Module 1 Part 2 Flashcards
What percentage of the brain does the cerebrum comprise?
83%
The cerebrum includes the right and left hemispheres, separated by the central sulcus.
What are the two hemispheres of the cerebrum?
Left Hemisphere and Right 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, primarily responsible 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 brain.
- Frontal Lobe
- Parietal Lobe
- Temporal Lobe
- Occipital Lobe
What is the main role of the frontal lobe?
Critical thinking and decision-making
It is the largest and most developed lobe.
What acronym can help remember the functions of the frontal lobe?
FLIPPER JW
Each letter stands for a specific function of the frontal lobe.
What does Broca’s area in the frontal lobe control?
Expressive speech
Damage here can lead to Broca’s aphasia.
What are the functions of the temporal lobe?
- Processes auditory information
- Language comprehension
- Memory formation
- Emotional responses
What is Wernicke’s area associated with?
Receptive speech and language comprehension
Mnemonic: ‘Wernicke’s for Word Comprehension.’
What can result from damage to the temporal lobe?
Auditory hallucinations, aphasia, amnesia
These are potential issues that may arise from temporal lobe dysfunction.
What is the primary function of the occipital lobe?
Interpreting visual information
It contains the primary visual cortex.
What are visual field defects?
Partial or complete loss of vision within one or both eyes’ visual field
Includes conditions like hemianopia and quadrantanopia.
What is the primary sensory area of the parietal lobe responsible for?
Processing sensory information from the body
Example: Feeling the warmth of a cup of coffee.
What is agnosia?
Inability to recognize or interpret sensory information
Example: Touching a pen but unable to recognize it by touch.
What is the function of the limbic system?
Regulates and modulates emotions and memory
It includes structures like the hypothalamus, thalamus, hippocampus, and amygdala.
What role does the hypothalamus play in the limbic system?
Regulatory functions like appetite, thirst, and circadian rhythms
Example acronym: WHAT HEC.
What does the amygdala regulate?
Mood, emotional memories, fear, anxiety, aggression
It connects smell to emotions.
What is the function of the cranial nerve I?
Smell
Mnemonic: ‘On’ for Olfactory Nerve.
What is the function of the cranial nerve II?
Vision
Mnemonic: ‘Old’ for Optic Nerve.
What does the Clock Drawing Test (CDT) screen for?
Signs of neurological issues such as Alzheimer’s disease
Performance impairment on the CDT may indicate right parietal lobe damage.
What is the function of the Opharyngeal Nerve (IX)?
Taste, swallowing, saliva
Example: Picture being at a German bakery, tasting delicious pastries, and swallowing them afterward.
Which mnemonic helps remember the Vagus Nerve (X)?
Guarded
Function: Autonomic functions, swallowing, speech.
What is the primary function of the Accessory Nerve (XI)?
Shoulder & neck movement
Example: Remember this with the image of a person with strong neck and shoulder muscles executing acrobatic stunts.
What does the Hypoglossal Nerve (XII) control?
Tongue movement
Example: Think of a frog hopping around using its versatile tongue to catch insects.
Which pathway is hyperactive in positive psychotic symptoms?
Mesolimbic Pathway
Example: Antagonism of D2 receptors in the mesolimbic pathway treats hallucinations and delusions.
What is a characteristic of atypical antipsychotics?
5HT2A (Serotonin) receptor antagonism
This distinguishes them from typical antipsychotics.
What is the impact of decreased dopamine in the Mesocortical Pathway?
Responsible for negative and depressive symptoms of schizophrenia
Example: Lack of motivation and emotional withdrawal in schizophrenic patients.
What can dopamine blockade in the Nigrostriatal Pathway lead to?
Increased acetylcholine levels
Blockade can lead to extrapyramidal symptoms (EPS), such as dystonia, parkinsonism, and akathisia.
What are symptoms of Acute Dystonia?
Muscle spasms of the face, neck, tongue, stiff neck
Example: A patient who suddenly develops a twisted neck might be experiencing acute dystonia.
What is the treatment for Akathisia?
Beta-blocker (propranolol), Benztropine (Cogentin), Benzodiazepine
Symptoms include restlessness and difficulty standing still.
Tardive Dyskinesia can cause what kind of muscle movements?
Involuntary abnormal movements of the mouth, tongue, face, and jaw
Examples: Persistent tongue protrusion and lip-smacking.
What is the first-pass effect?
Significant reduction of drug substrates by CYP450 enzymes in the liver after enteric absorption
Non-enteric routes of medication bypass this effect.
What is the mnemonic for drug inducers?
DROP ACT SCAM GBS
Includes agents like Dilantin, Rifampin, and Tobacco Smoking.
What is the effect of drug inhibitors?
Slowing down the metabolic rate, leading to increased serum levels of drugs
This can increase the risk of toxicity.
What does pharmacodynamics study?
Drug action on the body and how drugs interact with receptors, ion channels, and enzymes
It helps understand what drugs do to our bodies.
What is the role of an agonist?
Activates a receptor to produce a biological response
Example: Morphine mimics endorphins by binding to opioid receptors.
What can be mistaken for pseudo-parkinsonian symptoms?
Affective blunting or flattening
Symptoms include muscle rigidity, shuffling gait, and tremors.
What factor increases free drug concentration in older adults?
Diminished protein binding
This makes older adults more susceptible to drug toxicity.
What is the correct answer for the pathway most affected in Parkinson’s disease?
Nigrostriatal pathway
This pathway connects the substantia nigra with the striatum and is key in motor control.
What is a key symptom of Akinesia?
Absence of movement
Example: A patient accused of being lazy might suffer from akinesia.
What does the term ‘half-life’ refer to?
The time needed to clear 50% of the drug from the plasma
A steady state is achieved in five half-lives.
What can long-term D2 blockade lead to?
Tardive dyskinesia and involuntary facial movements
This highlights the importance of monitoring patients on antipsychotics.
Which neurotransmitter action can improve neuron communication?
Increase in neurotransmitter action at the synaptic cleft
This is an example of pharmacodynamics in action.
What action does an agonist receptor produce?
Initiates a biological response and opens the ion channels
Answer choice d) is correct since it describes what an agonist does at a receptor.
What is the effect of serotonin (5-HT)?
Increases well-being, satiety, reduces pain perception
Produced in the raphe nuclei of the brainstem.
What is the mnemonic associated with dopamine (DA) for its role in addiction?
Very Tired Addict
Associated with motor movement and produced in the substantia nigra, nucleus accumbens, and ventral tegmental area.
What are the effects of norepinephrine?
Increases heart rate, alertness, and well-being; decreases pain sensitivity and circulation
Produced in the locus coeruleus and medullary reticular formation.
What is the primary effect of acetylcholine (ACh)?
Increases heart rate, secretions, sweating, salivation, memory and muscle contractions
Synthesized by the Basalis nucleus of Meynert.
What is the most abundant inhibitory neurotransmitter?
GABA
Increases sleepiness, decreases anxiety, alertness, memory, and muscle tension.
What are the effects of glutamate?
Increased level of glutamate increases anxiety levels
Most abundant excitatory neurotransmitter.
What is the therapeutic range for lithium?
0.6-1.2 mEq/L
Toxicity can occur at 1.5 mEq/L or higher.
What are common side effects of lithium?
- Hypothyroidism
- Weight gain
- Fine hand tremors
- Fatigue
- Mental confusion
- Nystagmus
- GI symptoms: diarrhea, vomiting
- Renal issues: diabetes insipidus
- Cardiac issues: T-wave inversion
- Hematologic issues: leukocytosis
Coarse hand tremors are a sign of toxicity.
What drug interactions can affect lithium levels?
Increased with prostaglandin inhibitors like NSAIDs
Exceptions include Aspirin (ASA) and Tylenol.
What is a black box warning for valproic acid?
Hepatotoxicity and Pancreatitis
Monitor liver function tests (LFTs) regularly.
What is the therapeutic index for valproic acid?
50-125 mcg/ml
Check serum levels to ensure patients are within the therapeutic range.
What fetal abnormalities are associated with valproic acid?
- Neural tube defects (e.g., spina bifida)
- Cleft lip and cleft palate
- Cognitive impairment
Counsel female patients of childbearing potential about alternative medications.
What is a key concern regarding carbamazepine in the Asian population?
Stevens-Johnson syndrome
Screen for HLA-B*1502 allele before initiating.
What is the therapeutic range for carbamazepine?
4-12 µg/mL
Monitor levels for seizure control.
What is the mnemonic for remembering the side effects of carbamazepine?
C - Color pale
A - Agranulocytosis
R - Rash
B - Bleeding gums
A - Aplastic anemia
M - Med stop
A - Asians vulnerable
Zzz - fatigue
P - Pregnant?
I - Increased SOB
N - Nosebleeds
E - Elevated temp
Highlights critical side effects and monitoring needs.
What is the black box warning for Lamictal?
Stevens-Johnson syndrome
Discontinue immediately if symptoms occur.
What is the starting dose for Lamictal?
25 mg/day
Titrate gradually to avoid severe rash.
What medications can cause drug-induced mania?
- Syphilis
- SAM-e
- Steroids
- St. John’s Wort/Ginseng
- Antidepressants
- Isoniazid
- Levothyroxine
- Disulfiram
Always consider the possibility of drug-induced mania in patients presenting with new-onset symptoms.
What should be done if a patient experiences mania while on lithium?
Assess for medication adjustments
Consider other medications that may induce mania.
What medication is known to cause symptoms similar to mania?
Treatment for a sudden flare-up of rheumatic arthritis
This condition can trigger manic symptoms in susceptible individuals.
What medical condition is most likely to occur due to the addition of Flonase to a regimen including Valproate and Seroquel?
Mania episode
Flonase can interact with medications and potentially induce manic symptoms.
List the medications associated with depression in patients with bipolar disorder.
- Antiretrovirals (e.g., efavirenz)
- Steroids (e.g., prednisone)
- Accutane (Isotretinoin)
- Progesterone
- β-blockers (e.g., propranolol)
- Benzodiazepines (e.g., alprazolam)
- Interferon
- Statins (e.g., simvastatin)
These medications can exacerbate depressive symptoms in susceptible individuals.
True or False: Propranolol may worsen depression symptoms in patients being treated for hypertension.
True
Propranolol is known to have depressive effects.
What is the monitoring schedule for Clozapine (Clozaril)?
- Weekly for the first six months
- Every two weeks for the next six months
- Monthly if ANC is normal
This schedule is crucial for monitoring neutropenia risk.
What should be done if a patient’s ANC is less than 1000 mm3 while on Clozapine?
Discontinue Clozapine
This is necessary due to the risk of neutropenia.
What are the signs that a PMHNP should monitor for when a patient is on Clozapine?
- Fever
- Sore throat
- Chills
These signs may indicate an infection, necessitating the discontinuation of Clozapine.
What is the appropriate action if a patient on Carbamazepine has a WBC of 2500/µL and ANC of 750/µL?
Discontinue Tegretol, then retest WBC and ANC levels
This is essential due to the risk of agranulocytosis.
What are the potential interactions for Olanzapine due to smoking?
Increase dose if the patient starts smoking; decrease dose if the patient stops smoking
Smoking can induce the metabolism of Olanzapine.
What teratogenic risk is associated with Lithium?
Epstein anomaly
This congenital heart defect is particularly concerning during the first trimester.
What is the mnemonic to remember the symptoms of a hypertensive crisis?
Head Pounding Pains - Horrible, Palpitations, Pupils Dilated, Perspiration, and Pyrexia
This mnemonic helps recall the critical symptoms associated with a hypertensive crisis.
What is Neuroleptic Malignant Syndrome (NMS) primarily caused by?
Antipsychotics
Example: haloperidol can trigger NMS.
What is the first step in treating Neuroleptic Malignant Syndrome?
Discontinue the offending agent
This is crucial to prevent further complications.
Fill in the blank: Clozapine is mainly metabolized by the _____ enzyme.
CYP1A2
Understanding this metabolism pathway is vital for medication management.
What is the primary risk associated with taking benzodiazepines during pregnancy?
Floppy baby syndrome
This condition can lead to significant neonatal complications.
What medication acts as both a norepinephrine and dopamine reuptake inhibitor?
Bupropion
This medication is used for treating depression.
What is the first step in the treatment of Neuroleptic Malignant Syndrome (NMS)?
Always discontinue the offending agent
Discontinuing the medication that caused NMS is crucial for patient safety.
What type of medication is Bromocriptine (Parlodel)?
Dopamine D2 Agonist
Bromocriptine is used in the treatment of NMS.
What is Dantrolene used for?
Muscle relaxant for muscle rigidity
Dantrolene helps alleviate muscle rigidity associated with NMS.
When does Neuroleptic Malignant Syndrome typically develop after starting antipsychotic medications?
Often within the first two weeks
Rapid development of NMS can occur with dosage increases as well.
What is the primary distinction between NMS and Serotonin Syndrome?
NMS is caused by antipsychotic medications, while Serotonin Syndrome is caused by serotoninergic medications
Understanding the cause is essential for proper diagnosis and treatment.
What are some key symptoms of Serotonin Syndrome?
- Hyperreflexia
- Myoclonic jerks
- Agitation
- Rapid heart rate
- Elevation in blood pressure
- Headache
- Sweating
- Shivering
- Goosebumps
- Confusion
- Fever
- Seizures
- Unconsciousness
These symptoms are critical for recognizing Serotonin Syndrome.
What is the treatment for Serotonin Syndrome?
Discontinue the offending agent & administer Cyproheptadine
Cyproheptadine is an antihistamine that can help alleviate symptoms.
What should be the waiting period when switching from an SSRI to an MAOI?
Two weeks
This waiting period helps prevent Serotonin Syndrome.
What are the key similarities between Serotonin Syndrome and NMS?
- Both present with fever
- Both present with altered mental status
These similarities can complicate diagnosis.
What characterizes Serotonin Syndrome?
Hyperreflexia and myoclonic jerks
These are distinguishing features that help differentiate it from NMS.
What characterizes Neuroleptic Malignant Syndrome (NMS)?
Muscle rigidity, mutism, autonomic instability
Recognizing these symptoms is essential for diagnosis.
What mnemonic can help remember the symptoms of Serotonin Discontinuation Syndrome?
FANIMA - Fatigue, Achiness, Nausea, Impaired memory, Myalgia, Agitation
This acronym aids in recalling the symptoms.
What are common symptoms of Serotonin Discontinuation Syndrome?
- Fatigue and lethargy
- Myalgia
- Nausea and vomiting
- Ataxia
- Impaired memory
- Agitation
Recognizing these symptoms can help in the management of discontinuation syndrome.
What is the recommended approach for discontinuing SSRIs, TCAs, or MAOIs?
Always taper (not tape)
Tapering helps minimize withdrawal symptoms and complications.
What is the potential consequence of abrupt discontinuation of serotonin reuptake inhibitors?
Can lead to Serotonin Discontinuation Syndrome
Awareness of this risk is crucial for patient safety.
How long can discontinuation symptoms last?
Several days to weeks
The duration depends on individual factors and the specific medication involved.
What is a high-yield test-taking tip regarding SSRIs and St. John’s Wort?
Combining SSRIs with St. John’s Wort or using more than one SSRI can potentially lead to Serotonin Syndrome
This information is vital for safe medication management.
What does the ‘F’ in the acronym ‘FLIPPER JW’ stand for?
Flexibility
What does the ‘L’ represent in the acronym ‘FLIPPER JW’?
Language
What is indicated by the ‘I’ in ‘FLIPPER JW’?
Insight
What does ‘P’ stand for in ‘FLIPPER JW’?
Planning / Personality
What does the second ‘P’ in ‘FLIPPER JW’ refer to?
Prioritizing
What is represented by the ‘E’ in ‘FLIPPER JW’?
Expressive Speech
What does the ‘R’ in ‘FLIPPER JW’ stand for?
Reasoning
What does ‘J’ indicate in the acronym ‘FLIPPER JW’?
Judgment
What does ‘W’ represent in ‘FLIPPER JW’?
Working Memory
