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PMHNP > Neurobiology of Mental Illness (Weely 2) > Flashcards

Neurobiology of Mental Illness (Weely 2) Flashcards

1
Q

Cerebrum

A
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2
Q

Amygdala

A
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3
Q

hippocampus

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4
Q

midbrain

A

Involved in vision and hearing. Along with the hindbrain controls sleep, alertness and pain.
Manufactures serotonin, norepinephrine and dopamine.

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5
Q

cerebellum

A
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6
Q

thalamus

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Relay station, transmits nerve impulses throughout brain.

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7
Q

hypothalamus

A

regulates bodily drives and bodily conditions

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8
Q

Pons

A
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9
Q

medulla oblongota

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10
Q

Forebrain

A

Structures:
Function: controls higher mental functions such as learning, speech, thought, memory.

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11
Q

Limbic System

A

Structures:
Involves experiencing and expressing emotions and motivation.

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12
Q

Hindbrain

A

Structures:
Controls motor movements, heart rate, sleep and respiration. Manufactures norepinephrine and serotonin.

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13
Q

Receptor

A

Configured so that precisely shaped molecules fit and cause or prevent a response

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14
Q

Ligand

A

Transmitter substance that fits and evokes a response from a receptor

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15
Q

Synapse

A

Structure that permits a neuron to pass an electrical or chemical signal to another neuron

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16
Q

Neurotransmission

A

Communication between neurons

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17
Q

Neurotransmitters

A

Electrochemical messengers that send signals from neuron to neuron. either excite or stimulate an action in the cells (excitatory) or inhibit or stop an action (inhibitory).

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18
Q

Absorption

A

Getting the drug into the bloodstream.
Drug must pass through the stomach or small intestine into blood vessels(when taken orally). Molecules pass through cell membranes.

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19
Q

distribution

A

Getting the drug from the bloodstream to the tissues and organs.
Factors affecting distribution: size of organ, blood flow, solubility, plasma protein binding, anatomic barriers.

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20
Q

Metabolism

A

breaking the drug down into the inactive and typically water-soluble form.
Excretion via urine or feces. Occurs in liver, kidney, lungs, GI tract, plasma.

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21
Q

Excretion

A

Getting the drug out of the body

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22
Q

Bioavailability

A

The fraction of the dose that reaches the systemic circulation

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23
Q

Protein binding:

A

Drugs bind to plasma proteins and cannot leave circulation, they are too large to pass through gaps in capillary wall.
-Several psychotropics are protein binding.
-The more protein binding the less drug activity.

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24
Q

Lipid solubility

A

Lipid solubility is necessary for drugs passing through blood-brain barrier. Then can also pass through placenta.

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25
Q

MAO system:

A

Metabolizes Monoamines including dopamine, norepinephrine, serotonin

26
Q

Cytochrome P450 system

A

most drug interactions occur.
CYP2D6: Affects 90% of all drugs and 25% of all psychotropics. Found primarily in the liver. Also in intestine, lungs, brain, kidney.

27
Q

Substrate

A

Enzyme surfaces that receive inducers or inhibitor enzymes

28
Q

Inducers

A

Increases the drug metabolism to decrease serum drug concentration. Takes several days to weeks to develop.

29
Q

Inhibitors

A

decreases the drug metabolism to increase serum drug concentrations. Happens almost immediately.

30
Q

Effect of smoking on CYP 450

A

-Cigarette smoking causes induction of CYP-450 1A2, causes more enzyme to be synthesized.
-Leads to 40-50% reduction in serum level of target drug.
-Same effects from secondhand smoke.
-Maximum enzyme induction occurs with 7-12 cigarettes per day for some meds such as clozapine and olanzapine.
-1/2 ppd or more, higher dose of meds is needed.

31
Q

Normal metabolizers:

A

Persons with one or 2 functioning copies of CYP2D6 or CYP C19.

32
Q

Ultra-rapid Metabolizers

A

-Multiple copies of CYP2D6 or CYPC19.
-High risk for poor efficacy
-About 10-29% of people who are of East african or Middle eastern Descent are Ultra-Rapid metabolizers of CYP2D6 drugs.

33
Q

Poor Metabolizers

A

Patients with 2 inactivated copies of either CYP2D6 or CYPC19. High risk for toxicity.
-5-10 % of caucasians have higher likelihood to have lower CYP2D6 activity making them poor metabolizers of CYP2D6 drugs.
-20% of Asian descent have reduced activity of CYP2C19 and require lower dose of certain psychotropics.

34
Q

Half-Life

A

Amount of time required for 50% of drug to disappear from body.

35
Q

Washout Period

A

To discontinue a drug, five half lives are required to eliminate approximately 97% of the drug.

36
Q

Clearance:

A

Total amount of blood, serum, or plasma from which a drug is completely removed per unit time.
Lithium is one of the few psych drugs eliminated by kidneys.

37
Q

Steady State

A

-Drug elimination equals drug availability.
-Reach steady state in about 5 times the elimination half life. rate of accumulation determined by half-life.

38
Q

Pharmacodynamics

A

Effect the drug has on body: desired effects, side effects, adverse effects

39
Q

Agonists

A

Substance activates receptors

40
Q

Antagonists

A

Substance blocks receptors

41
Q

Partial agonist

A

Cannot produce full response

42
Q

Inverse agonists

A

Produces an effect other than agonist

43
Q

Indirect agonist

A

Produces an effect without having the specific effect on a receptor

44
Q

Down-regulation

A

Chronic exposure to certain drugs causes receptors to change. Pharmacodynamic tolerance causes reduction in receptor sensitivity.

45
Q

Glutamate

A

Amino acid neurotransmitter
-Principle excitatory neurotransmitter
-Biosynthesized as byproduct of cell metabolism
-removed by reuptake
-Acts on NMDA, AMPA, Kainate receptors.
-at high levels can have major neurotoxic effects.
-implicated in the brain damage caused by stroke, hypoglycemia, sustained hypoxia or ischemia and some degenerative diseases.

46
Q

Aspartate

A

Amino acid neurotransmitter

47
Q

GABA

A

Amino acid neurotransmitter
-Principle inhibitory neurotransmitter
-GABA agonists: benzodiazepenes, barbiturates, alcohol.
-Biosynthesis: Glutamate acted on glutamic acid decarboxylase (GAD) and B6 to form GABA.
-Found in the brain, modulates other neurotransmitter systems rather that provide a direct stimulus.
-prevents brain from overstimulation.
-Reduction in GABA results in epilepsy.

48
Q

Principle GABA Binding Sites

A

Benzodiazepine/alcohol (Agonist)
Barbiturate(indirect agonist)
Steroid(indirect agonist
Picrotoxin(inverse agonist)

49
Q

Glycine

A

Amino acid neurotransmitter

50
Q

Biogenic amines

A

medium concentration in brain.
Can be excitatory or inhibitory as a function of the receptor.
Slow acting and long duration.
Examples: acetylcholine, epinephrine, norepinephrine, dopamine, serotonin.

51
Q

Histamine

A

Role of histamine in mental illness is under investigation.
Involved in peripheral allergic responses, control of gastric secretions, cardiac stimulation, and alertness.
Some psychotropic drugs block histamine. This results in weight gain, sedation and hypotension.

52
Q

Acetylcholine

A

Has mostly excitatory effects
-Synthesized from dietary choline found in red meat and vegetables.
-Has 2 receptor types (nicotinic and muscarinic)

53
Q

Epinephrine

A
54
Q

norepinephrine

A

-Norepinephrine (noradrenalin), the most prevalent neurotransmitter in the nervous system.
-Precursor to Epinephrine (adrenaline) has limited distribution in the brain but controls the fight-or-flight response in the peripheral nervous system
-Involved in pulse, blood pressure, changes in attention, learning and memory, sleep and wakefulness, and mood regulation.
-Excess norepinephrine: several anxiety disorders
Deficits: memory loss, social withdrawal, and depression

55
Q

Dopamine

A

-Involved in reward and motivation.
-located mostly in the brainstem
-involved in complex movements, motivation, cognition and regulation of emotional responses.
-generally excitatory, synthesized from tyrosine.
-implicated in schizophrenia, movement disorders, psychoses.

56
Q

Serotonin

A
57
Q

Major acetylcholine pathways

A

Dorsolateral Pons–>mid/hindbraine(REM sleep)
Basal Forebrain->Cortex (perceptual learning and attention
medial Septum->memory in the hippocampus
-Involved in Alzheimer’s (decreased acetylcholine secreting neurons) and myasthenia gravis (reduced acetylcholine receptors.

58
Q

Dopamine pathways (D1-D4)

A

D1=Nigrostriatal (Substantia Nigra  Striatum) [Motor movement]
D2=Mesolimbic (VTA  limbic system) [Reinforcement and Addiction]
D3=Mesocortical (VTA  prefrontal cortex) [Working memory and planning]
D4=Tuberoinfundibular tract (hypothalamus  pituitary) [neuroendocrine regulation]

59
Q

Norepinephrine pathway

A

locus ceruleus: acts throughout brain (vigilance and attentiveness.

60
Q

5 HT Roles

A

Mood regulation
Eating disorders
Sleep and dreaming
Arousal
Sexual behavior
Pain
Aggression

61
Q

Major 5HT Pathways

A

-Produced in the brain and intestines
-Serotonin contributes to the delusions, hallucinations, and withdrawn behavior seen in schizophrenia.
-Some antidepressants block serotonin reuptake causing longer availability of
-5-HT in the synapse= improved mood.
Dorsal Raphe Nuclei –>cortex, striatum
Medial Raphe Nuclei –> cortex, hippocampus

62
Q
A

PMHNP (15 decks)

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