Module 1 Flashcards
What percentage of the brain does the cerebrum comprise?
83%
The cerebrum includes both right and left hemispheres, separated by the central sulcus.
What are the two halves of the cerebrum called?
Right Hemisphere and Left Hemisphere
Each hemisphere controls functions of the opposite side of the body.
What is the primary function of the left hemisphere?
Controls most functions of the right side of the body
Dominant in most people, especially for tasks like writing.
What is the primary function of the right hemisphere?
Controls most functions of the left side of the body
Responsible for understanding facial expressions and emotions.
List the four major lobes of the cerebrum.
- Frontal Lobe
- Parietal Lobe
- Temporal Lobe
- Occipital Lobe
What is the primary function of the frontal lobe?
Responsible for critical thinking and decision-making
Involved in advanced cognitive processes.
What acronym helps remember the functions of the frontal lobe?
FLIPPER JW
F - Flexibility, L - Language, I - Insight, P - Planning, P - Prioritizing, E - Expressive Speech, R - Reasoning, J - Judgment, W - Working Memory.
What is Broca’s area associated with?
Expressive speech
Damage here leads to Broca’s aphasia, affecting speech production.
What is the primary function of the temporal lobe?
Processes auditory information and memory formation
Includes Wernicke’s area for language comprehension.
What mnemonic is associated with Wernicke’s area?
Wernicke’s for Word Comprehension
This area is crucial for receptive speech and language understanding.
What is the primary function of the occipital lobe?
Responsible for interpreting visual information
Contains the primary visual cortex.
What are visual field defects?
Partial or complete loss of vision within one or both eyes’ visual field
Can result from damage to the occipital lobe.
What is agnosia?
Inability to recognize or interpret sensory information
Can occur due to damage in the parietal lobe.
Which lobe is primarily responsible for sensory information processing?
Parietal Lobe
Involved in spatial awareness and sensation interpretation.
What does the limbic system regulate?
Emotions and memory
Includes structures like the hypothalamus, thalamus, hippocampus, and amygdala.
What is the function of the hypothalamus?
Regulates appetite, thirst, circadian rhythms, and hormonal balance
Important for maintaining homeostasis.
What is the role of the amygdala?
Modulates mood and emotional memories
Involved in fear and anxiety responses.
What does the Clock Drawing Test assess?
Signs of neurological issues such as Alzheimer’s disease and other dementias
Quick screening method completed in under 2 minutes.
What cranial nerve is associated with the sense of smell?
Olfactory Nerve (I)
Remembered with the mnemonic ‘On’.
What does the optic nerve (II) control?
Vision
Remembered with the mnemonic ‘Old’.
What is the function of the vagus nerve (X)?
Autonomic functions, swallowing, speech
Remembered with the mnemonic ‘Guarded’.
What is receptive aphasia also known as?
Wernicke’s aphasia
Inability to comprehend spoken and written language.
What is a symptom of dysfunction in the frontal lobe?
Memory difficulties, planning challenges, prioritizing issues, lack of insight, and impulse control problems
Indicates potential frontal lobe damage.
What is the function of the Opharyngeal Nerve (IX)?
Taste, swallowing, saliva
Mnemonic: German. Example: Picture being at a German bakery, tasting delicious pastries, and swallowing them afterward.
What is the function of the Vagus Nerve (X)?
Autonomic functions, swallowing, speech
Mnemonic: Guarded. Example: Visualize a protective guard monitoring your body’s involuntary responses and speech.
What is the function of the Accessory Nerve (XI)?
Shoulder & neck movement
Mnemonic: A. Example: Remember this with the image of a person with strong neck and shoulder muscles executing acrobatic stunts.
What is the function of the Hypoglossal Nerve (XII)?
Tongue movement
Mnemonic: Hop. Example: Think of a frog hopping around using its versatile tongue to catch insects.
What characterizes atypical antipsychotics?
5HT2A (Serotonin) receptor antagonism
Typical vs. Atypical Antipsychotics.
What does hyperactivity of dopamine in the mesolimbic pathway modulate?
Positive psychotic symptoms
Example: Antagonism of D2 receptors in the mesolimbic pathway treats hallucinations and delusions.
What is postulated to be responsible for negative and depressive symptoms of schizophrenia?
Decreased dopamine in the mesocortical projection
Example: Lack of motivation and emotional withdrawal in schizophrenic patients.
What does blockade of dopamine in the nigrostriatal pathway lead to?
Increased acetylcholine levels, extrapyramidal symptoms (EPS)
Example: Long-term D2 blockade can cause tardive dyskinesia and involuntary facial movements.
What happens when the D2 receptor is blocked in the tuberoinfundibular pathway?
Increase in prolactin levels
Example: A patient on antipsychotic medication experiencing decreased libido or irregular menstruation.
What mnemonic helps recall the four dopamine pathways?
Many Men Never Travel
(Mesolimbic, Mesocortical, Nigrostriatal, Tuberoinfundibular).
What are the symptoms of acute dystonia?
Muscle spasms, stiff neck, facial grimacing
Example: A patient who suddenly develops a twisted neck might be experiencing acute dystonia.
What is akathisia characterized by?
Restlessness, pacing, difficulty standing still
Example: A patient who can’t sit still during a session might be experiencing akathisia.
What are common symptoms of akinesia?
Absence of movement, difficulty initiating motions
Example: A patient accused of being lazy might suffer from akinesia.
What symptoms mimic Parkinson’s disease due to D2 blockade?
Muscle rigidity, shuffling gait, motor slowing
Example: A patient who appears uninterested due to their flat facial expression might be experiencing pseudo-Parkinsonia.
What are the symptoms of tardive dyskinesia?
Involuntary abnormal muscle movements of the mouth, tongue, face, jaw
Example: Persistent tongue protrusion and rolling, lip-smacking, and facial dystonia.
What is the study of pharmacokinetics concerned with?
Absorption, distribution, metabolism, excretion (ADME)
Pharmacokinetics focuses on what the body does to a drug.
Where does absorption of orally administered drugs primarily occur?
Small intestines
This is where the drug moves into the body.
What is the first-pass effect?
Reduction of drug concentration by CYP450 enzymes in the liver after enteric absorption
Non-enteric routes of medication bypass the first-pass effect.
What is meant by half-life in pharmacokinetics?
Time needed to clear 50% of the drug from the plasma
A steady state is achieved in five half-lives.
What do inducers do in pharmacokinetics?
Speed up metabolic rate, decreasing serum levels of drugs
Example: Chemicals in tobacco smoke can accelerate the metabolism of clozapine and olanzapine.
What mnemonic helps remember inducers?
DROP ACT SCAM GBS
Includes drugs like Dilantin, Rifampin, OCPs, and others.
What do inhibitors do in pharmacokinetics?
Slow down metabolic rate, increasing serum levels of drugs
Higher risk of toxicity is associated with inhibitors.
What mnemonic helps remember inhibitors?
SICKFACES.COM
Includes drugs like Sodium Valproate, Isoniazid, and Ketoconazole.
What factors affect drug metabolism?
- Age
- Physiological integrity
- Nutritional status
- Intracellular volume
Elderly-specific factors include reduced metabolism and increased risk of toxicity.
What is the main factor affecting drug toxicity in older adults?
Diminished protein binding
This increases free drug concentration, making older adults more susceptible to drug toxicity.
What is pharmacodynamics?
Study of drug action on the body
It includes how drugs interact with receptors, ion channels, and enzymes.
What does an agonist do at a receptor?
Initiates a biological response and opens the ion channels
Example: Morphine mimics endorphins by binding to opioid receptors.
What is a partial agonist?
Binds to a receptor but does not fully activate it
Example: Buprenorphine has lower efficacy than full agonists like morphine.
What is the effect of an inverse agonist?
Induces an opposite biological response
Example: Inverse agonists for benzodiazepine receptors can cause anxiety.
What is the role of an antagonist?
Blocks a receptor to inhibit biological response
Example: Naloxone reverses opioid overdose symptoms by blocking opioid receptors.
What is the function of enzyme inhibitors?
Slow or stop the catalytic action of an enzyme
Example: Monoamine oxidase inhibitors reduce the breakdown of neurotransmitters.
What is the impact of reuptake inhibitors?
Hinders absorption of neurotransmitters by the synapse
Allows for higher neurotransmitter concentrations in the synaptic cleft.
What do receptor interactions drive in the body?
Biological response, including enhanced neurotransmission and blocked ion channels.
What action does an agonist receptor produce?
Initiates a biological response and opens the ion channels.
What is a partial agonist?
Partially activates the receptor, resulting in limited activities.
What does an antagonist do?
Prevents the agonist from opening the channel and does not trigger a biological response.
What is the role of serotonin (5-HT) in the body?
Increases well-being, satiety, and reduces pain perception.
Where is serotonin produced?
Raphe nuclei of the brainstem.
What mnemonic can help remember the effects of serotonin?
“Serene-tonin” for well-being and mood regulation.
What are the effects of dopamine (DA)?
Increases sense of well-being and satiety, decreases hunger and cravings.
Where is dopamine produced?
Substantia nigra, nucleus accumbens, ventral tegmental area.
What mnemonic can help remember dopamine’s role?
“Very Tired Addict” for DA’s role in addiction and reward.
What effects does norepinephrine have?
Increases heart rate, alertness, well-being; decreases pain sensitivity and circulation.
Where is norepinephrine produced?
Locus coeruleus and medullary reticular formation.
What mnemonic can help remember norepinephrine?
“Fight or flight” neurotransmitter for alertness and heart rate.
What are the effects of acetylcholine (ACh)?
Increases heart rate, secretions, sweating, salivation, memory, and muscle contractions.
Where is acetylcholine synthesized?
Basalis nucleus of Meynert.
What mnemonic can help remember ACh’s effects?
“ACh makes your heart race(h)” for its effect on heart rate.
What is the primary role of GABA?
Most abundant inhibitory neurotransmitter; increases sleepiness, decreases anxiety.
What mnemonic can help remember GABA’s calming effects?
“GABA Gab” for its calming effects.
What are the effects of glutamate?
Most abundant excitatory neurotransmitter; increased levels can increase anxiety.
What mnemonic can help remember glutamate’s excitatory effect?
“Glute-tensed” for excitatory effect causing anxiety.
What is lithium’s therapeutic range?
0.6-1.2 mEq/L.
What toxicity level indicates lithium toxicity?
1.5 mEq/L or higher.
What are some side effects of lithium?
- Hypothyroidism
- Weight gain
- Central nervous system defects
- Fine hand tremors
- Fatigue
- Mental confusion
- Headaches
- Coarse hand tremors (toxicity sign)
- Nystagmus
- Maculopapular rash
- GI symptoms
- Renal issues
- Cardiac issues
- Hematologic issues
What are signs of lithium toxicity?
- Severe nausea & vomiting
- Diarrhea
- Confusion & drowsiness
- Blurred vision & slurred speech
- Muscle weakness & ataxia
- Coarse hand tremors
What should be done in case of lithium toxicity?
Immediately stop taking lithium and check levels.
What drug interactions can affect lithium levels?
Lithium levels increase with prostaglandin inhibitors like NSAIDs.
What is valproic acid’s black box warning?
Hepatotoxicity and pancreatitis.
What is the therapeutic index of valproic acid?
50-125 mcg/ml.
What fetal abnormalities are associated with valproic acid during pregnancy?
- Neural tube defects
- Cleft lip and cleft palate
- Cognitive impairment
What is carbamazepine’s black box warning?
Agranulocytosis and aplastic anemia.
What is the therapeutic range for carbamazepine?
4-12 µg/mL.
What severe skin reaction is associated with carbamazepine in Asian individuals?
Stevens-Johnson syndrome.
What is the mnemonic for remembering side effects of carbamazepine?
C – Color pale, A – Agranulocytosis, R – Rash, B – Bleeding gums, A – Aplastic anemia, M – Med stop, A – Asians vulnerable to Stevens-Johnson syndrome, Zzz – fatigue, P – Pregnant? Neural tube defects.
What is Lamictal used for?
Managing acute episodes and preventing bipolar mood episodes.
What is Lamictal’s black box warning?
Stevens-Johnson syndrome.
What are key signs of Stevens-Johnson syndrome?
- Fever
- Sore throat
- Facial swelling
- Tongue rash
- Skin sloughing
What does the 4 SAILED method stand for regarding conditions/medications causing mania?
- Syphilis
- SAM-e
- Steroids
- St. John’s Wort/Ginseng
- Antidepressants
- Isoniazid
- Levothyroxine
- Disulfiram
What is the action taken for drug-induced mania?
Discontinue or adjust the causative medication.
What should be monitored closely when initiating medications that may induce mania?
Patients with a history of mood disorders.
What medication is known to cause symptoms similar to mania?
Treatment for a sudden flare-up of rheumatic arthritis
This medication may induce manic symptoms in susceptible individuals.
What condition is most likely to occur due to the addition of Flonase to a regimen including Valproate and Seroquel?
Mania Episode
Flonase can potentially trigger manic episodes in patients with bipolar disorder.
What does the mnemonic ‘S – Syphilis, S – SAM-e, S – Steroids, S – St. John’s Wort/Ginseng, A – Antidepressants, I – Isoniazid, Le – Levothyroxine, D – Disulfiram’ represent?
Medications that may induce mania in patients with bipolar disorder
This mnemonic helps recall medications that can exacerbate mania.
Which medication is known to worsen depression symptoms in patients treated for hypertension?
Propranolol
Propranolol is a beta blocker that can contribute to depressive symptoms.
What is the monitoring schedule for Clozapine (Clozaril)?
Weekly for the first six months, every two weeks for the next six months, then monthly if ANC is normal
This schedule is critical to prevent neutropenia.
What should be done if a patient’s absolute neutrophil count (ANC) is less than 1000mm3 while on Clozapine?
Discontinue Clozapine
This is necessary to prevent severe complications.
What are the symptoms of a hypertensive crisis?
Elevated blood pressure, sudden explosive headache, facial flushing, palpitations, pupillary dilation, diaphoresis, fever
Symptoms indicate a life-threatening condition requiring immediate intervention.
What is the teratogenic risk associated with Lithium?
Epstein anomaly
Lithium use during the first trimester is particularly concerning for cardiac defects.
What mnemonic can help remember the signs of Neuroleptic Malignant Syndrome (NMS)?
‘higH C-PeeK-a-boo’ for elevated CPK and ‘Myo-ROOM-dark urine’ for myoglobinuria
These mnemonics aid in recalling key symptoms associated with NMS.
What medication acts as both a norepinephrine and dopamine reuptake inhibitor?
Bupropion
Bupropion is commonly used for depression and has a unique mechanism of action.
What should be monitored when a patient is on Olanzapine?
Lipid levels and abdominal circumference
These measurements help assess for metabolic syndrome.
Fill in the blank: Clozapine is metabolized primarily by the _______ enzyme.
CYP1A2
Understanding this metabolism is crucial for managing drug interactions.
What teratogenic risk is associated with Carbamazepine?
Neural tube defect
Carbamazepine is known to increase the risk of serious congenital malformations.
What is a potential side effect of Wellbutrin (Bupropion)?
Decreased seizure threshold
This makes it contraindicated in patients with a history of seizures.
Which medication should be avoided in a patient taking Isocarboxazid due to potential interactions?
Methylphenidate
This stimulant can cause hypertensive crises when combined with MAOIs.
What is the first step in treating Neuroleptic Malignant Syndrome (NMS)?
Always discontinue the offending agent.
What type of medication is Bromocriptine (Parlodel)?
Dopamine D2 Agonist.
What is the mnemonic associated with Bromocriptine?
“Bromance with D2”.
What is Dantrolene used for?
Muscle relaxant for muscle rigidity.
What is the mnemonic for Dantrolene?
“Dan-t-rocks those rigid muscles.”
How quickly can NMS develop after starting or increasing antipsychotic medication?
Rapidly, often within the first two weeks.
What is essential to distinguish NMS from?
Serotonin Syndrome.
What types of medications can cause Serotonin Syndrome?
Antidepressants (e.g., SSRI, TCA, MAOI, SNRI).
What is an example of a medication combination that can lead to Serotonin Syndrome?
Taking both an SSRI and an MAOI simultaneously.
List key symptoms of Serotonin Syndrome.
- Hyperreflexia
- Myoclonic Jerks
- Agitation
- Rapid heart rate
- Elevation in blood pressure
- Headache
- Sweating
- Shivering
- Goosebumps
- Confusion
- Fever
- Seizures
- Unconsciousness
What is the treatment for Serotonin Syndrome?
Discontinue the offending agent & administer Cyproheptadine.
What is a preventative measure when switching from an SSRI to an MAOI?
Wait two weeks.
How long should one wait when switching from Prozac to MAOIs?
Five weeks.
What are the similarities between Serotonin Syndrome and Neuroleptic Malignant Syndrome?
Both present with fever and altered mental status.
What characterizes Serotonin Syndrome?
Hyperreflexia and myoclonic jerks.
What characterizes Neuroleptic Malignant Syndrome (NMS)?
Muscle rigidity, mutism, autonomic instability.
What can combining an SSRI with St. John’s Wort lead to?
Potentially lead to Serotonin Syndrome.
What is Serotonin Discontinuation Syndrome?
A condition that occurs after abrupt discontinuation of serotonin reuptake inhibitors.
List symptoms of Serotonin Discontinuation Syndrome.
- Fatigue and lethargy
- Myalgia
- Nausea and vomiting
- Ataxia
- Impaired memory
- Agitation
What mnemonic can help remember the symptoms of Serotonin Discontinuation Syndrome?
FANIMA - Fatigue, Achiness, Nausea, Impaired memory, Myalgia, Agitation.
What is crucial to do when tapering SSRIs, TCAs, or MAOIs?
Always taper (not tape).
What factors increase the risk of Serotonin Discontinuation Syndrome?
Duration of treatment; patients on medications for extended periods may have increased risk.
How long can discontinuation symptoms last?
Several days to weeks.
What is important to monitor during tapering?
Monitoring is crucial for safe discontinuation and minimizing symptoms.
