Chp 3 Book Flashcards
a network of structures in the brain’s temporal lobes that’s responsible for emotional and social processing, learning, and motivation
Limbic system
Located in limbic system
Responsible for short-term memory and transferring it to long-term storage, as well as spatial memory and emotional processing
Hippocampus
Located in limbic system
A small structure that processes emotions, especially fear, anxiety, and aggression, and links them to memories, learning, and the senses
Amygdala
Produces hormones, manages mood, hunger, thirst, sexual arousal, blood pressure, body temperature, and heart rate, and feeds information into the limbic system
Hypothalamus
Located in limbic system
An arch-shaped convolution that processes emotions, regulates behavior, and controls autonomic motor function
Cingulate gyrus
Psychotropic medications work by….
changing the amount of neurotransmitters available in the synapse, which is the microscopic gap between neurons.
Is the range of doses at which a medication is effective without unacceptable adverse events. Drugs with a narrow TI (NTIDs) have a narrow window between their effective doses and those at which they produce adverse toxic effects.
The therapeutic index (TI)
Explain the hypothalamic-pituitary-adrenal axis
Hypothalamus releases corticotropin-releasing hormones
CRH stimulate pituitary to release adrenocorticotropic hormone
Adrenocorticotropin stimulates adrenal glands and releases cortisol
Cortisol associated with fight or flight
Name Neurotransmitter
Decrease
Parkinsons & Depression
Increase
Schizophrenia & Mania
Dopamine DA
Name Neurotransmitter
Decrease:
Depression
Increase:
Mania, Anxiety, Schizophrenia
Norepinephrine NE
Name Neurotransmitter
Decreased
Depression
Only association
Serotonin 5-HT
Name Neurotransmitter
Decrease
Sedation & Weight gain
Histamine
Name the Amino Acid
Decrease:
Anxiety, Schizophrenia, Mania, Huntington’s disease
Increase:
Reduction of Anxiety
GABA
Name the Cholinergic
Decrease Level
Alzheimer’s, Huntington’s, Parkinson’s
Increase Level
Depression
Acetylcholine ACh
This peptide is involved in regulation of pain & possibly mood & anxiety
Substance P
This peptide is possibly involved in disorders involving dopamine, Schizophrenia & Parkinsons
Neurotensin
Brain Imaging Tech
Can show the state the person is in. Sleep, awake, anesthetized
EEG
Brain Imaging Tech
Can detect: Lesions, Abrasions, Areas of infraction, Aneurysm
Findings
Schizophrenia
Cognitive disorders
CT
Brain Imaging Tech
Can detect
Brain edema
Ischemia
Infection
Neoplasm
Trauma
Findings
Schizophrenia
Reduction in temporal & prefrontal lobes
MRI
Brain Imaging Tech
Can Detect:
Oxygen Ultilization
Glucose Metabolism
Blood flow
Neurotransmitter-receptors interaction
Findings
Schizophrenia
Abnormalities in Limbic system
Mood disorder
Abnormalities in temporal lobe
Adult ADHD
Decreased Ulitilzation of Glucose
PET
Enzyme responsible for metabolizing most drugs is…
Cytochrome P450
Flurazepam, temazepam, triazolam
Are approved solely for…
Insomnia
They are benzos
Chlordiazepoxide, diazepam, lorazepam
Are all commonly prescribed for…
Alcohol withdrawal
Anterograde amnesia vs retrograde amnesia
Anterograde
This type of amnesia affects a person’s ability to learn new information and form new memories. Can be caused by Benzos, Barbiturates, Alcohol
Retrograde amnesia
This type of amnesia affects a person’s ability to recall past memories, including memories that were recently learned.
Ataxia
Impaired coordination
Zolpidem
(Ambein)
Short Acting Sedative Hypnotic sleep agents (Z-hypnotics)
Zaleplon
(Sonata)
Short Acting Sedative Hypnotic sleep agents (Z-hypnotics)
Eszopiclone
(Lunesta)
Short Acting Sedative Hypnotic sleep agents (Z-hypnotics)
Ramelteon
May lower testosterone & raise Prolactin.
Contradicted with Fluvoxamine
Name class & use of Ramelteon
Melatonin receptor agonist
Sleep
This tricyclic antidepressants is approved for insomnia.
It doesn’t make you fall asleep faster but keeps you asleep by blocking Histamine which promotes wakefulness.
Contradicted in patients with Urinary Retention, Glaucoma, or MAOIs
Doxepin (Silenor)
Suvorexant
Orexin receptor Antagonist
Treats insomnia
neuropeptid Orexin produced by hypothalamus promotes wakefulness
Lemborexant
Orexin receptor Antagonist
Treats insomnia
neuropeptid Orexin produced by hypothalamus promotes wakefulness
Suvorexant & Lemborexant
Treats insomnia- block Orexin receptors (Promotes Wakefulness)
Controlled substances
Contradicted in whom
Narcolepsy patients
Buspirone is approved for treatment of …..
Which receptor(s) does it work on?
Controlled Substance?
(BuSpar)
Anxiety
Serotonin
Not CS
First line to treat depressive disorder
SSRI
Fluoxetine is the most activating SSRI. Very long half-life. Maybe taken how often
Possibly 1 time per week
Sertraline (SSRI) Causes this SE more than other SSRIs
GI upset
Which SSRI should be taken at bed time due to its Sedation Properties
Fluvoxamine
Paroxetine (SSRI) has this major SE
Anticholinergic
Citalopram (SSRI) has this SE
QT interval prolongation
Bupropion (Wellbutrin)
This type of medication
Also, FDA approved for…
Norepinephrine & Dopamine reuptake inhibitor NDRI - Antidepressants
Also, Smoking Cessation
Mirtazapine (Remeron)
Vs
Bupropion (Wellbutrin)
Energy levels…
Appetite….
Sex….
Mirtazapine (NaSSA)
Sedation & Weight Gain & Less Sex Dysfunction
Bupropion (NDRI)
Insomnia, Anorexia, Weight loss , Less Sexual Dysfunction
SSRI or SNRI
Can help with neuropathic pain
SNRI
Duloxetine (SNRI) Antidepressants
Helps these areas of pain management
Diabetic peripheral neuropathy
Fibromyalgia
Chronic musculoskeletal pain
Tricyclic antidepressants are not often prescribed due to…
SE
Lethal upon OD
Last line Antidepressants
MAOI
Valproate is an Anti convulsant & mood stabilizer. Balmces GABA & Glutamate
Common SE: Sedation, weight gain, tremor
Serious SE:
Contradicted:
Thrombocytopenia
Pancreatitis
Hepatic failure
Hyperammonemia
Contradicted: Preggers or Liver Failure
Carbamazepine
2nd line mood stabilizer or Bipolar & Anticonvulsants
Monitor CBC, ECG, LFT & Sodium
Pregnancy test needed
This serious adverse affect may happen…. (Esp in this population)
These types of medications maybe affected…
Stevens-Johnson syndrome
Asians
Antivirals, anticontraceptives, immunosuppressant
Lamotrigine
Anticonvulsant & Mood stabilizer
For (Acute or Maintenance) of bipolar
Serious adverse SE
Maintenance
Stevens-Johnson syndrome
Taking an Antipsychotic & depletion of dopamine can lead to this potentially fatal condition
S/S
Neuroleptic malignant syndrome
Muscle rigidity
Alter mental status
Hyperthermia
BP, HR, RR
Which are typical or atypical antipsychotics
Typical = 1st generation
Atypical = 2nd generation
First line of treatment in schizophrenia
2nd generation atypical antipsychotics
Less SE
Treat both positive & Negative Symptoms of schizophrenia
1st generation antipsychotic block dopamine
Whereas, 2nd generation are Antagonist for…
Dopamine & Serotonin
Hyperprolactinemia & Gynoclamastia are seen in these meds
1st generation antipsychotic
Pimavanserin 2nd generation atypical antipsychotics
Is only FDA approved for…
Parkinson’s psychosis
Unique that it only Antagonises serotonin receptors
Aripiprazole, brexipipazole, quetiapine 2nd generation atypical antipsychotics
Also approved for…
Major depressive disorder as adjucates to antidepressants
Cariprazine, lurasidone, quetiapine 2nd generation atypical antipsychotics
Also approved for…
Bipolar disorder
2nd generation atypical antipsychotics
All have this SE
Weight gain, hyperglycemia, Hyperlipidemia
Absolute neutrophil count is measured weekly for 6 months. Then once every 2 weeks fo 6 months. Then every 4 weeks afterwards in this medication
Clozapine
Best antipsychotic med - only prescribed after 2 other meds failed due to strong SE
Clozapine 2nd generation atypical antipsychotics
Most effective- only prescribed after 2 other meds failed.
Serious SE:
Contradicted:
Weight gain / Diabetes
Sever Sedation, Orthostatic Hypotension, anticholinergic
Seizures
Bone marrow & Neutropenia
Contradicted: Seizures conditions
Clozapine 2nd generation atypical antipsychotics
Levels with smoking
Smoking lowers levels in blood
Risperidone
Potent D² Antagonist.
High rates of EPS
Hyperprolactinemia
Orthostatic hypotension
Class of medication
2nd generation atypical antipsychotics
Quetiapine
2nd generation atypical antipsychotics
Potency?
Low
High risk for Sedation / low for EPS
Olanzapine 2nd generation atypical antipsychotics
Posses Sedation & anticholinergic effects. Weight gain & hyperglycemia
Long-acting Injectable formulario is available.
Precautions with Injectable
Server Delirium/ Sedation
Most be monitored fir 3 hours after
An inherited condition in which nerve cells in the brain break down over time.
It typically starts in a person’s 30s or 40s.
Results in progressive movement, thinking (cognitive), and psychiatric symptoms.
Drug interventions:
Huntington’s disease
Antipsychotics
Atomoxetine, Guanfacine, Clonidine
All approved for treating…
ADHD
In Alzheimer’s all approved medication targets these neurotransmitters…
Glutamate & Acetylcholine
Donepezil, galantamine, rivastigmine
Class
Use
Cholinesterase inhibitors ( Stop destruction of Acetylcholine)
Helping memory issues in Alzheimer’s
Fill in with appropriate neurotransmitters
Excess ____ is involved in thought Disturbances of schizophrenia
Deficiencies of _____ and/or _____ underline depression & Anxiety.
Insufficient ____ may also play a role in Anxiety
Excess ____ & Insufficient _____ are involved in Alzheimer’s
Dopamine
Norepinephrine/ Serotonin
GABA
Glutamate / Acetylcholine
Do ADHD meds increase or decrease dopamine/ norepinephrine
Increase
Antipsychotics (decrease / increase) Dopamine
Antidepressants (decrease / increase) Serotonin/ Norepinephrine
Alzheimer’s meds do what to Acetylcholine & Glutamate
Decrease dopamine
Increase Serotonin Norepinephrine
Decrease Glutamate/ Increase Acetylcholine
Which medication increases blood levels of lamotrigine, increasing Stevens-Johnson Syndrome risk?
A. Carbamazepine
B. Lithium
C. Quetiapine
D. Valproate
D. Valproate
