Exam 1: week 3 Flashcards
What are the different neurotransmitters that are released by neurons in the brain that pertain to mental health
- norepinephrine
- serotonin
- dopamine
- glutamate
- γ aminobutyric acid (GABA)
- acetylcholine
- epinephrine
What are the two ways that neurotransmitters are destroyed
Enzymes
- acetylcholinesterase breaks down acetylcholine
Reuptake
- excess neurotransmitters are absorbed back into the presynaptic neuron
- norepinephrine
What is insufficient transmission
When either there isn’t enough neurotransmitter released from presynaptic neuron or there is an issue with the receptors making them unable to bind enough neurotransmitter
What is the limbic system of the brain
Area of the cerebrum that plays a major role in emotional status and psychological function
Which neurotransmitters are active in the limbic system of the brain
- norepinephrine
- serotonin
- dopamine
What is the function of the brain stem
Processes sensory information then passes that information to the limbic system
What is the function of the hypothalamus
- basic drives
- link between thought and emotion
- function of internal organs
What is the function of the cerebellum
- coordinates smooth muscle
- regulates skeletal muscle
- maintains equilibrium and balance
What is the function of the cerebrum
- consciousness
- emotional status
- memory
- skeletal muscle movement
- language/communication
What are the three ways we can visualize the brain
- electrical
- structural
- functional
What does electrical visualization of the brain entail
Shows the electrical signals in the brain
- electroencephalography (EEG)
What is an EEG
An electrical method of visualization of the brain that shows the state a person is in and supports the identification of brain abnormalities
What are structural imaging techniques for visualizing the brain
Provide overall images of the brain and its layers
- can reveal schizophrenia and cognitive disorders
- computed tomography (CT)
- magnetic resonance imaging (MRI)
What is a CT
An xray showing slices of the brain. It is done fast (2.5 minutes) and can be used in an urgent situation.
Can see:
- large masses
- bleeds
- lesions
- infarcts
What is an MRI
A detailed imaging technique using magnetic fields. This takes longer than a CT (30-60 minutes).
Can see:
- edema
- trauma
- ischemia
- neoplasms
What are the functional imagine techniques for visualizing the brain
Reveals the physiological activity of the brain
- can detect schizophrenia, mood disorders, and adult ADHD
- functional magnetic resonance imaging (fMRI)
- positron emission tomography (PET)
- single photon emission computed tomography (SPECT)
What is an fMRI
Visualizes brain activity through blood O2
What is a PET scan
A tracer is injected to show the activity of the brain through a 3D image of the brain
What is SPECT
Just like a PET scan but shows the activity of each brain layer as well as the whole brain
What occurs with too much acetylcholine
Depression
What does acetylcholine do in the brain
- learning
- memory
- regulates mood
- affect sexual behavior
- affect aggressive behavior
- stimulates parasympathetic nervous system
What occurs with too little acetylcholine
- dementia
- Alzheimer’s
- Huntington’s
- Parkinson’s
What does dopamine do in the brain
- fine muscle movement
- integrates emotions and thoughts
- decision making (frontal lobe)
- Stimulates hypothalamus to release hormones
What occurs with too much dopamine
- schizophrenia
- mania
What occurs with too little dopamine
- ADHD (frontal cortex)
- Parkinson’s (substantia nigra in the midbrain)
What does serotonin do in the brain
- sleep regulation
- hunger
- mood
- pain perception
- hormonal activity
- aggression
- sexual behavior
What occurs with too little serotonin
- depression
- OCD
What occurs with too much serotonin
anxiety
What does GABA do in the brain
- inhibition of aggression, anxiety, and excitation
- anticonvulsant properties
- muscle relaxant properties
What occurs with too little GABA
- anxiety
- schizophrenia
- mania
- Huntington’s
What occurs with too much GABA
anxiety reduction
What does norepinephrine do in the brain
- mood
- attention
- arousal
- stimulates sympathetic “fight-or-flight”
What occurs with too little norepinephrine
depression
What occurs with too much norepinephrine
- schizophrenia
- mania
- anxiety
What does glutamate do in the brain
- learning
- memory
- excitatory
What occurs with too little glutamate
psychosis
what occurs with too much glutamate
- Alzheimer’s
- neurotoxic
What occurs with too little epinephrine
depression
What occurs with too much epinephrine
anxiety
What is pharmacodynamics
what drugs do in the body and how they do it
What is pharmacokinetics
Movement of the drug through the body
- Absorption
- Distribution
- Metabolism
- Excretion
What are benzodiazepines
Drugs that promote activity of GABA and has a calming effect
- anti-anxiety
- hypnotic
- anticonvulsant
- amnestic
- muscle relaxant
- addictive
What are some common benzodiazepine drugs for anxiety
All are schedule c-IV according to the DEA
- diazepam (Valium)
- clonazepam (Klonopin)
- alprazolam (Xanax)
- lorazepam (Ativan)
What is the scale used to determine if a patient has an anxiety disorder
SWICKIR anxiety scale; worries plus 3 additional symptoms for at least 6 months
S- somatic symptoms
W- worries
I- irritability
C- concentration
K- keyed-up/on edge
I- initial insomnia
R- relaxation difficulties
What are some benzodiazepine drugs used for insomnia
Used for their predominant hypnotic effects
- Flurazepam (Dalmane)
- Temazepam (Restoril)
- Triazolam (Halcion)
What are some benzodiazepine drugs used for alcohol withdrawal
- Chlordiazepoxide (Librium)
- Diazepam (Valium)
- Lorazepam (Ativan)
What are Z-hypnotics
Nonbenzodiazepine receptor agonists. Short acting sedatives that have the hypnotic effect of benzos without the antianxiety, muscle relaxant, or anticonvulsant properties.
- Quick onset
- short half-life (up to 8 hours)
what are some Z-hypnotic drugs
- Zolpidem (Ambien)
- Zaleplon (Sonata)
- Eszopiclone (Lunesta)
What is something that is important to tell a patient who is taking Eszopiclone
will have a bad taste in their mouth when they wake up
What is Ramelteon (Rozerem)
- treats insomnia
- melatonin receptor agonist
- helps regulate circadian rhythms
- no abuse potential
What are the side effects of Ramelteon (Rozerem)
- headache
- dizziness
What is Doxepin (Silenor)
- used for trouble staying asleep
- low dose tricyclic antidepressant
- sedative effects from histamine-1 (H1) receptor antagonism
What are orexins
neuropeptides produced in the hypothalamus that promote wakefulness
What are some orexin receptor antagonist drugs
- Suvorexant (Belsomra)
- Lemborexant (Dayvigo)
What is Buspirone (BuSpar)
- used in generalized anxiety disorder
- partial serotonin agonist (unlike benzos that effect GABA)
- no potential for abuse
- not a CNS depressant
- no sedative effect
What are some side effects of Buspirone (BuSpar)
- headache
- dizziness
- nausea
- insomnia
What are SSRIs and SNRIs
selective serotonin (norepinephrine) reuptake inhibitors that are used to treat depression but can also be used to treat many anxiety disorders
What are some anxiety disorders that can be treated with selective serotonin reuptake inhibitors (SSRIs)
- OCD
- social anxiety disorder (SAD)
- generalized anxiety disorder (GAD)
- panic disorder (PD)
- PTSD
Which serotonin-norepinephrine reuptake inhibitors (SNRIs) are used to treat anxiety disorders
Venlafaxine (Effexor)
- generalized anxiety disorder
- social anxiety disorder
- panic disorder
Duloxetine (Cymbalta)
- generalized anxiety disorder
What is the monoamine hypothesis of depression
depression is caused by a deficiency of norepinephrine, serotonin, dopamine or a combination of the three
what is the prolonged use hypothesis
prolonged use of antidepressants can lead to neurotrophic factor production leading to increased neuron survival and new neurologic pathways being formed in the brain
How do tricyclic antidepressants work
blocks the reuptake of norepinephrine or both norepinephrine and serotonin
What are some side effects of tricyclic antidepressants
- orthostatic hypotension
- confusion
- disturbed concentration
-sedation/drowsiness - anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention)
- overdose can be fatal
can lead to mania in bipolar pts
What are the tricyclic antidepressant drugs
- Amitriptyline (Elavil)
- Nortriptyline (Pamelor)
- Imipramine (Tofranil)
How do MAOIs work
Used to treat depression
Inhibits monoamine oxidase which is the enzyme that breaks down neurotransmitters (serotonin, norepinephrine, dopamine). This allows more neurotransmitters to be released from the presynaptic neuron.
What needs to be avoided when taking MAOIs
tyramine rich foods such as
- cheese
- wine
- fish
- meat
eating these food can lead to a hypertensive crisis
Also these have a lot of interactions with other drugs
What are some MAOI drugs
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Selegiline (EMSAM)
What are some side effects of MAOIs
- hypertensive crisis when eating tyramine rich foods
- photosensitivity
- weight gain
- sexual dysfunction
What is serotonin syndrome
A potential life-threatening syndrome that occurs when taking multiple serotonin altering drugs.
- onset of 6 hours
- treat with cyproheptadine
What are the signs and symptoms of serotonin syndrome
- N/V/D
- diaphoresis (sweating)
- tachycardia
- fever
- tremors
- muscle rigidity
- agitation
- delirium
- coma
What are some SSRI drugs
Used to treat depressed mood, OCD, obesity, bulimia, and anxiety
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluvoxamine (Luvox)
What are some side effects of SSRIs
- N/V
- low libido
- apathy
- headache
- painful menstruation
- insomnia
- rash
- taste changes
- tremor
- dizziness
- weight loss/gain
What are some SNRI drugs
- Venlafaxine (Effexor)
- Desvenlafaxine (Pristiq)
- Duloxetine (Cymbalta)
- Levomilnacipran (Fetzima)
What are the side effects of SNRIs
- hypertension at higher doses
- less anticholinergic effects of SSRIs
What is Mirtazapine (Remeron)
A norepinephrine and serotonin specific antidepressant (NaSSA)
What is Bupropion (Wellbutrin) (Zyban)
Norepinephrine dopamine reuptake inhibitor (NDRI)
- used in smoking cessation
- no sexual dysfunction
- abrupt D/C can cause seizures
- my cause appetite suppression
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What are some mood stabilizing agents
Lithium
Anticonvulsants
Off-label drugs
what is the gold standard of mood stabilization
Lithium (Eskalith, Lithobid)
- stabilizes depression and mania
- narrow therapeutic index
- potential toxicity
- mechanism unknown but may be electrical due to it being a positive cation
What are some complications of lithium treatment
- fluid imbalance (polyuria, edema)
- bradycardia
- hypothyroidism in long term use
- hyponetremia (leads to toxicity)
What are some anticonvulsant drugs used for mood stabilization
Carbamazepine (Tegretol)
- for acute mania
Divalproex (Depakote)
- managing impulsive aggression
Lamotrigine (Lamictal)
- maintenance therapy
Oxcarbezepine (Trileptal)
What are some off-label drugs used for mood stabilization
- gabapentin (Neurontin)
- pregabalin (Lyrica)
- Topiramate (Topamax)
What are some side effects of mood stabilizers
- weight gain
- somnolence (sleepiness)
- agranulocytosis
- thrombocytopenia
- hepatitis
- Steven Johnsons syndrome
What is the therapeutic blood level for lithium
0.8-1.4 mEq/L
What is the maintenance blood level for lithium
0.4-1.3 mEq/L
What is the toxic blood level for lithium
1.5 mEq/L and above
What are the symptoms of lithium toxicity
- N/V/D
- abdominal pain
- dizziness
- weakness
- confusion
- memory problems
- psychosis
- tremors
- nystagmus
- seizure
- coma
- kidney failure
How do you treat lithium toxicity
Activated charcoal
NG tube to remove stomach contents
IV fluids
permanent neuro/cognitive symptoms may persist after treatment
What are the characteristics of first-generation antipsychotic drugs
Treat the positive symptoms of schizophrenia (delusions, hallucinations)
- dopamine receptor antagonists
- muscarinic antagonists for histamine, acetylcholine, and norepinephrine receptors
- has significant side effects
What are the side effects of first-generation antipsychotics
- weight gain
- sedation
- Extrapyramidal symptoms (involuntary facial movements)
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what are the characteristics of second-generation antipsychotics
Treat the positive and negative symptoms of schizophrenia
- dopamine and serotonin antagonists
- fewer extrapyramidal symptoms
- increased risk of metabolic syndrome (increased weight, blood sugar, triglycerides, and insulin resistance)
What are some second generation antipsychotic drugs
- Clozapine (Clozaril)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
- Ziprasidone (Geodon)
- Aripiprazole (Abilify)
- Paliperidone (Invega)
- Iloperidone (Fanapt)
- Lurasidone (Latuda)
- Asenapine (Saphris)
What are some important characteristics of Clozapine (Clozaril)
- first second-gen antipsychotic
- highly effective at treating schizophrenia
- lowest possibility of extrapyramidal symptoms
- required absolute neutrophil testing for agranulocytosis
- prescriber must be certified in REMS program and enroll the patient in the program
What are some side effects of Clozapine (Clozaril)
- seizures
- myocarditis
- agranulocytosis
- hypersalivation
- weight gain
What are some medications used for ADHD
Stimulants
- Methylphenidate (Ritalin, Concerta)
- Amphetamines (Adderall, Vyvanse)
Nonstimulants
- Atomoxetine (Strattera)
- Guanfacine (Intuniv)
- Clonidine (Kapay)
What drug classes are used to treat Alzheimer’s
Cholinesterase Inhibitors
Glutamate blockers
How do cholinesterase inhibitors help Alzheimer’s
Slows the rate of memory loss by inhibiting the breakdown of acetylcholine
How do glutamate blockers help Alzheimer’s
Stops the excessive stimulation of NMDA by glutamate while still allowing glutamate to activate when making new memories
What are some western traditional worldviews
- identity is found in self
- values autonomy, independence, and self-reliance
- mind and body are separate entities
- disease has a cause and treatment is aimed at the cause
- time is linear
- success is obtained by preparing for the future
What are some eastern traditional worldviews
- identity is found in the family
- mind, body, and spirit is one entity
- time is circular and recurring
- born into fate; duty to comply to that fate
- disease caused by fluctuating of opposing forces
What are some indigenous culture worldviews
- significance of place of humans in the world
- identity is found in the tribe
- person is an entity only in relation to others
- disease is the lack of harmony between the individual and the environment
What is enculturation
The transmission of a culture’s worldview, beliefs, values, and practices to its members
What is ethnocentrism
The universal tendency of humans to think their way of thinking is the only correct way
What is cultural imposition
Process in which people or groups try impose their own values on others because they believe their way is superior
What is somatization
When psychological issues are expressed as physical ailments
This is seen in cultures where they believe their mind and body are one entity
What is Susto
Among indigenous people in Latin America, this is an illness is considered a spirit attack.
symptoms include anxiety, insomnia, fever, depression, and diarrhea
What is acculturation
When immigrants are learning the beliefs, values, and practices of their new cultural setting
What is assimilation
when immigrants adopt the culture of their new home as well as teaching their culture to those around them
What is the difference between immigrants and refugees
immigrants chose to move but refugees are forced from their home culture
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