CH2 Neurobiologic Theories And Psychopharmacology

Question 0

What are the 4 lobes of the Cerebrum and what does each control?

Answer 0

1) Frontal Lobe - Controls the organization of thought, body movement, memories, emotions, and moral behavior.
2) Parietal Lobes - Taste, touch and spatial orientation.
3) Temporal Lobes - Smelling, hearing, memory, and emotional expression.
4) Occipital Lobes - Language and visual interpretation (i.e., depth perception).

Question 1

What is the difference, with respect to function, between the right and left brain?

Answer 1

1) Left Brain - Controls the right side of the body and is the center for reasoning and analytical functioning such as reading, writing and math.
2) Right Brain - Controls the left side of the body and is the center for active thinking, intuition and artistic abilities.

Question 2

Which 3 Psych disorders are associated with abnormalities in the Frontal Lobes?

Answer 2

1) Schizophrenia
2) ADHD
3) Dementia

Question 3

What is the function of the cerebellum and how is associated with Parkinson’s Disease and Dementia?

Answer 3

The Cerebellum coordinates movement and postural adjustments. Research has shown that ⬇ Dopamine to this area is associated with lack of smooth coordinated movement as seen in Parkinson’s Disease and Dementia.

Question 4

Describe the anatomical location of the midbrain. What is it’s function?

Answer 4

The midbrain connects the Pons and the Cerebellum. It controls the Reticular Activating System and the Extrapyramidal System.

Question 5

What is the function of the Reticular Activating System and the Extrapyramidal System.

Answer 5

1) Reticular Activating System - Motor activity, sleep/consciousness, and awareness.
2) Extrapyramidal System - Relays information about movement and coordination from the brain to the spinal nerves.

Question 6

What is the Locus Ceruleus?

Answer 6

Locus Ceruleus - A small group of Norepinephrine-producing neurons in the brain stem associated with stress, anxiety, and impulsive behavior.

Question 7

Where is the Limbic System and which anatomical structure are included?

Answer 7

The Limbic System is an area of the brain located above the brain stem and includes the following:

1) Thalamus - Regulates activity, sensation, and emotion.
2) Hypothalamus - Regulates temperature, appetite control, endocrine function, sex drive and impulsive behavior associated with anger, or excitement.
3) Hippocampus - Emotional arousal
4) Amygdala - Memory

Question 8

Define Psychoimmunology

Answer 8

Psychoimmunology - A new field of study that examines the effect of psychosocial stressors on the body’s immune system.

Question 9

Define Depot Injection

Answer 9

Depot Injection - A slow release, injectable form of antipsychotic medication for maintenance therapy.

Question 10

What are the 4 Excitatory Neurotransmitters and what do each control?

Answer 10

1) Dopamine - Complex movements, motivation, cognition, regulation of emotional response.
2) Norepinephrine - Attention, learning, memory, sleep/wakefulness, moods.
3) Epinephrine - Fight or flight response.
4) Glutamate - Major neurotoxic effects at high levels.

Question 11

What are the 2 Neurotransmitters that are Inhibitory and what does each regulate?

Answer 11

1) Serotonin - Food intake, sleep/wakefulness, temp, pain, sexual behaviors and emotions.
2) GABA - Regulates other Neurotransmitters.

Question 12

Which Neurotransmitter is both excitatory and inhibitory and what does it regulate?

Answer 12

Acetylcholine - Regulates sleep/wakefulness, and signals muscles to become alert.

Question 13

Which Neurotransmitter is classified as a neuromodulator?

Answer 13

Histamine

Question 14

Define the following terms as they relate to Psychopharmacology:

1) Efficacy
2) Potency
3) Half-Life

Answer 14

1) Efficacy - Maximum therapeutic effect
2) Potency - Amount of drug needed for maximum effect.
3) Half-Life - Amount of time it takes for half the drug to be eliminated form the body.

Question 15

What are the 3 types of Neuroleptics (Antypsychotic drugs)?

Answer 15

1) Conventional - Chlorpromazine, fluphenazine, thioridazine, haloperidol, loxapine.
2) Atypical - Clozapine, risperidone, olanzapine.
3) New Generation (Dopamine system stabilizers) - Aripiprazole

Question 16

What is the MOA of Neuroleptics aka Antipsychotic drugs?

Answer 16

Neuroleptics block dopamine receptors

Question 17

What are the 4 main side effects and 4 less common side effects of Antipsychotics.

Answer 17

MAIN SIDE EFFECTS
1) Extrapyramidal Syndrome
2) Neuroleptic Malignant Sysndrome
3) Tardive Dyskenesia
4) Anticholinergic Effects
LESS COMMON SIDE EFFECTS
1) ⬆ Prolactin
2) Weight gain (Atypical agents except zipasidone)
3) Prolonged QT intervals
4) Agranulocytosis (clozapine)

Question 18

What are the symptoms of the following side effects associated with Antipsychotic drugs:

1) Extrapyramidal Syndrome
2) Neuroleptic Malignant Sysndrome
3) Tardive Dyskenesia
4) Anticholinergic Effects

Answer 18

1) Extrapyramidal Syndrome - Includes Acute Dystonia, Pseudoparkinsonism, and Akathisia.
2) Neuroleptic Malignant Syndrome - Ridgidity, high fever, unstable BP, diaphoresis, pallor, delirium, ⬆ phosphor insane.
3) Tardive Dyskenesia - Involuntary movements of the tongue, face, neck, extremities and truncal musculature.
4) Anticholinergic Effects - Dry mouth constipation, urinary retention, blurred vision, photophobia, nasal congestion and memory loss.

Question 19

What signs should the nurse look for in patient with the following Extrapyramidal Symptoms associated with the use of Antipsychotic drugs:

1) Dystonia
2) Pseudoparkinsonism
3) Akathisia

Answer 19

1) Dystonia - Acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and laryngospasms.
2) Pseudoparkinsonism - Stiff/stooped posture, mask-like facies, ⬇ arm swing, shuffling gait, drooling, tremor and bradycardia.
3) Akathisia - An intense need to move about. Client appears restless, anxious, and agitated.

Question 20

What are the 4 types of Antipdepressants?

Answer 20

1) Tricyclic and related cyclic Antidepressants (TCAs)
2) Selective Serotonin Reuptake Inhibitors
3) Monoamine Oxidase Inhibitors (MAOIs)
4) Others - i.e., venlafaxine, buprioprion, duloxitine, trazodone, nefazodone. L

Question 21

What are the 7 Side Effects of SSRIs used to treat depression?

Answer 21

1) Anxiety
2) Agitation
3) Akathisia
4) Insomnia
5) Nausea
6) Sexual Dysfunction
7) Weight gain

Question 22

What are the 6 Side Effects of TCAs used to treat depression?

Answer 22

1) Anticholinergic effects
2) Orthostatic hypotension
3) Sedation
4) Weight gain
5) Tachycardia
6) Sexual dysfunction

Question 23

What rare the 7 Side Effects of the MAOIs used to treat depression?

Answer 23

1) Daytime sedation
2) Insomnia
3) Weight gain
4) Dry mouth
5) Orthostatic hypotension
6) Sexual dysfunction
7) Hypertensive crisis (with foods containing Tyramine)

Question 24

What is Serotonin Syndrome and what are the SxS?

Answer 24

Serotonin Syndrome is. Drug interaction that happens when a patient takes and SSRI in conjunction with an MAOI. SxS include agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia, coma and death.

Question 25

Whatare the appropriate teaching for a patient taking SSRIs, TCAs, and MAOIs?

Answer 25

1) SSRIs - Take 1st thing in the morning, skip dose if missed dose is over 8 hours.
2) TCAs - Take at night and skip dose if missed dose is over 3 hours.
3) MAOIs - Avoid foods with Tyramine i.e., cheeses, aged meats, and beers.

Question 26

Which drug is the first line of choice in the treatment of Bipolar disorder?

Answer 26

Lithium

Question 27

Which 5 Anticonvulsants are used as mood stabilizers in treating bipolar disorder?

Answer 27

1) Carbamazepine
2) Valproic acid
3) Topiramate
4) Gabapentin
5) Oxcarbazepine

Question 28

Define Kindling Process

Answer 28

Kindling Process - the snowball like effect seen when minor seizure activity seems to build up into more frequent and severe seizures.

Question 29

What are the 9 common side effects of Lithium?

Answer 29

1) Nausea
2) Diarrhea
3) Anorexia
4) Fine hand tremor
5) Polydipsia and polyuria
6) Metallic taste
7) Fatigue
8) Weight gain
9) Acne

Question 30

What are the 5 SxS of Lithium Toxicity?

Answer 30

1) Vomiting
2) Diarrhea
3) Muscle weakness
4) Drowsiness
5) Lack of coordination

Question 31

What are the side effect of the following Anticonvulsants used to as mood stabilizer to treat bipolar disorder:

1) Carbamazepine
2) Valproic Acid
3) Topiramate

Answer 31

1) Carbamazepine - Drowsiness, sedation, dry mouth, blurred vision, rash and orthostatic hypotension.
2) Valproic Acid - Drowsiness, sedation, dry mouth, blurred vision, weight gain, alopecia, and hand tremor.
3) Topiramate - Drowsiness, sedation, dry mouth, blurred vision, dizziness, sedation, and weight loss.

Question 32

What are the appropriate patient teaching for a patient taking Lithium and Anticonvulsants for Tx of Bipolar disorder?

Answer 32

1) Check blood levels of lithium 12 hours after dose

2) Take these drugs with meals

Question 33

What are the 4 Side affects of Benzodiazepines used to treat anxiety?

Answer 33

1) Physical and psychological dependence
2) Tolerance build up
3) CNS depression
4) Hangover effect

Question 34

What are the 2 Side affects of Buspirone, used to treat anxiety?

Answer 34

1) Dizziness
2) Sedation
3) Nausea
4) Headache

Question 35

What should you teach your patient who is taking Benzodiazapines or Buspirone to treat their anxiety?

Answer 35

1) Avoid alcohol (Benzodiazepines potentiate alcohol’s side effects)
2) Do not discontinue use abruptly

Question 36

What are some of the drugs included in the Stimulant drug class and what are their indications?

Answer 36

Stimulants include Amphetamines such as methylphenidate (Ritalin), adderall, and dextroamphetamine.
Stimulants are indicated for ADHD, ADD, and narcolepsy.

Question 37

What are the 4 Side Effects of Stimulants?

Answer 37

1) Anorexia
2) Weight Loss
3) Irritability growth
4) Weight Suppression

Question 38

What 4 patient teachings are appropriate for a client taking stimulants?

Answer 38

1) Dose after meals
2) Avoid caffeine, sugar and chocolate
3) Take drug holidays to normalize growing process
4) Store out of reach of children

Question 39

What is the indication for the Disulfiram (Antabuse)?

Answer 39

Used as a deterrent from drinking alcohol.

Question 40

What are the 5 Side Effects experienced by clients taking Disulfiram?

Answer 40

1) Fatigue
2) Drowsiness
3) Halitosis
4) Tremor
5) Impotence

Question 41

What are some common products that contain alcohol that should be avoided by clients taking disulfiram?

Answer 41

1) Shaving cream
2) Deodorant
3) OTC cough meds

Question 42

In which 3 ways are Extrapyramidal Symptoms (dystonia, akathisia, and pseudopasrkinsonism) managed?

Answer 42

1) Lowering the dosage of the antipsychotic
2) Changing to a different antipsychotic
3) Administering anticholinergics (i.e., Cogentin or Benadryl)

Question 43

Which 3 major disorder of spasms and stiffness can happen to patients with Acute Dystonia?

Answer 43

1) Torticollis - Twisted head and neck
2) Opisthotonus - Tightness in the entire body with the head back and an arched neck.
3) Oculogyric - Eyes rolled back in a locked position

Question 44

Along with Anticholinergics, which other drug can be administered to a patient experiencing Pseudoparkinsonism?

Answer 44

Amantadine - A dopamine agonist that increases transmission of dopamine blocked by the antipsychotic drugs.

Question 45

Along with Anticholinergics, which other drug can be administered to a patient experiencing Akathisia?

Answer 45

Beta-Blockers or Benzodiazapines

Question 46

What is Tardive Dyskenesia?

Answer 46

Tardive Dyskinesia is a syndrome of PERMANENT involuntary movement caused by the longterm use of conventional antipsychotics.

Question 47

Clozapine is Atypical antipsychotic drug that has a high risk of causing Agranulocytosis. What are the symptoms of Agranulocytosis and how is it treated?

Answer 47

SxS of Agranulocytosis are fever, malaise, ulcerative sore throat and leukopenia.