neurobiology and pharmacology Flashcards
put the steps/phases of a synapse in order
presynaptic cell
post synaptic cell
impulse
conduction
synapse
presynaptic cell —> impulse —> conduction —>synapse —> post synaptic cell
functions of the brainstem and limbic system
controls heart rate, breathing digestion and sleeping
limbic system plays a crucial role in emotional status and psychological function using norepinephrine, epinephrine, and serotonin as it’s neurotransmitters.
hypothalamus
controls basic drives (hunger, sex, thirst)
linking higher activities to the functioning of internal organs
processing sensory information that is sent to the cerebral cortex
regulates sleep/wake cycle
cerebellum
receives information from the sensory systems, the spinal cord, and regulates voluntary movements/coordination, maintains balance and equilibrium
cerebrum
responsible for our conscious perception of the external world/our body, emotional status/ memory and control of skeletal muscles, language and the ability to communicate.
recall the difference between a drug agonist and antagonist
agonist: comes from the Latin, meaning contender, so mimics the effects of the neurotransmitter at the site to “contend” for the same response
antagonist: in a book these are the bad guys (directly opposed to the good guys), and they block a neurotransmitter from binding to it’s receptor, thereby obstructing the mechanism of action
Benzodiazepines (end in AM)
Panic
Alprazolam (Xanax)
Clonazepam (Klonopin)
Diazepam (Valium)
Insomnia
Flurazepam (Dalmane)
Temazepam (Restoril)
Triazolam (Halcion)
Alcohol Withdrawal
Chlordiazepoxide (Librium)
Diazepam (Valium)
Lorazepam (Ativan)
MOA: promote activity of GABA, calming effect
antianxiety, hypnotic, anticonvulsant, amnestic, muscle relaxant properties
CNS depressant=WATCH FOR RESPIRATORY DEPRESSION
Controlled substance=withdrawal sx/sx: anxiety, insomnia, muscle tension, seizures
can cause paradoxical reactions (anxiety, agitation)
can be abused
caution if patient must do tasks requiring alertness
Short-Acting Sedative-Hypnotic Sleep Agents
(Z hypnotics)
Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)
possess hypnotic and amnestic effects without the antianxiety, anticonvulsant, or muscle relaxant effects of benzodiazepines.
still a controlled substance
less potent than benzos
caution in elderly d/t sedative effects (falls, fractures, and delirium)
Melatonin Receptor Agonists
Ramelteon (Rozerem)
Doxepin (Silenor)
Orexin receptor agonists
Suvorexant
Lemborexant
highly selective and potent
FDA approved for insomnia
not a controlled substance
side effects: headache and dizziness.
can decrease testosterone levels (low sex drive)
CONTRAINDICATED WITH FLUVOXAMINE (an SSRI)–DO NOT GIVE TOGETHER
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Doxepin: not a controlled substance, but people taking it must avoid MAOIs, and should also not take it if they have severe urinary retention or glaucoma
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ORAs: contraindicated in patients with narcolepsy
rare side effects of sleep paralysis, hallucinations (waking or falling asleep, etc) have happened
controlled substance
Buspirone
FDA approved for GAD tx
serotonergic
not a controlled substance
taken daily
several weeks for antianxiety onset
SSRIs
Fluoxetine (Prozac) **MOST ACTIVATING
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Clexa) PROLONGS QT INTERVAL
Escitalopram (Lexapro)
Fluvoxamine (Luvox) **MOST SEDATIVE
selective serotonin reuptake inhibitors (happier)
most sedative agent is Luvox (CANNOT start at bedtime)
side effects are minimal and tolerable (anticholinergic effects of nausea, nervousness, insomnia, headache, dizziness, agitation, sexual dysfunction
Wellbutrin
NDRI (norepinephrine and dopamine)
side effects: insomnia, tremor, anorexia, weight loss.
CONTRAINDICATIONS: pts. with eating disorders, or those abruptly d/c ing alcohol or sedatives (including benzos) secondary to seizure risk
SNRIs
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Levomilnacipran (Fetizma)
increase serotonin and norepinephrine by inhibiting reuptake
more likely to cause excessive sweating
TCAs
MOA: block reuptake of serotonin and norepinephrine
not first line because of side effects:
sedation and weight gain (d/t blocking H1 receptors)
dizziness and orthostatic hypotension (d/t blocking of alpha 1 receptors)
anticholinergic (blocking M1 receptors) =blurred vision, dry mouth, tachycardia, urinary retention, constipation.
can cause confusion and memory difficulties in elderly
block sodium channels in the heart–overdose fatal–give smallest possible dose to suicidal patients.
MAOIs
Phenelzine (Nardil)
Isocarboxazid (Marplan)
Tranylcypromine (Parnate)
Selegiline (Emsam)
last-line agents not widely used because of interactions and dietary restrictions.
cannot give with SSRIs or buspirone d/t risk of serotonin syndrome
cannot give with psychostimulants d/t risk of hypertensive crisis.
can’t give with OTC serotonergic meds or with sympathomimetic OTC meds.
cannot eat cheese, pickled/smoked fish, wine, etc.
