Module 6: Psychopharmacology

Question 1

Recall the role and function of neurotransmitters

Answer 1

• GABA- inhibitory
• –> plays a role in inhibition; reduces aggression, excitation and anxiety, may pay a role in pain perception, has anticonvulsant and muscle-relaxing properties, may impair cognition and psychomotor functioning
• serotonin- inhibitory
• –> plays a role in sleep regulation, hunger, mood states, and pain perception, alters hormonal activity, plays a role in aggression and sexual behaviour
• dopamine - inhibitory or excitatory
• –> involved in fine muscle movement, integration of emotions and thoughts, involved in decision making, stimulates hypothalamus to release hormones
• acetylcholine - inhibitory or excitatory
• –> plays a role in learning, memory, regulates mood, mania, sexual aggression, affects sexual and aggressive behaviour, and stimulates parasympathetic nervous system
• norepinephrine -excitatory
• –> causes changes in mood, causes changes in attention and arousal, stimulates sympathetic branch of autonomic nervous system for fight or flight in response to stress
• glutamate - excitatory
• –> is excitatory, AMPA plays a roll in learning and memory

Question 2

Discuss the categories of psychotropic medications used to treat psychiatric illness

Answer 2

Benzodiazepines

- enhance the inhibitory neurotransmitter GABA, can be used to treat insomnia at higher doses and lower doses can reduce anxiety without being as soporific (sleep producing)
- diazepam (valium)
- clonazepam (rivotril)
- alprazolam (xanax)
- loraepam (ativan) 

Short- Active Sedative - Hypnotic Sleep Drugs

- also promotes GABA and inhibits neurotransmitters 
- onset of action is faster than that of most benzodiazepines
    - >zopiclone (imogene) -- because the potential of misuse should not be taken for more than 7-10 consecutive days 

Melatonin Receptor Agonists

- short term relief of anxiety without strong sedative effects 
    - > buspirone hydochloride (bustab)

Question 3

Antianxiety and hypnotic drugs (target symptoms and major side effects)

Answer 3

• decrease neural excitability
• can produce drowsiness, impaired coordination
• zopiclone has a bitter taste upon awaking

Question 4

Tricyclic Antidepressants (TCAs) (target symptoms and major side effects)

Answer 4

work by inhibiting the reuptake of norepinephrine and serotonin into the presynaptic neurone. These neurotransmitters accumulate in the synapse; thus increasing actions

• Adverse effects: blurred vision, dry mouth, constipation and urinary hesitancy.
  - nortruptuline hydrochloride (aventyl, norventyl)
  - amitriptyline hydrochloride (elavil, levate)
  - imipramine hydrochloride (impril)

Question 5

Selective Serotonin Reuptake Inhibitors (SSRIs) (target symptoms and major side effects)

Answer 5

slow the reuptake of serotonin into the presynaptic neutron

• Common Adverse effects: insomnia, low libido, and failure to orgasm, and nausea or vomiting
• SSRI’s in high doses can cause ventricular arrhythmias that can lead to death
  - fluoxetine hydrochloride (prozac)
  - paroxetine hydrochloride (paxil)
  - citalopram hydrobromide (celera)
  - escitalopram oxalate (cipralex)
  - fluvoxamine maleate (luvox)
  - sertraline hydrochloride (zoloft)

Question 6

Monoamine Oxidase inhibitors (MAOIs) (target symptoms and major side effects)

Answer 6

inhibit monamine oxidase, the enzyme that breaks down neurotransmitters

    - phenelzine sulfate (nardil)
    - tranylcypromine sulfate (parant)
    - selefiline hydrochloride (anipryl)
    - avoid taking tyramine, cheese, wine, beer

Question 7

Lithium Carbonate (mood stabilizer)

Answer 7

• often given to those with bipolar disorder, specifically during the manic phase
  Side effects: sinus bradycardia, tremor,

Question 8

Identify specific cautions for a patient taking natural health products and psychotropic drugs

Answer 8

many patients take natural products and supplements 
major concern 
    - potential long-term effects 
        - nerve damage
        - kidney damage 
        - liver damage 
    - possibility of adverse chemical reactions
        - with other substances
        - with conventional medications

Question 9

Anticonvulsant drugs

Answer 9

work by inhibiting neuronal excitability

- valproate (amiable as sodium divalproex and valproic acid (depakene)
- carbamazepine (tegretol)
- lamotrigdine (lamictal)
- gabapentin (neurontin)
- topiramate (topamax)
- oxcarbazepine (trileptal)

Question 10

antipsychotic drugs

Answer 10

• conventional antipsychotics (also referred to as first generation, typical or standard
• strong antagonists (blocking agents)
  
  • > bind to D2 dopamine receptors
  • > block attachment of dopamine
  • > reduce dopaminergic transmission
• significant adverse effects
  
  • > weight gain
  • > sedation
  • > extrapyramidal effects
• Antipsychotic drugs second generation
  
  • > produce fewer extrapyramidal side effects (EPS)
  • > target both negative and positive symptoms
  • > others chosen as a first line treatment
  • > dopamine and serotonin blockers
    • • examples: clozapine, risperidone, quetiapine fumarate, olanzapine

Question 11

Stimulants - Drug treatment for attention-deficit/hyperactivity disorder

Answer 11

-block reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the concentration of these monoamines in the synaptic cleft

Adverse effects
- agitation, exacerbation of psychotic thought processes, hypertension, and long-term growth suppression as well as potential misuse and abuse

Question 12

compliance

Answer 12

effective teaching about the medications, side effects and moods/feelings, teach patients to get up slowly,