication remains in the plasma. A drug's half-life is the time required for plasma concentrations of a drug to decrease to half of an initial value. After each successive half-life, half of the medication remains in the plasma that was there before. For instance, after the eighth half-life, less than 0.5% of the medication remains in the plasma, which is half of the medication in the plasma that was present after the seventh half-life

 

PTS: 1 DIF: Comprehension
REF: How and Why Psychiatric Medications Work

 

5. Most psychiatric drugs act on the:

 

a. central nervous system
b. entire body directly
c. midbrain
d. peripheral nerves

 

ANS: A
Most psychiatric drugs act on the central nervous system. As a result of this, the drug is required to leave the bloodstream to enter the interstitial fluid, the cerebrospinal fluid, or the brain cells.

 

PTS: 1 DIF: Comprehension
REF: How and Why Psychiatric Medications Work

 

6. Most antipsychotic drugs produce their effects by:

 

a. controlling the release of pituitary adrenal axis hormones and their effect on the brain
b. binding to a specific brain receptor or affect one or more neurotransmitter systems
c. being water-soluble and rapidly circulating throughout the brain
d. causing an initial placebo effect followed by the true pharmaceutical effect

 

ANS: B
The majority of antipsychotic medications produce their effects as a result of binding to specific brain cell receptors or affecting one or more neurotransmitter systems. As an example, the receptors for dopamine are the receptors that are bound strongly by the majority of antipsychotic medications.

 

PTS: 1 DIF: Comprehension
REF: How and Why Psychiatric Medications Work

 

7. The drugs that have been known as major tranquilizers are now called:

 

a. antidepressants
b. antipsychotics
c. anxiolytics
d. mood stabilizers

 

ANS: B
The drugs that have been known as major tranquilizers are now called antipsychotics. The drugs are also known as neuroleptics. Unlike minor tranquilizers, major tranquilizers are rarely abused. These major tranquilizers include phenothiazine (Thorazine, Mellaril, Prolixin, Stelazine), indoles, thioxanthene, butyrophenone (Haldol), piperazine, and piperidine family of compounds.

 

PTS: 1 DIF: Knowledge REF: Antipsychotic Drugs

 

8. Which one of the following symptoms is MOST likely to improve when ÒclassicalÓ first-generation antipsychotic medication is taken?

 

a. delusions
b. anhedonia
c. poor hygiene
d. social isolation

 

ANS: A
First-generation antipsychotics decrease the positive signs of schizophrenia such as delusions and hallucinations. Second-generation antipsychotics are effective with reducing both the positive and negative symptoms. Anhedonia, poor hygiene, and social isolation are negative symptoms of schizophrenia and would therefore be reduced by prescribing a second-generation antipsychotic.

 

PTS: 1 DIF: Application
REF: Antipsychotic Drugs| Indications and Evidence for Effectiveness

 

9. One way that ÒclassicalÓ first-generation antipsychotic drugs are grouped is by potency. A drug would be MOST likely considered a high-potency drug if a typical dose were:

 

a. 200 mg
b. 100 mg
c. 50 mg
d. 5 mg

 

ANS: D
A drug would most likely be considered high potency if a typical dose were 5 mg. A drug is classified as high potency when a dose of only a few milligrams can result in significant antipsychotic effects. This is in contrast with low-potency antipsychotics, which may require 50 times as large of a dose to result in similar effects. Examples of high-potency antipsychotics are Prolixin, Stelazine, and Haldol.

 

PTS: 1 DIF: Comprehension
REF: Antipsychotic Drugs| Grouping by Potency Class

 

10. Low-potency ÒclassicalÓ first-generation antipsychotic drugs, when compared to high-potency ÒclassicalÓ first-generation antipsychotic drugs, are more likely to cause:

 

a. sedation
b. agitation
c. aggression
d. excitation

 

ANS: A
Low-potency first-generation antipsychotic medications are more likely to produce sedation than high-potency medications. Low-potency medications are also more likely to be anticholinergic and cause more orthostasis. However, high-potency medications are more likely to produce particular troublesome complications.