Exam 2 (Drugs) Flashcards
Know the basics of the 4 theories of antidepressant actions discussed in the book
Amine- people who suffered from depression didn’t have enough amines (NTs), particularly, norepinephrine (NE), in their synapses
Reuptake- people lacked serotonin in their synapses; TCAs work by inhibiting reuptake; symptoms don’t abate until 2-4 weeks following- why?!?
Downregulation- explains delay- at first cells are starved for NT’s, have to down regulate receptors before things stabilize
Neurotrophic/plasticity-cell goes through many changes after an antidepressant is introduced to the system and the increase in neurotrophins (cell nutrients) is the most important change; cAMP (cyclic AMP) & BDNF increases after taking antidepressants
Know the medications in the SSRI class and understand the mechanism of action of this class
Prozac, Paxil, Zoloft, Lexapro, Luvox, Celexa, Trintellix [previously known as Brintellix] and Viibryd (8)
inhibits reuptake of serotonin so more serotonin molecules are near cell body area and over time the increase of serotonin causes autoreceptors to decrease (to downregulate) and become desensitized (autoreceptors, when triggered, signal cell to decrease production of serotonin, so when downregulated, they allow cell to produce more serotonin than normal)
Know the medications in the SNRI class and understand the mechanism of action of this class
Effexor, Cymbalta, Pristiq
Potent inhibitors of the reuptake of serotonin and norepinephrine, resulting in higher concentrations in the synaptic cleft; Better tolerated than TCAs
Know the 3 most commonly prescribed antidepressants in the TCA class and understand the mechanism of action of this class. Be aware of the purposes for which these three medications are actually prescribed in most cases (discussed in class).
Elavil= usually prescribed for sleep
Sinequan= usually prescribed for sleep
Nortriptyline= usually prescribed for pain or headaches
inhibition of reuptake of norepinephrine and serotonin and slightly dopamine; TCAs also block receptors on acetylcholine, histamine, and epinephrine neurons
Know the most commonly prescribed MAO Inhibitor - the one that is administered via the transdermal route - and understand the mechanism of action.
Selegiline
Bypasses first-pass metabolism so it doesn’t activate as many MAO enzymes in the gut so people don’t have to restrict their foods; MAOIs inhibit the enzyme MAO that breaks down NTs thought to be related to depression; when drugs inhibit MAO enzyme, more NE is in synaptic cleft to bind to receptors which causes downregulation of receptors and more NE to stay in the synaptic cleft
Be able to rate the 6 most common benzodiazepines (discussed in class) based on their duration of action.
- Librium= used a lot for alcohol withdrawal; makes GABA more effective to replace effects of alcohol; temporary suspension of alcohol withdrawal effects
- Valium= oldest; “Mommy’s little helper”; Diazapam; even faster-acting than Xanax because it’s so lipophilic
- Klonopin= clonazepam
- Temazepam (Restoril)= very similar to Klonopin, they both are short-acting
- Ativan (Lorazepam)
- Xanax (Alprazolam); very fast-acting
What is the mechanism of action of BuSpar?
It is a serotonin agonist and antagonist. It acts as a serotonin antagonist on 5-HT1a receptors (blocks serotonin on these receptors)
What is the mechanism of action of Benzodiazepines?
Benzo’s are pure GABA agonists because they facilitate binding at GABA receptors. GABAa is the target for benzo’s
What is metabolic syndrome?
Increased blood sugar, increased cholesterol, and weight gain
What is akathisia? What does it look like? What medications can be used to remedy this side effect?
Early onset side effect of neuroleptics/1st generation antipsychotics.
Subjective experience of motor restlessness (inability to sit still, foot tapping, pacing, shaking of the hands). Benzos and beta-blockers can remedy this.
What is tardive dyskinesia? What does it look like? What is the approximate yearly risk of this side effect for people who are taking the 1st generation antipsychotic medications (know the risks for both middle-aged and older adults)? What is the approximate yearly risk of tardive dyskinesia for people who are taking the 2nd generation antipsychotics?
This is a late-onset side effect of neuroleptics/1st generation antipsychotics.
Abnormal movement of the mouth, lips, and tongue that may be accompanied by involuntary twitching and jerking of muscles.
Approximate yearly risk for people developing this on 1st generation antipsychotics is generally 15-20%, then for people over 40 it is 5-10% and for the elderly it is 80%.
Approximate yearly risk for atypical antipsychotics is 1%.
What are the three most commonly prescribed 1st generation antipsychotics? Which one is rarely used due to anticholinergic side effects - but is powerfully sedating and can be helpful in violently aggressive patients?
Thorazine- very anticholinergic and is powerfully sedating which is helpful to use for violent/aggressive patients
Halidol- commonly used; helps with positive symptoms of Schizophrenia but is known for producing side effects such as parkinsonism and tardive dyskinesia
Prolixen
What are the most commonly prescribed 2nd generation (aka atypical) antipsychotics? Know how these rank in order of their likelihood to cause metabolic syndrome. What makes these medications ‘atypical’?
Atypical because they block serotonin, not dopamine.
Most metabolically offensive to least:
Clozaril= rare, compromises white blood cells.
Zyprexa=comes in injectable form; implicated in Type 2 Diabetes
Seroquel
Risperdal= injectable; most likely to cause lactation
Invega= injectable
Geodon
Abilify
Latuda
Rexulti
What are anti-cholinergic side-effects?
Neuroleptic meds blocking acetylcholine receptors in both the peripheral and the central nervous system. The primary CNS side effect is delirium. Also includes dry mouth, constipation, urinary retention, blurred vision, and withdrawal reactions
Which antipsychotics are available in an once-monthly injectable form?
1st generation= Halidol and Prolixen
2nd generation= Zyprexa, Risperdal, Invega, and Abilify
