Chapt 20 and 21.central and peripheral nervous system Flashcards
What is the biochemical imbalance theory?
Mental disorders – associated with abnormal levels of endogenous chemicals, such as neurotransmitters, in the brain
*Neurotransmitter
What is the difference between negative and positive?
-Positive means excitatory
-Negative is inhibitory
*Neurotransmitter
What dopamine do?(Both expictory and inhibitory)
Influences both motor and thinking areas of the brain- addiction, paranoia, schizophrenia
*Neurotransmitter
What does norepinephrine do?(Excitatory)
Affects stress sleep, attention, and focus and ANS
Important for attentiveness, emotions, sleeping
-More norephinerphine increase anxiety
-Less norepinephrine decreases insomnia
What does serotonin do? - inhibitory
regulates moods, emotions, cognition, memory, learning,
sensory perception – mood disorders
mood disorders
What does GABA do ? - inhibitory
regulates brain activity – regulates anxiety/ panic d/o
Gabby gabs non stop and it makes her sleepy
Describe anxiety?
Tension, nervousness, apprehension, fear; symptoms associated with SNS stimulation
Describe sedation?
Loss of awareness to stimuli. Could be used in preop before antesthia
Describe hypnosis?
Extreme sedation, loss of ability to sense incoming stimuli. More sever sedation
What is lorazepam(Ativan)
BENZODIAZEPINES
What is therapeutic actions of lorazepam(Ativan)
BENZODIAZEPINES
Enhance effects of GABA
What is the indication for lorazepam(Ativan)?
BENZODIAZEPINES
-Anxiety disorders (first line drugs)
* Anticonvulsant
* ETOH withdrawal
* Hyperexcitability and agitation
* Pre-op anxiety, tension
* Often given concurrently with antidepressants,
antipsychotics, and mood stabilizers
What are pharmacokinetics for lorazepam(Ativan)?
Schedule IV drugs
What is the antidote for lorazepam(Ativan)?
Antidote: flumazenil (Romazicon) – benzo antagonist
What are adverse effects for lorazepam(Ativan)?
CNS depression sedation, confusion, depression, lethargy
* CV effects hypo/hyper-tension, arrhythmias, palpitations
* Respiratory difficulties
* GI N/V, dry mouth, constipation
* Paradoxical reactions
* Withdrawal symptoms occur if medications are stopped
abruptly – high dosing for >4 months then abrupt stop
What are contras for lorazepam(Ativan)?
Allergy, psychosis, narrow angle glaucoma
* Pregnancy/ lactation
What are cautions for lorazepam(Ativan)?
Renal/liver dysfunction
* Older adults Monitor for fall and
hypotensive effects
What are drug interactions for lorazepam(Ativan)?
CNS depressants, ETOH
* Oral contraceptives benzo effect
may be increased
What is depression a deficiency of ?
Norepinephrine (NE), dopamine, serotonin(5HT)
What is fluoxetine (Prozac)?
Selective serotonin reuptake inhibitor
What is the thereapeutic action of fluoxetine (Prozac)?
-Selectively inhibit serotonin reuptake
-Little or no effect on norepinephrine or dopamine reuptake
-Result in increased serotonin concentrations at nerve endings
-**Advantage over tricyclics and MAOIs: little or no effect on cardiovascular system
What do does SSRIs help with?
-Depression
-Bipolar disorder
-Obesity
-Eating disorders
-Obsessive-compulsive disorder
-Panic attacks or disorders
-Social anxiety disorders
-Posttraumatic stress disorders (PTSD)
-Treatment of various substance abuse problems – bupropion [Wellbutrin] is used for smoking cessation treatment at low levels
What are adverse affects of fluoxetine (Prozac)?
-CNS effects -> HA, drowsiness, dizziness
-GI -> N/V/D, dry mouth, weight gain (paroxetine)
Suicidal ideation (esp. in early weeks of therapy) more for children
**Read Focus on The Evidence Box 21.2
Who should you be cautious of with fluoxetine (Prozac)?
-Renal and hepatic dysfunction
-Pregnancy only if the benefit outweighs the risk
