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Pathopharm Exam 3 > Module 7: Part 1 > Flashcards

Module 7: Part 1 Flashcards

1
Q

what does the term schizophrenia mean

A

Schizo = split
Phrenia = state of mind

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2
Q

hx of schizophrenia term

A

is a term coined by Eugene Bleuler in 1911 to describe a collection of illnesses characterized by thought disorders

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3
Q

what % of population has schizophrenia

A

1%

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4
Q

when does schizophrenia emerge

A

in young adults, slightly earlier in males

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5
Q

genetic predisposition of schizophrenia (2)

A

Monozygotic twins concordance rate 30% to 50%

Dizygotic twins/siblings concordance rate 15%

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6
Q

Neuroanatomic alterations with schizophrenia

A
  • Enlargement of lateral and third ventricles
  • widening of frontal cortical fissures and sulci
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7
Q

Neurotransmitter alterations with schizophrenia (2)

A

Brain dopamine pathways altered

Glutamate (acts on the N-methyl-D-aspartate [NMDA] receptor subtype)
Implicated in learning and memory

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8
Q

clinical manifestations of schizophrenia (4)

A

Hallucinations
Delusions
Disorganized behavior
Negative symptoms

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9
Q

disorganized behavior characteristics with schizophrenia (2)

A

Disorganized speech
Disorganized behavior

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10
Q

negative symptoms with schizophrenia (4)

A

Affective flattening
Anhedonia (inability to obtain pleasure)
Alogia (limited spoken responses)
Avolition (lack of drive or desire)

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11
Q

what does anhedonia mean

A

inability to obtain pleasure

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12
Q

Alogia

A

limited spoken responses

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13
Q

avolition

A

lack of drive or desire

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14
Q

mood refers to

A

a sustained emotional state

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15
Q

affective states are

A

brief emotional feelings

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16
Q

depression

A

States such as sadness become prominent

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17
Q

2 categories of mood disorder

A
  • unipolar
  • bipolar
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18
Q

unipolar mood disorder

A

Also called major depression, clinical depression

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19
Q

twin studies/concordance rates with mood disorders

A

40% monozygotic; dizygotic 11%

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20
Q

neuroendocrine dysregulation types (2)

A

Hypothalamic-pituitary-adrenal system dysregulation

Hypothalamic-pituitary-thyroid (HPT) system dysregulation

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21
Q

20% to 30% of persons with unipolar depression have an altered ____________ system

A

HPT

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22
Q

HPT system dysregulation has increased CSF levels of

A

thyrotropin-releasing hormone (TRH)

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23
Q

Blunted thyrotropin-stimulating hormone (TSH) response to TRH challenge is a characteristic of

A

HPT System Dysregulation

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24
Q

____________ nocturnal rise in TSH is seen with HPT system dysregulation

A

decreased

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25
Q

clinical manifestations of mood disorders (2)

A

depression
mania

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26
Q

treatment of mood disorders (3)

A

Antidepressants
Psychotherapy
Combination of both

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27
Q

Three major classes of antidepressant medications

A

Monoamine oxidase inhibitors (MAOIs)

Tricyclic antidepressants (TCAs)

Selective serotonin reuptake inhibitors (SSRIs)

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28
Q

all major classes of antidepressants…

A

increase monoamine neurotransmitter levels within the synapse

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29
Q

panic disorder usually responds to

A

80% respond to cognitive behavioral therapy (CBT) and/or antidepressant medication

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30
Q

generalized anxiety disorder physiologic changes (2; vague)

A

Norepinephrine and serotonin abnormalities

GABA-BZ receptor alterations

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31
Q

Excessive and persistent worries
are a characteristic of

A

generalized anxiety disorder

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32
Q

Posttraumatic stress disorder (PTSD) occurs after exposure to

A

terrifying, life-threatening trauma

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33
Q

lifetime prevalence rate of PTSD

A

7 to 8%

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34
Q

PTSD in adult brains

A

smaller hippocampus, brain structure susceptible to damaging effects of the stress hormone cortisol and excitatory amino acids

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35
Q

PTSD in pediatric brains

A

studies reveal generalized effect of trauma on reducing total brain volume

adult PTSD: smaller hippocampus

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36
Q

obsessive-compulsive disorder

A

Repetitive, intrusive thoughts and/or compulsions

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37
Q

obsessions vs compulsions

A

Obsessions: preoccupation with contamination, doubting, religious or sexual themes; believe a negative outcome will occur if a specific act is not performed

Compulsions: physical and mental ritualized acts

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38
Q

obsessions

A

involve a preoccupation with contamination, doubting, religious or sexual themes, or the belief that a negative outcome will occur if a specific act is not performed

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39
Q

compulsions

A

physical and mental ritualized acts

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40
Q

psychopharmacology includes (4)

A

antidepressants, anxiolytics, lithium and the antipsychotics.

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41
Q

treatment goal for psychopharmacology

A

is to be able to treat patients on an outpatient basis.

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42
Q

depression occurs in up to ____________ % of the population, especially in ____________

A

4; the elderly

43
Q

how is depression usually treated

A

with antidepressants or anxiolytics.

44
Q

More serious psychological disorders such as bipolar and psychotic disorders are usually treated with (2)

A

lithium or the antipsychotics

45
Q

depression characteristics (6)

A

sustained mood disturbances

impaired memory and concentration

disturbed sleep

reduced energy level

reduced libido

impaired sleep.

46
Q

diagnostic criteria of depression

A
  • 5+ of following symptoms within a 2 week period:
  • Depressed mood most of the day, nearly every day (subjective report (e.g. feels sad or empty) or observation made by others (e.g., appears tearful)
  • Markedly diminished interest/pleasure in all/almost all, activities most of the day, nearly every day (subjective or observation by others)
47
Q

amitriptyline class

A

Tricyclic antidepressants (TCA’s)

48
Q

imipramine (Tofranil) class

A

TCA

49
Q

desipramine (Norpramin) class

A

TCA

50
Q

doxepin (Silenor) class

A

TCA

51
Q

clomipramine class

A

TCA

& SSRI
(affects serotonin > NE)

52
Q

maprotiline HCl class

A

TCA

53
Q

nortriptyline (Pamelor) class

A

TCA

54
Q

protriptyline class

A

TCA

55
Q

trimipramine class

A

TCA

56
Q

phenelzine (Nardil) class

A

MAOI

57
Q

tranylcypromine (Parnate) class

A

MAOI

58
Q

isocarboxazid (Marplan) class

A

MAOI

59
Q

clorgyline class

A

MAOI

(specific for MAO type A) (research only)

60
Q

amoxapine class

A

Second Generation Drugs (not true SSRIs)

61
Q

bupropion (Wellbutrin) class

A

Second Generation Drugs (not true SSRIs)

62
Q

nefazodone class

A

Second Generation Drugs (not true SSRIs)

63
Q

trazodone class

A

Second Generation Drugs (not true SSRIs)

64
Q

mirtazapine (Remeron) class

A

Second Generation Drugs (not true SSRIs)

65
Q

vilazodone (Viibryd) class

A

Second Generation Drugs (not true SSRIs)

66
Q

vortioxetine (Trintellix) class

A

Second Generation Drugs (not true SSRIs)

67
Q

fluoxetine (Prozac) class

A

Serotonin-Specific Reuptake Inhibitors (SSRIs)

68
Q

clomipramine (Anafranil) class

A

Serotonin-Specific Reuptake Inhibitors (SSRIs)

69
Q

sertraline (Zoloft) class

A

Serotonin-Specific Reuptake Inhibitors (SSRIs)

70
Q

venlafaxine (Effexor XR) class

A

Serotonin-Specific Reuptake Inhibitors (SSRIs)

71
Q

paroxetine (Paxil) class

A

Serotonin-Specific Reuptake Inhibitors (SSRIs)

72
Q

citalopram (Celexa) class

A

Serotonin-Specific Reuptake Inhibitors (SSRIs)

73
Q

escitalopram (Lexapro) class

A

Serotonin-Specific Reuptake Inhibitors (SSRIs)

74
Q

fluvoxamine (Luvox) class

A

Serotonin-Specific Reuptake Inhibitors (SSRIs)

75
Q

atomoxetine (Strattera) class

A

Norepinephrine-Specific Reuptake Inhibitors (NSRI’s)

76
Q

venlafaxine (Effexor) class

A

Serotonin/Norepinephrine Reuptake Inhibitors (SNRI’s)

77
Q

desvenlafaxine (Pristiq) class

A

Serotonin/Norepinephrine Reuptake Inhibitors (SNRI’s)

78
Q

duloxetine (Cymbalta) class

A

Serotonin/Norepinephrine Reuptake Inhibitors (SNRI’s)

79
Q

milnacipran (Savella) class

A

Serotonin/Norepinephrine Reuptake Inhibitors (SNRI’s)

80
Q

levomilnacipran (Fetzima) class

A

Serotonin/Norepinephrine Reuptake Inhibitors (SNRI’s)

81
Q

Tricyclic agents are thought to enhance the actions of ____________ by inhibiting reuptake which is the primary mechanism of termination of action.

A

biogenic amines

82
Q

Imipramine (Tofranil), a prototypic tricyclic antidepressant blocks____________ reuptake.

A

norepinephrine

83
Q

Tricyclics with tertiary amine side chains also have effects on other neurotransmitters, like ____________ .

A

serotonin

84
Q

Among the tricyclics, ____________ has prominent actions on the serotonin system and has been shown effective in treating obsessive compulsive disorder.

A

clomipramine (Anafranil)

85
Q

Fluoxetine (Prozac) and other inhibitors of serotonin reuptake are
____________ with little direct action at other neurotransmitter sites.

A

relatively selective in their effects

86
Q

____________ has actions at both serotonin and norepinephrine sites, with about five times greater selectivity for serotonin. ____________ is similar.

A

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

87
Q

____________ has about ten times greater serotonin selectivity compared to norepinephrine.

A

Paroxetine (Paxil)

88
Q

3 drugs that should NOT be used in patients with uncontrolled narrow angle glaucoma due to possible anticholinergic side effects

A

Duloxetine (Cymbalta)
milnacipran (Savella)
levomilnacipran (Fetzima)

89
Q

with antidepressants, blockade of ____________ produces a stimulant effect.

A

dopamine transport

90
Q

Inhibition of ____________ uptake may result in antidepressant effects.

A

serotonin

91
Q

Inhibition of ____________ reuptake consistently produces an antidepressant action.

A

norepinephrine

92
Q

most common adverse effects of SSRI’s

A

Nausea
Headache
Insomnia
Nervousness
Fatigue
Sexual Dysfunction

93
Q

less common adverse effects of SSRIs (3)

A

Inappropriate ADH secretion

Rashes

Extrapyrmidal effects early in treatment: akathisia, dystonia, oro-lingual dyskinesia

94
Q

most common adverse effects of SNRIs (6)

A

same as SSRIs

Nausea
Headache
Insomnia
Nervousness
Fatigue
Sexual Dysfunction

95
Q

significant warnings of SNRIs and SSRIs

A

Bleeding enhanced when used with aspirin, NSAID’s, & Coumadin

↑ suicidal ideations

96
Q

coumadin with SSRIs and SNRIs

A

blockade of serotonin uptake into platelets which inhibits platelet aggregation.

97
Q

tricyclic antidepressant side effects (7)

A

Urinary retention
Constipation
Weight Gain
Sexual Dysfunction
Confusion/Delirium
Orthostatic Hypotension
Cardiac dysrhythmias

98
Q

MAOI side effects (5)

A

Sleep disturbances
Orthostatic Hypotension
Weight Gain
Sexual Dysfunction
Drug/Food Interactions*

99
Q

MAOIs should bot be used with ____________ because …

A

clomipramine (SSRI) or narcotics (merpidine)

it may cause a serotonin syndrome

100
Q

serotonin syndrome includes (6 symptoms)

A

hyperpyrexia, agitation, neuromuscular irritability, hypotension, coma, and death.

101
Q

specific adverse effect for Venlafaxine (Effexor)

A

at higher doses, a dose-dependent increase in diastolic blood pressure is seen

102
Q

specific adverse effect for Bupropion (Wellbutrin):

A

at high doses SEIZURES (contraindicated in patients who have an increased risk of seizure).

103
Q

Trazodone rare side effect

A

priapism, sometimes leading to permanent loss of erectile function.

104
Q
A

Pathopharm Exam 3 (18 decks)

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