Exam 1 Review Flashcards
SSRIs for PTSD?
SSRIs are approved as a first-line treatment of PTSD.
A 51-year-old male veteran with chronic PTSD has agreed to begin pharmacotherapy for his debilitating symptoms of arousal and anxiety associated with his experiences in Iraq 2 years ago. Which of the following would be appropriate as first-line treatment?
-Paroxetine, lorazepam, d-cycloserine, or quetiapine
-Paroxetine, lorazepam, d-cycloserine
-Paroxetine
-Paroxetine or lorazepam
Paroxetine, a selective serotonin reuptake inhibitor (SSRI), is approved for use in PTSD. The SSRI sertraline is also approved for PTSD. Lorazepam is a benzodiazepine. Benzodiazepines do not have
evidence of efficacy in PTSD and are not generally recommended for first-line use in PTSD. d-cycloserine, an N-methyl-d-aspartate (NMDA) agonist, has been theorized to be useful in facilitating fear extinction, and may be useful in conjunction with exposure therapy. However, it is not a first-line choice. Quetiapine, an atypical antipsychotic, is not approved as first-line treatment for PTSD but may be useful
in selected cases as a third-line treatment, specifically for sleep and possible reduction of nightmares.
A 38-year-old man with a history of treatment-resistant PTSD has now experienced improvement on quetiapine 300 mg/day, duloxetine 90 mg/day, and zolpidem 10 mg at bedtime. However, he complains of ongoing nightmares and difficulty staying asleep. He was previously initiated on prazosin 3 mg at bedtime, but he experienced intolerable dizziness, and it was discontinued. Can this patient be rechallenged with prazosin? If so, at what dose?
-No; prazosin is contraindicated with quetiapine
-Yes; dose should be initiated at 3 mg at bedtime
-No; prazosin should not be reattempted in patients with previous intolerability
-Yes; dose should be initiated at 1 mg at bedtime
Yes; dose should be initiated at 1 mg at bedtime. Prazosin, an alpha 1 antagonist, can be an effective treatment for nightmares in PTSD. The initial dose of prazosin should be 1 mg at bedtime and titrated up 1 mg every 2–3 days to decrease the risk of syncope and Orthostatic Hypotension.
SSRIs (list drugs)
Citalopram
Escitalopram
Paroxetine
Sertraline
Fluoxetine
Fluvoxamine
Fluvoxamine (prescriber notes)
Brand name: Luvox
used mostly for OCD
SSRI
OCD treatment
SSRIs for first-line pharma tx (start at half dose IF: elderly/worried about adverse effects/comorbid GAD)
CBT first-line therapy
Clomipramine is second-line
Other meds: Venlafaxine, Pindolol, Phenelzine, Buspirone, 5-HT, L-Tryptophan, Clonazepam, and Risperidone
OCD diagnosis
To meet criteria: either obsessions or compulsions that take up more than 1 hour per day or significantly interfere with normal functioning
Obsessions: intrusive, inappropriate, recurrent and persistent thoughts that cause marked anxiety and distress
Compulsions: repetitive behaviors or mental acts done by the individual in response to the obsession or according to rules that must be rigidly applied
Criteria for PTSD diagnosis
-Exposure to actual or threatened death, serious injury, or sexual violence
-1 or more intrusion symptoms (e.g., distressing memories/dreams, reliving experience)
-Persistent efforts to avoid trauma stimuli
-2 or more persistent negative alterations in cognitions and mood
-2 or more marked alterations in arousal and reactivity
Symptoms present for 1 month or longer, cause sign clinical distress or impairment in area of functioning, not caused by substance or other underlying medical condition
What medications could be used to augment OCD treatment?
Mood stabilizers (valproate, lithium, carbamazepine)
Cataplexy
A sudden, brief loss of voluntary muscle tone triggered by strong emotions such as laughter, excitement, anger or fear. There is a strong association between cataplexy and narcolepsy
Sodium Oxybate
A medication that improves nighttime sleep architecture and reduces excessive daytime sleepiness (EDS) and cataplexy in narcolepsy by modulating GABA receptors.
Valporic acid treatment precautions
Valproic acid = Valproate = Depakote
Adverse effects include pancytopenia (thrombocytopenia) and liver toxicity
Order complete blood count (CBC) and liver function labs before starting Valproic acid/Depakote
What laboratory parameter should be closely monitored to prevent the development of thrombocytopenia in a patient on Valproic Acid therapy?
-Platelet count
-White blood cell count
-Serum creatinine levels
-Serum albumin levels
Valproic Acid can lead to a decrease in platelet count, a condition known as thrombocytopenia. Monitoring platelet count is crucial to detect this side effect early and prevent complications such as
bleeding.
Lamotrigine (Lamictal) adverse effects
Can cause life-threatening rash (Steven Johnson Syndrome Rash also known as toxic epidermal necrolysis); minimize risk by very slow up-titration
Avoid interactions with valproate as they raise lamotrigine levels
Educate patients to look out for rashes daily and if rash is developed contact doctor and stop lamotrigine immediately, seek immediate care
Which of the following symptoms should be closely monitored during the initiation of Lamotrigine therapy?
-Dry mouth
-Skin rashes
-Increased appetite
-Muscle weakness
Lamotrigine is associated with a risk of severe skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis. Patients should be closely monitored for any signs of skin rash, especially during the initial weeks of treatment.
How often should patients be monitored for potential skin rashes during the titration phase of Lamotrigine treatment?
-Monthly
-Daily
-Weekly
-Every 3 months
Daily. During the titration phase of Lamotrigine treatment, patients should be monitored for potential skin rashes on a daily basis. Skin reactions, if they occur, often appear early in treatment. Close monitoring allows for prompt intervention in case of any rash development, which is important to prevent the progression of severe skin reactions.
A woman in her 20th week of pregnancy has been resumed on lithium for bipolar disorder. The PMHNP knows that the patient may become subtherapeutic despite taking the medication as prescribed due to:
Increased blood volume occurs as pregnancy progresses and patients may need higher doses of medication to maintain concentration effects. Fetal metabolism has no impact on maternal metabolism, but caution is exercised for potential adverse effects to the fetus. Pregnant women do not have decreased muscle mass or reduced blood volume.
Sertraline (prescriber notes)
Brand name: Zoloft
Best tolerated, best choice for pregnancy
SSRI
A patient with schizophrenia was discharged from the hospital on olanzapine 5 mg twice a day. He immediately resumed smoking cigarettes and escalated to one pack per day. Upon presenting for his 1-week follow-up appointment, the patient reports he is having trouble sleeping and the voices have started to return. Which of the following actions should the PMHNP take?
- increase his olanzapine and schedule a FU visit in 2 days
- send the patient to the ED for stabilization
- change to another antipsychotic med and refer to psychiatrist
- tell him to stop smoking and give him a nicotine patch
Increase his olanzapine and schedule a follow up visit because the patient’s symptoms are no longer controlled and smoking is a known inducer of the CYP450 pathway. The patient has not indicated a threat of harm to self or others; changing to another antipsychotic
medication requires re-titration and is not indicated. Telling a patient to stop smoking may trigger a psychological paradox and can erode
therapeutic alliance.
Bupropion
Brand name: Wellbutrin
NE and DA reuptake inhibitor
Appropriate first-line treatment for MDD
Can be used to augment (usually SSRI)
Can be used for smoking cessation and ADHD
Dose in the morning
CYP450 1A2 Inducers
Smoking (can affect the metabolism of antipsychotics like clozapine and olanzapine)
Rifampin (antibiotic)
Carbamazepine (anticonvulsant, mood stabilizer)
When explaining the means by which neurotransmitters relate to mental illness, a patient asks, “What is a neurotransmitter?” The best answer is:
-The space between nerve cells
-A fatty layer covering the axon
-A chemical messenger
-A nerve cell
A neurotransmitter is a chemical messenger, created from dietary substrates, that transmits information between neurons.
DSM-5 Criteria for MDD (unipolar depression)
5 or more of the following symptoms (including at least 1 depressed mood and loss of interest or pleasure) in the same 2-week period; each of these represents a change from previous functioning:
-Depressed mood (subjective or observed)
-Loss of interest or pleasure
-Change in weight or appetite
-Insomnia or hypersomnia
-Psychomotor retardation or agitation (observed)
-Loss of energy or fatigue
-Worthless or guilt
-Impaired concentration or indecisiveness
-Thoughts of death or suicidal ideation or suicide attempt
Major Depressive Disorder SIGECAPS
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor Agitation/Retardation
Suicide
5 or more of the above symptoms must be present within a 2 week time period to diagnose.
Symptoms MUST interfere with social, occupational, OR interpersonal functioning.
Cannot be accounted for by another psychiatric disorder.
No past manic or hypomanic episodes
(Mania = at least 7 days; Hypomania = at least 4 days)
Underlying Bipolar? DIGFAST
Distractibility
Indiscretion
Grandiosity
Flight of Ideas
Activities Increase
Sleep Deficit
Talkativeness
-If having these ^ symptoms in response to antidepressant treatment (or in general), may indicate underlying bipolar disorder
First line treatments for MDD
SSRIs, SNRIs, Bupropion (Wellbutrin), Mirtazapine (Remeron)
Margaret is a 42-year-old patient with untreated depression. She is reluctant to begin antidepressant treatment due to concerns about treatment-induced weight gain. Which of the following antidepressant treatments is associated with the greatest risk of weight gain?
-Vilazodone
-Mirtazapine
-Fluoxetine
-Escitalopram
Mirtazapine. Meta-analysis has shown that mirtazapine, an alpha 2 antagonist, may cause both short- and long-term weight gain. This is consistent with its secondary pharmacological properties: mirtazapine is an antagonist at both serotonin 2C and histamine 1 receptors, the combination of which has been proposed to cause weight gain. However, it should be noted that average weight gain with any antidepressant is small, and rather than a widespread effect it may instead be that a small number of individuals experience significant weight gain due to their genetic predispositions and other factors.
Adverse effects of SSRIs
-Transient = nausea, bowel changes, headaches, fatigue, agitation
-Sexual (up to 75% incidence)
-Serotonin syndrome/toxicity
Serotonin Syndrome (Serotonin Toxicity)
Start with and escalates to :
1)Diarrhea/restlessness
2)Mydriasis (dilated pupils), Diaphoresis, HTN, tachycardia
3)Extreme agitation, tremor, rigidity, increased reflexes
4)Autonomic instability, hyperthermia, delirium, seizures
5)coma, respiratory failure, renal failure, death
Educate patient on early signs and when to call office
Escitalopram (prescriber notes)
Brand name: Lexapro
Fewest adverse effects
SSRI
Fluoxetine (prescriber notes)
Brand name: Prozac
Best for children 8+ and adolescents; longest half-life; can give weak dose (90mg once weekly after starting on daily dose); good for forgetful/noncompliant patients
SSRI
Citalopram (prescriber notes)
Brand name: Celexa
Adverse effects = prolonging QT interval (–>abnormal heart rhythms; sudden cardiac death); AVOID IF CARDIAC HISTORY; limit dose to 40mg daily, in patients 60+ limit to 20mg daily
SSRI
Paroxetine (prescriber notes)
Brand name: Paxil
Highest amount of adverse effects in SSRI class; worst sexual side effects; can treat premature ejaculation
SSRI
(Add wellbutrin (low and slow!) to reduce sexual side effects, can increase risk for serotonin toxicitiy)
Which class of anxiolytic medications is often considered a first-line treatment for generalized anxiety disorder and has a lower risk of dependence compared to benzodiazepines?
-Beta-blockers
-Selective Serotonin Reuptake Inhibitors (SSRIs)
-Benzodiazepines
-Antihistamines
SSRIs are a class of antidepressant medications that are commonly used as first-line treatment for generalized anxiety disorder. They work by increasing serotonin levels in the brain, which helps regulate
mood and reduce anxiety. Unlike benzodiazepines, SSRIs have a lower risk of dependence and are generally considered safer for long-term use.
A 28-year-old female presents for help in managing a generalized anxiety disorder. An appropriate first-line agent would be:
-Duloxetine
-Sertraline
-Nortriptyline
-Bupriopion
Sertraline. SSRIs are suggested as a first-line treatment for Generalized Anxiety D/O.
A 35-year-old female presents to your office and begins to divulge her frequent worries: ever since she was young, she was worried someone close to her would die in a freak accident. As she grew older, this worry was exacerbated by the fear that she would pass away without telling her friends and family how important they are to her. Additionally, once she had children, she became so worried for their safety that she rarely lets them leave the house. Furthermore, she has constant worries about how things will work
out for her in the future, and recently experienced a panic attack. Based only on what you know here, how might you currently diagnose this patient?
-PTSD
-Panic disorder
-Social anxiety disorder
-Generalized anxiety disorder
Generalized anxiety disorder. This patient is displaying core symptoms of generalized anxiety disorder via generalized anxiety and worry. Although she did have a panic attack, a single panic attack is insufficient for a diagnosis of either panic disorder or social anxiety disorder.
Ashely, 26 years old, presents for a psychiatric evaluation stating, “The doctor thought I might have panic disorder.” She states that she has had 2 panic attacks that caused her to go to the emergency department (ED) where she had a thorough work-up that did not reveal any serious physical health problems. She was told to seek psychiatric care. Which of the following statements would not be consistent with the diagnosis of panic disorder?
-“I felt a sense that I wasn’t really present”
-“It came from nowhere, I had to pull the car over, my heart was pounding.”
-“I’m afraid it might happen again so I’m hesitant to go too far from home.”
-“My attacks always happen after I’ve had a bad argument with my boyfriend.”
“My attacks always happen after I’ve had a bad argument with my boyfriend.”
A 26-year-old patient with panic disorder is ready to begin pharmacotherapy. Which of the following would be appropriate treatment options?
-Depakote
-Trazodone
-Sertraline or Alprazolam
-Clomipramine
Sertraline or Alprazolam. SSRIs are appropriate first-line treatment options for panic disorder as well as for generalized anxiety disorder, social anxiety disorder, and PTSD. For panic disorder, benzodiazepines are an appropriate treatment option, although many clinicians prefer not to use them as the first-line option.
Benzodiazepines are also appropriate treatment options for generalized anxiety disorder or social anxiety disorder, although again may not be the first-line choice. They do not have evidence of efficacy for PTSD. Most patients with anxiety or stress-related disorders may benefit most from combined treatment with both nonpharmacological options, such as cognitive behavioral therapy, and pharmacological
options.
In treating an acute manic episode of Bipolar Disorder, which class of medications is often used as first-line treatment due to its rapid onset of action?
-Tricyclic Antidepressants (TCAs)
-Antipsychotics
-Selective Serotonin Reuptake Inhibitors (SSRIs)
-Benzodiazepines
Antipsychotics
What is the first-line mood stabilizer often prescribed for the maintenance treatment of Bipolar Disorder?
-Venlafaxine
-Lithium
-Fluoxetine
-Quetiapine
Lithium is a well-established mood stabilizer and is often considered a first-line treatment for the maintenance phase of Bipolar Disorder. It helps to prevent both manic and depressive episodes.
Fluoxetine is an antidepressant and should be used cautiously in Bipolar Disorder due to the risk of
triggering manic episodes.
Venlafaxine is an antidepressant that can potentially induce mania, and quetiapine is an atypical antipsychotic used to manage acute manic and depressive episodes.
Katherine is a 24-year-old patient who presents with symptoms of depression (including sadness, feelings of worthlessness, and suicidal ideation) occurring every day for the past month. Clinical
interview with Katherine reveals that she has a maternal aunt with bipolar disorder I. Further assessment reveals that this patient also feels distracted and as though her thoughts are racing. Upon speaking with the patient’s mother, it is discovered that Katherine has been, at times, more talkative than usual and irritable with her friends and family. Which class of medication would not be recommended as monotherapy for this patient?
-A mood stabilizer
-All of these would be recommended as monotherapy
-An antipsychotic
-An antidepressant
Expert consensus and published guidelines recommend that antidepressant monotherapy not be used (and is contraindicated) in patients with depression who exhibit mixed features and a positive family history of bipolar disorder.
A 24-year-old man with bipolar disorder is being initiated on lithium, with monitoring of his levels until a therapeutic serum concentration is achieved. Once the patient is stabilized, how often should his serum lithium levels be monitored (excluding one-off situations such as dose or illness change)?
-Every 2 to 3 months
-Every 1 to 2 years
-Every 6 to 12 months
-Routine monitoring is not necessary
Once a patient is stabilized, lithium levels need only be monitored every 6 to 12 months.
A 38-year-old male reports excessive daytime sleepiness for the last 2 weeks in the setting of restructuring at his job. He is unable to tell if he is having more trouble falling asleep or staying asleep. Sometimes he wakes up at 4 a.m. and is unable to fall back asleep. What should the PMHNP do first?
-Prescribe mirtazapine 15 mg at bedtime
-Request the patient complete a sleep log
-Add an extra blanket to his bed covers
-Prescribe zolpidem 10 mg at bedtime as needed
Request the patient complete a sleep log to gather more information regarding sleep latency, sleep efficiency, and sleep maintenance in order to make appropriate recommendations. Zolpidem as a sedative hypnotic is primarily used for patients who have trouble falling asleep. Mirtazapine is an antidepressant that is sometimes used off label in insomnia and for difficulty staying asleep. Environmental factors conducive to sleep include reducing the temperature of the environment and adding a blanket warmer.
Which of the following medications can be used to manage cataplexy in patients with narcolepsy?
-Methylphenidate
-Zolpidem
-Diphenhydramine
-Sodium Oxybate
Sodium Oxybate. It is an effective treatment for cataplexy, a symptom of narcolepsy characterized by sudden muscle weakness triggered by strong emotions.
Methylphenidate
Stimulant that can help with daytime sleepiness
Increases DA levels in the synapse
Also used for ADHD
Diphenhydramine
Brand name: Benadryl
An antihistamine with sedative properties
Antagonist at H1
Acetylcholine (associated pathology)
ACh too high = Parkinsonism
ACh too low = Dementia
Acetylcholine (effect)
Increases: HR, secretions, sweating, salivation, memory, muscle contractions
Norepinephrine (associated pathology)
NE too high = anxiety
NE too low = depression
Norepinephrine (effect)
Increases: HR, alertness, well-being.
Decreases: pain sensitivity &circulation
Dopamine (associated pathology)
DA too high = Psychosis
DA too low = PD, Anhedonia, Addiction
Dopamine (effect)
Increases: sense of well-being and satiety
Decreases: hunger and cravings
Serotonin (associated pathology)
5HT too high = Serotonin syndrome
5HT too low = Depression, OCD, Anxiety
Serotonin (effect)
Increases: well-being, satiety
Reduces pain perception
GABA (associated pathology)
GABA too high = sedated/asleep
GABA too low = anxiety
GABA (effect)
Increases sleepiness.
Decreases: anxiety, alertness, memory, muscle tension
Denise is a 32-year-old patient with shift work disorder who reports that she is having difficulty in her job as a pastry chef due to excessive sleepiness during her shift. Which of the following is a potential therapeutic mechanism to promote wakefulness?
-Inhibit histamine activity
-Inhibit Dopamine activity
-Inhibit gamma-aminobutyric acid (GABA) activity
-Inhibit orexin activity
Inhibit gamma-aminobutyric acid (GABA) activity. When the VLPO is active and GABA is released to the TMN, the sleep promoter is on and the wake promoter is inhibited. Thus, inhibiting GABA activity can promote wakefulness.
Neurotransmitters fluctuate not only on a circadian (24-hour) basis, but also throughout the sleep cycle.____ levels steadily increase during the first couple of hours of sleep, plateau, and then steadily decline before waking.
-GABA/galanin
-Acetylcholine
-Histamine
-Hypocretin/orexin
GABA and galanin levels steadily increase during the first couple of hours of sleep, plateau, and then steadily decline before waking.
What pattern do hypocretin/orexin levels have during sleep?
Hypocretin/orexin levels steadily decrease during the first couple of hours of sleep, plateau, and then steadily increase before waking.
What pattern do Acetylcholine (ACh) levels have during sleep?
Acetylcholine levels fluctuate throughout the sleep cycle, reaching their lowest levels during stage 4 sleep and peaking during REM sleep.
What pattern do Histamine levels have during sleep?
Histamine levels fluctuate throughout the sleep cycle, peaking during stage 2 sleep, and are at their lowest during REM sleep.
A 22-year-old college student stays up all night completing his thesis paper and then has to work the following day. While taking his break in the employee lounge he falls asleep in his chair. His fatigue and urge to sleep are hypothetically related to accumulation of which of the following neurotransmitters?
-Histamine
-Adenosine
-Melatonin
-Orexin
Adenosine. The sleep/wake cycle is mediated by two opposing drives: homeostatic sleep drive and circadian wake drive. Homeostatic sleep drive is dependent on the accumulation of adenosine, which increases the longer one is awake and decreases with sleep. Accumulated adenosine leads to disinhibition of the ventrolateral preoptic nucleus and thus the release of GABA in the tuberomammillary nucleus to inhibit wakefulness. Antagonists at adenosine receptors, therefore, can promote wakefulness by preventing accumulated adenosine from binding to its receptors. Caffeine is the most notable example of an adenosine receptor antagonist.
Orexin
“The wake circuit”; peptide neurotransmitters produced in the lateral hypothalamus that promote wakefulness and stabilize the sleep-wake cycle. Orexin levels are low at the end of the day.
Orexin deficiency (loss or degeneration of orexin producing neurons) is associated with narcolepsy type 1 (with cataplexy)
The PMHNP is monitoring a serum drug level for a medication with a 24-hour half-life. How many hours will it take to reach steady state?
120 hours; steady state is achieved in five half-lives of the medication
(5 × 24 = 120).
Half-life of a medication
the time it takes for the amount of a drug’s active substance in your body to reduce by half (as compared to the peak of absorption)
A 25-year-old woman reports frequently falling asleep during the day for the last 6 months. This has been affecting her work as a computer help desk agent, noting she sometimes nods off during calls but also during times of high volume. When her head hits the back of the chair she wakes up and realizes what has happened. She insists she consistently sleeps 8 hours each night. This is most consistent with which of the following?
-Circadian rhythm sleep disorder
-Night terrors
-Hypersomnia
-Narcolepsy
Narcolepsy is characterized by two or more episodes of sleep latency lasting less than 8 minutes and/or two or more episodes of rapid eye movement (REM) sleep; it commonly occurs in the late teens and 20s. Circadian rhythm sleep disorder is often caused by changes in scheduling (shift work, jet lag) and requires a period of acclimation. Primary hypersomnia is excessive daytime drowsiness not due to an environmental sleep disturbance, underlying medical condition, substance induced disorder, or mood disorder, and is not associated with sleep paralysis (cataplexy). Night terrors are episodes of screaming or intense fear and flailing 2 to 3 hours after falling asleep and is often paired with sleepwalking, unlike nightmares, which are not remembered, and are most common in children between the ages of 2 to 12
John is a 22-year-old RN who has started his first job in the cardiothoracic ICU. After his orientation he began his full-time position working three 12-hour night shifts per week. On his days off he reports excessive fatigue during the day with periods of falling asleep while driving. He also reports difficulty staying awake at work during his first night back to work. Which of the following is the most likely diagnosis?
-Night terrors
-Hypersomnia
-Circadian rhythm sleep disorder
-Narcolepsy
Circadian rhythm sleep disorder is often caused by changes in scheduling (shift work, jet lag) and requires a period of acclimation. Primary hypersomnia is excessive daytime drowsiness not due to an environmental sleep disturbance, underlying medical condition, substance induced disorder, or mood disorder, and is not associated with sleep paralysis (cataplexy). Night terrors are episodes of screaming or intense fear and flailing 2 to 3 hours after falling asleep and is often paired with sleepwalking, unlike nightmares, which are not remembered, and are most common in children between the ages of 2 to 12. Narcolepsy is characterized by two or more episodes of sleep latency lasting less than 8 minutes and/or two or more episodes of rapid eye movement (REM) sleep; it commonly occurs in the late teens and 20s.
Which of the following medications is considered a first-line treatment for narcolepsy?
-Selective serotonin reuptake inhibitors (SSRls)
-Modafinil
-Antipsychotic medications
-Benzodiazepines
Modafinil is considered a first-line treatment for narcolepsy. It is a wakefulness-promoting agent that helps improve daytime alertness without causing the same level of stimulation and potential abuse as other stimulant medications.
Benzodiazepines may help with sleep, but they are generally not the first-line treatment for narcolepsy and can have undesirable side effects.
Insomnia treatment
1st line:
-“Z” drugs: zaleplon, zolpidem, zopiclone
-Dual orexin receptor antagonists (DORAs)
-H1 antagonists (doxepin, diphenhydramine)
-5HT2A Antagonists (trazodone)
-Alpha1 Antagonists
2nd line:
-Benzodiazepines (avoid in OSA and COPD)
Circadian Rhythm Disorder treatment
Bright light and melatonergic agents
Ion Channels
When activated by neurotransmitters, these channels open to allow ions (e.g., Na+, K+, Cl-) to pass into or out of the neuron, influencing its electrical activity
G-Protein-Coupled Receptors (GPCRs)
Receptors that activate secondary messengers inside the cell to exert their effects indirectly
Partial Agonists
Drugs that partially activate receptors but do not elicit the full effect, often used to balance neurotransmission (e.g., aripiprazole as a dopamine partial agonist)
In the presence of a full agonist, the partial agonist will actually turn down the strength of various downstream signals = stabilizers
Cytochrome P450 (CYP450)
Most psychotropic drugs also target the CYP450 drug metabolizing enzymes either as a substrate, inhibitor, and/or inducer. CYP450 enzymes in the gut wall or liver convert the drug substrate into a biotransformed product in the bloodstream. After passing through the gut wall and liver, the drug will exist partially as unchanged drug and partially as biotransformed product in the bloodstream.
Enzymes in Neurotransmitter Metabolism
Enzymes are responsible for breaking down neurotransmitters and terminating their action
Monoamine Oxidase (MAO)
Breaks down monoamines like serotonin, norepinephrine, and dopamine. MAO inhibitors (e.g., phenelzine) block this enzyme, increasing the levels of these neurotransmitters
Acetylcholinesterase
Breaks down acetylcholine in the synaptic cleft. Inhibitors like donepezil increase acetylcholine levels and are used in treating Alzheimer’s disease.
Pharmacodynamics
the study of the relationship between drug concentration and effect on the body
The PMHNP knows that the study of how the body absorbs, distributes, metabolizes, and excretes a medication is known as:
Pharmacokinetics
(effect the organism has on the drug)
