LEARN THIS ISH Flashcards
When does delirium tremens occur in EtOH withdrawal?
days 2-8
What are tardive dyskinesias? When is its onset? What is its tx?
- involuntary repetitive movement of lips, tongue with choreoathetoid movements of arms, legs
- 3-6 months
- tx = usually permanent so PREVENT THIS FROM HAPPENING
What does D2 receptor block do to the hypothalamus?
- poikilothermia
- weight gain (bad)
What is the anatomy of the nigrostriatal system?
Substantia nigra –> striatum
NT?
motor/movement
drive
DA
What is pseudoparkinsonism? When is its onset? What is its tx?
- tremor, bradykinesia, rigidity, shuffling gait
- 5-90 days
- tx = Anticholinergic agents or amantadine
What do 5HT + DA together do?
- sex drive
- appetite
- aggression
What does increased Mg++ excretion cause?
convulsions
What does it mean to be an “atypical” antipsychotic?
- bad D2 block
- good 5HT2a block
- good against negative symptoms
What does NE do?
- increases energy
- increases interest
- increases motivation
What is the tx for acute EtOH tox?
- supportive + fluids/electrolytes
- *** thiamine
What meds can help an alcoholic quit?
- disulfram (Antabuse) –> alcohol sensitization
- Naltrexone (Revia) = opiod antagonis –> reduce craving, consumption, and relapse
- acamprosate (Campral) = block NMDA receptor –> reduce craving and relapse BUT can mitigate glu hyperexcitability during withdrawal!
- psychotherapy
What is the anatomy of the mesocortical system?
VTA –> prefrontal cortex
What is the tx for acute benzo tox?
flumazenil
What NTs are anxiolytic?
GABA
Name 2 enzymes needed for EtOH metabolism.
- aldehyde dehydrogenase
- CYP2E1
What NTs cause euphoria?
- DA
- 5HT
What does D2 receptor block do to the tuberoinfundibular pathway?
causes hyperprolactinemia (bad)
What does histamine H1 receptor block do to the CNS?
- weight gain
- sedation
Which drugs cause weight gain via block of hypothalamic DA receptors?
What do you need to do for your patient?
- atypical antipsychotics
- monitor weight, blood glucose (checking for DM), and lipids
NT?
increases energy, increases interest, increases motivation
NE
How do you treat Parkinson’s?
- elevate dopamine (levodopa, carbidopa)
- lower muscarinic activity
What does it mean to be a “typical” antipsychotic?
- good D2 block
- less 5HT2a block
- good against positive symptoms
- bad side effects from blocking D2 (EPS)
This is for somatosensory of the body.
VPL
Dx? What drug could have caused this?
tremor, bradykinesia, rigidity, shuffling gait.
- pseudoparkinsonism
- via Haloperidol
This is for hearing (m for music).
medial geniculate nucleus (MGN)
What is dystonia? When is its onset? What is its tx?
- Torticollis, swollen tongue, trismus, oculogyric crisis, opisthotonos.
- 1-5 days
- tx = antimuscarinics (diphenhydramine, benztropine)
What NTs cause altered perception?
5HT
What does the lateral geniculate nucleus (LGN) do?
vision (L for light)
What does DA do?
- motor/movement
- drive
What does D2 receptor block do to the nigrostriatal pathway?
increases extrapyramidal SEs –> parkinsonianisms (bad)
What does D2 receptor block do to the mesocortical pathway?
increases the negative symptoms (bad)
What does increased blood lactate cause?
- acidosis
- behavioral disturbances
Where does the VA/VL project and what’s it important for?
from the cerebellum and from the basal ganglia –> cortex movement
Outcomes of hyperprolactinemia?
- galactorrhea***
- decreased libido, sexual dysfunction, erectile dysfunction, infertility, amenorrhea, and gynecomastia
What does the VPM do?
somatosensory of the face (makeup on your face)
NT?
drives impulses
5HT
What does decreased uric acid excretion cause?
gout
What does D2 receptor block do to the chemoreceptor trigger zone?
causes an anti-emetic effect (good!)
What does muscarinic cholinergic block do to the ANS?
- NO PEE, NO SEE, NO SPIT, NO SHIT
- difficulty urinating
- blurred vision
- dry mouth
- constipation
NT?
mood
emotion
cognitive function
5HT + NE + DA together
What is the mechanism of action for dissociative anesthetics?
antagonist at NMDA-glu receptors
What does muscarinic cholinergic block do to the CNS?
causes a toxic confusional state
What is akathisia? When is its onset? What is its tx?
- Motor restlessness, inability to sit still (not anxiety or agitation)
- 6-60 days
- tx = difficult. Reduce dose or change drug; add anticholinergic and / or possibly β- blocker, benzodiazepines.
What does 5HT do?
drives impulses
What does increased Acetyl CoA cause?
increased fatty acid synthesis –> decreased fat breakdown –> fatty liver
What does the VPL do?
somatosensory for the body
What does alpha-1 receptor block do to the ANS?
- orthostatic hypotension
- impotence
- failure to ejaculate
What is the anatomy of the mesolimbic system?
VTA –> NA
What NTs cause CNS stimulation?
- DA
- NE
- ACh
What NTs/channels in the brain cause cravings?
- DA
- NMDA
This is the ability of one drug to suppress the withdrawal of another; act at the same target.
cross-dependence
Where is dopamine synthesized? What’s its final destination?
- synthesis in the VTA *** think VTA to DA
- final dest = nucleus accumbens (NA)
NT?
sex drive
appetite
aggression
5HT + DA together
How does cocaine work?
it blocks DA reuptake
When do seizures occur in EtOH withdrawal?
immediately –> 4 days
What is Stevens-Johnson syndrome?
- hypersensitivity where cell death causes separation of dermis from epidermis
- SE of carbamazepine***
How do you treat drug-induced Parkinson’s in a schizo pt?
lower anti-muscarinic activity - give anticholinergics like diphenhydramine or benztropine
The rate of onset of anesthetics is ______ to blood solubility.
inversely proportional - more soluble in blood = SLOWER onset
What do 5HT + NE + DA together do?
- mood
- emotion
- cognitive function
This is for vision (L for light).
lateral geniculate nucleus (LGN)
What is the tx for opioid withdrawal?
- clonidine
- methadone
What is an interference in body temperature regulation at the hypothalamus called?
poikilothermia
What is the tx for CNS stimulant withdrawal?
behavioral modifications
What does increased NADH cause?
decreased Krebs –> decreased gluconeogenesis –> hypoglycemia***
What is the tx for acute barb tox?
supportive
What factors influence the rapidity of onset of anesthetic action?
- concentration in inspired air (increased = increased rate)
- solubility (increased = slower rate)
What does D2 receptor block do to the mesolimbic pathway?
decreases positive symptoms (good!)
What causes fatty liver?
EtOH –> increased Acetyl CoA –> increased fatty acid synthesis –> decreased fat breakdown –> fatty liver
ALL drugs of abuse, at some point, enhance _____.
dopamine
What is the anatomy of the tuberoinfundibular system?
hypothalamus –> pituitary (decreased prolactin release, poikilothermia, increased eating)
Dx? What drug could have caused this?
involuntary repetitive movement of lips, tongue with choreoathetoid movements of arms, legs
- tardive dyskinesias
- via Haloperidol
What is the medial geniculate nucleus (MGN) for?
hearing (M for music)
What is cross-dependence?
ability of one drug to suppress the withdrawal of another; act at the same target
Dx? What drug could have caused this?
Torticollis, swollen tongue, trismus, oculogyric crisis, opisthotonos.
- dx = dystonia
- via Haloperidol
This is for somatosensory of the face (makeup on your face).
VPM
What is the tx for EtOH withdrawal?
- benzos (chlordiazepoxide, lorazepam)
- α2 adrenergic agonist (clonidine)
What is neuroleptic malignant syndrome? What is the tx?
- catatonia, stupor, fever, unstable blood pressure
- malignant hyperthermia
- tx = sodium dantrolene
Dx? What drug could have caused this?
Motor restlessness, inability to sit still (not anxiety or agitation)
- akathisia
- via Haloperidol
What does 5HT2a receptor block do to the mesocortical pathway?
- decreases negative symptoms (good)
- causes weight gain
What do 5HT + NE together do?
- anxiety
- irritability
