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Nursing - Bloomberg > 370: Cognitive Patho > Flashcards

370: Cognitive Patho Flashcards

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1
Q

Which neurotransmitter is most prevalent in the brain?

A

Glutamate

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2
Q

Negative symptoms of schizophrenia

A

Decreased motivation
Blunted affect
Poor self-care
Social withdrawal

4 A's:  
Apathy / Ambivalence
Affect blunted 
Associative loosening 
Autism
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3
Q

Positive symptoms of schizophrenia

A

Paranoia
Hallucinations
Agitation
Delusions

(PHAD)

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4
Q

Cognitive symptoms of schizophrenia

A

Disordered thinking
Memory and learning
Lack of focus

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5
Q

Pathophysiology of schizophrenia

A
  1. Dysregulation of dopamine (up or down)

2. Imbalance of dopamine and serotonin

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6
Q

First generation antipsychotics (FGA)

A
  1. D2 antagonists (decrease dopamine transmission)
2. Blockade on receptors for:
Serotonin 
Histamine
Acetylcholine 
Norepinephrine 
Dopamine 
(SHAND)
  1. Classified by potency
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7
Q

Second generation antipsychotics (SGAs) aka Atypical agents

A
  1. Decreased serotonin transmission
  2. Low affinity for D2 receptors

(Serotonin has inhibitory effects on DA)

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8
Q

Medicated cooperative stage

A

1st week of antipsychotic action

Decreased agitation, hostility

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9
Q

Improved socialization stage

A

2-6 week of antipsychotic action

Obeys rules, attends meetings, etc

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10
Q

Elimination of thought disorder stage

A

2 weeks - months of antipsychotic action

Decreased delusions, hallucinations, thought disturbances

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11
Q

Maintenance Stage of antipsychotic action

A

Achieves baseline level of functioning

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12
Q

Positive symptoms of schizophrenia

A

Too much dopamine in MESOLIMBIC area

Treat with FGAs (D2 blockers) or SGAs

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13
Q

Negative symptoms of schizophrenia

A

Not enough dopamine in MESOCORTICAL area

Treat with SGAs (restore balance between serotonin and dopamine)

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14
Q

What is a protype of a First Gen Antipsychotic (FGA)?

A

Chlorpromazine

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15
Q

Low potency agents of FGA

A

(Low D2 affinity, non selective)

Sedation, orthostatic hypotension, anticholinergic effects, weight gain

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16
Q

High potency agents of FGAs

A

(High D2 affinity/selectivity)

Extrapyramidal symptoms, prolactin release, arrhythmias

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17
Q

What is a prototype of a high potency agent of FGA?

A

Haloperidol

18
Q

Extrapyramidal Symptoms

A
  1. Movement disorders
  2. Due to blockade of D2 receptors in nigrostriatal region
  3. Low DA, high Ach
19
Q

Extrapyramidal movement disorders

A

High potency agents, occur early:

  1. Acute dystopia (muscle spasms)
  2. Akinesia (Parkinsonism)
  3. Akathesia (internal motor restlessness)

Prolonged med use:
4. Tardive Dyskinesia (invol muscle movements)

(AAAT)

20
Q

Severe spasm of muscles in tongue, face, neck, back

A

Acute dystopia

Treated with anticholinergics

21
Q

Tremor, rigidity, slow shuffling gait

A

Akinesia / Parkinsonism

Treated with anticholinergics

22
Q

Profound restlessness, pacing, movement

A

Akathisia

Treated with anticholinergics

23
Q

Involuntary twisting, writhing movements of face, tongue; may be irreversible, no reliable treatment

A

Tardive Dyskinesia

Treated with anticholinergics

24
Q

Anticholinergics

A

(Benztropine, diphenhydramine)

Restore balance between DA and Ach

25
Q

Neuroleptic Malignant Syndrome (NMS)

A
  1. More likely with high potency antipsychotics

Sudden fever, muscle rigidity, sweating, increased HR, labile BP, altered LOC, confusion, seizures, coma, arrhythmia, death

D/c antipsychotics, no antidote

26
Q

What is a prototype of a Second Gen Antipsychotics (SGA)?

A

Olanzapine

Others: Risperidobe, Clozapine

Blockade of 5-HT2 receptors (restore DA/5HT balance)

Side effects: weight gain

27
Q

Side effects of Second Gen Antipsychotics (SGA)

A

Weight gain, diabetes, increased cholesterol, prolonged QT interval

28
Q

Clozapine

A

Risk of agranulocytosis

29
Q

Agranulocytosis

A

Drop in blood cell counts

Could be fatal due to sepsis

Monitor WBC and neutrophil counts

30
Q

Monoamine hypothesis of depression

A

Deficit of one or more NE, 5HT, or DA neurotransmission

31
Q

Principal symptoms of depression

A

Depressed mood, loss of interest/pleasure

Respond by 4 weeks

32
Q

Somatic symptoms of Depression

A

Sleep pattern, changes in appetite, weight changes, fatigue

Respond in 1-3 weeks

33
Q

Antidepressant drug classes

A
  1. SSRIs
  2. SNRIs
  3. TCAs
  4. Atypical/Antidepressants
  5. MAOIs
34
Q

What is a prototype of SSRIs?

A

fluoxetine (Prozac)

  1. Blocks neuronal reuptakr of 5HT
  2. Long half-life
35
Q

SSRI Side effects

A
  1. Serotonin Syndrome
  2. Sexual dysfunction
  3. Nausea, HA, weight gain
  4. CNS stimulation (nervousness, insomnia, anxiety)
  5. Headache
36
Q

Serotonin Syndrome

A
  1. Altered mental status (confusion, agitation, hallucination)
  2. Increased muscle tone
  3. Tremor
  4. Rigidity
  5. Sweating
  6. Fever
37
Q

What is a prototype of TCA antidepressants?

A

Amitriptyline (Elavil)

  1. Blocks neuronal reuptake of NE/5HT
  2. Long half-lives
  3. Second-Line therapy
38
Q

What are side effects of TCAs?

A 
(TCAS)
Thrombocytopenia 
Cardiac (arrhythmia, MI, stroke)
Anticholinergic (tachycardia, urinary retention, etc)
Seizures
39
Q

Side effects of TCAs antidepressants

A
  1. Sedation (H1 receptor blockade)
  2. Orthostatic hypotension (blockade of alpha1-adrenergic receptors)
  3. Anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention, tachycardia, etc) (muscarinic cholinergic receptor blockade)
  4. Weight gain (5HT2 receptor blockade)
  5. Cardiac toxicity (arrhythmias)
  6. Diaphoresis (sweating)
  7. Seizures
  8. Hypomania
40
Q

What is a prototype of SNRI antidepressants?

A

Venlafaxine (Effexor)

  1. Block reuptake of NE and 5HT

Side effects: nausea, HA, insomnia, weight loss/anorexia, sexual dysfunction, increased BP

41
Q

What is a prototype of an atypical antidepressant?

A

Bupropion (Wellbutrin)

  1. Blocks DA and NE reuptake. Also works on nicotine receptors.
  2. Shorter half life

Side effects: agitation, HA, nausea, dry mouth, insomnia, constipation, weight loss, psychosis (rare)

Nursing - Bloomberg (52 decks)

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