Ch 4 Flashcards
Psychotropic illness
Alteration of neurotransmitters
Goals of psychiatric mental health
Understand biological basis of normal and abnormal brain functions
Apply understanding go care of individuals treated with psychotropic drugs
Functions of brain
Homeostasis ANS and hormones Biological drives and behavior Cycle of sleep and wakefulness Circadian rhythms Conscious mental activity Memory Social skills
Positron-emission tomography (PET) and single-photon emission computed tomography (SPECT)
Perceptual, cognitive, emotional, behavioral functions
Evidence of metabolic changes in unmedicated individuals with depression, schizo, OCD
Functional magnetic resonance imaging (fMRI)
Cognitive function
Effects of psychotropic medications
Neurotransmission
Feature of neurons and ability to initiate signals
Conduct electrical impulses
Dopamine
Decrease: Parkinson’s, depression
Increase: schizo, mania
Norepinephrine
Decrease: depression
Increase:anxiety states
Serotonin
Decrease: depression
Increase: anxiety
Histamine
High levels associated with anxiety and depression
Gamma-Amino butyric acid (GABA)
Decrease: anxiety, schizo, mania, Huntington chorea
Increase: reduction of anxiety, schizo, mania
Glutamate
Major mediator of excitatory signals in CNS
Cognition, memory, learning
Acetylcholine
Decrease: Alzheimer’s, Huntington chores, Parkinson’s
Increase: depression
Neurotransmitters (Peptides-Neuromodulators)
Substance P
Somatostatin
Neurotensin
Substance P
Regulation of mood and anxiety
Pain management
Somatostatin
Decrease: Alzheimer’s
Increase:Huntington’s
Neurotensin
Decrease levels in spinal fluid of patients with schizo
Psychotropic drugs
Anti anxiety hypnotics Antidepressant Mood stabilizers Anti-convulsants Anti-psychotics ADHD Agents Alzheimer agents Herbal treatments
Monoamines
Organic
Catecholamines (norepinephrine, epinephrine, dopamine)
Indolamines (serotonin)
Monoamine oxidase (MAO)
Enzyme destroys monoamines
Monoamine oxidase inhibitors (MAOIs) action
Increase concentration of monoamines by inhibiting action of MAO
Monoamine oxidase inhibitors (MAOIs) drugs
phenelzine (Nardil)
tranylcypromineb(Parnate)
EMSAM transdermal
Hypertensive crisis
Tyramine ingested in OTC meds, beer, wine, aged cheese, organ meats, avocados
No tyramine 2 weeks after stopping MAOIs
Pharmocokinetic
Effects of drugs on plasma concentrations
Pharmacodynamic
Combined effects of drugs
Norepinephrine dopamine reuptake inhibitors (NDRIs):
bupropion (Wellbutrin)
Do not act on serotonin system
Inhibit nicotine acetylcholine receptors to reduce addictive effects
Serotonin antagonists reuptake inhibitors (SARIs):
Trazadone (Desyrel)
Not first choice
Useful for insomnia
Can cause priapism
Selective norepinephrine reuptake inhibitors (NRIs):
Atomoxetine (strattera)
ADHD when stimulants not tolerated
Not significant to antidepressant benefits
Anti anxiety
Diazepam (Valium)
Clonazepam (klonopin)
Alprazolam (Xanax)
Insomnia
Flurazepam (dalmane)
Triazolam (Halcoin)
Benzodiazepines
Promote activity of GABA by binding to specific receptor of GABAa
buspirone (Buspar)
Anxiolytics with less potential for dependence
Z-hypnotics action
Nonbenzo
Short acting
Sedative and hypnotic sleep agent
Z-hypnotics drugs
Zolpidem (ambien)
Zaleplon (sonata)
Eszopiclone (lunesta)
Melatonin receptor agonist
Ramelteon (rozerem)
Acts similar to melatonin
Helps regulate circadian rhythms
Mood stabilizers drugs
Lithium (eskalith, lithobid)
Lithium (eskalith, lithobid)
Stabilize depression and mania (bipolar disorder)
Narrows therapeutic index
Potential for toxicity
Toxic Effects: tremor, ataxia, confusion, convulsions, N/V
Anticonvulsant mood stabilizers
Valproate (depakote/ depakene)
Carbamazepine (Tegretol)
Iamotrogine ( lamictal)
Valproate (depakote/ depakene)
Very effective in managing impulsive aggression
Carbamazepine (Tegretol)
Acute mania
Iamotrogine ( lamictal)
Maintenance therapy
Watch for rash (Stevens Johnson’s )
Off-label mood stabilizers
Oxcarbazepine (trileptal)
Gabapentin (neurotin)
Topiramate (topamax)
