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Pharm > Neuropharmacology > Flashcards

Neuropharmacology Flashcards

1
Q

Which class of medications has the highest rate of being prescribed?

A

antidepressants

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2
Q

List the 6 major categories of psychiatric disorders:

A
  • neurosis
  • psychosis
  • depression
  • schizophrenia
  • Tourette’s syndrome
  • dementia
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3
Q

Which types of psychological disturbances are categorized under “neurosis”?

A

mild forms of mental disorders
- anxiety
- hysteria
- hypochondria
- phobias
- OCD
- panic disorders
- PTSD

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4
Q

Diseases classified as “psychosis”:

A
  • schizophrenia
  • organic psychoses
  • bipolar disorder
  • psychotic depression
  • drug-induced psychoses
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5
Q

How is the word “psychosis” derived?

A

psyche = mind/soul
osis = abnormal condition

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6
Q

Pharmacological treatment of depression presumes…

A

a brain deficiency in dopamine, norepi, serotonin, or altered receptor activities

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7
Q

Positive symptoms of schizophrenia:

A
  • delusion
  • hallucinations
  • disorganized speech/thinking
  • grossly disorganized behaviors/catatonic behaviors
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8
Q

Negative symptoms of schizophrenia:

A
  • lack of emotion
  • lack of interest/motivation
  • flat affect
  • alogia
  • inappropriate socializing/isolation
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9
Q

Cognitive symptoms of schizophrenia:

A
  • disorganized thinking
  • slow thinking
  • difficulty understanding, expressing
  • poor concentration & memory
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10
Q

How is dopamine related to schizophrenia?

A
  • schizophrenic individuals produce more dopamine than typical brain
  • increased activity at D2 receptor
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11
Q

4 dopamine pathways in the brain:

A

1) mesolimbic
2) mesocortical
3) nigrostriatal
4) tuberoinfundibular

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12
Q

Location of the mesolimbic pathway:

A

from the tegmentum (midbrain) to the nucleus accumbens (limbic system)

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13
Q

Blocking the mesolimbic dopamine pathway has what effect?

A

decrease in positive symptoms

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14
Q

Location of the mesocortical pathway:

A

from tegmentum (midbrain) to frontal & limbic cortex

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15
Q

Effect of blocking the mesocortical dopamine pathway:

A

may produce or worsen negative symptoms d/t an increase in 5HT which inhibits dopamine release
*explains why negative symptoms are unaffected or worsened by drugs that only block dopamine receptors

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16
Q

Location of the nigrostriatal pathway:

A

from the substantia nigra (midbrain) to basal nuclei

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17
Q

Importance of the nigrostriatal pathway:

A

regulates posture and voluntary movement
*first gen antipsychotics block receptors here and cause parkinson’s-like syndrome (EPS)

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18
Q

Location of the tuberoinfundibular pathway:

A

from hypothalamus to anterior pituitary

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19
Q

Effect of blocking the tuberoinfundibular pathway:

A

dopamine inhibits prolactin release, so blocking dopamine here may lead to galactorrhea, amenorrhea, sexual dysfxn

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20
Q

Where do FGAs work? What symptoms are they most successful at treating?

A
  • block D2 receptors in limbic system
  • (muscarinic, adrenergic, & histaminergic receptors affected too)
  • most effective against positive symptoms but may cause EPS
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21
Q

Most potent FGA?
Least potent FGA?

A

most = haloperidol
least = chlorpromazine

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22
Q

Clozapine effects and benefits?

A
  • effective for both positive and negative symptoms
  • no parkinsons-like symptoms
  • blocks D2 and 5HT receptors
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23
Q

Adverse effect of clozapine:

A

agranulocytosis

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24
Q

Common adverse effects of SGAs:

A
  • sedation
  • weight gain
  • orthostatic hypotension
  • EPS
  • parkinsonism
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25
Q

Activation of 5-HT2 receptors causes what?

A

blocks release of dopamine

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26
Q

Blocking 5-HT2 receptors causes what?

A

increases release of dopamine

27
Q

Effect of blocking 5-HT in each of the 4 dopamine pathways:

A
  • nigrostriatal: increased DA release = less EPS than FGAs
  • mesocortical: increased DA release improves negative symptoms
  • tuberoinfundibular: increased DA release = less prolactinemia than FGAs
  • mesolimbic: less effect here than other 3 pathways; SGAs block DA receptors and improve positive symptoms
28
Q

How does tardive dyskinesia differ from EPS?

A
  • TD may be irreversible/take years to resolve
  • incidence higher in elderly with FGAs (53%)
  • lower incidence in elderly with SGAs (5)
29
Q

Which drug produces a zero incidence of tardive dyskinesia?

A

Clozapine

30
Q

Descibe parkinsonism:

A
  • tremor
  • rigidity
  • akinesia/bradykinesia
  • cognitive fxn eventually declines
  • s/s d/t degeneration of inhibitory DA pathway from substantia nigra to caudate nucleus in striatum
31
Q

Treatment for parkinson’s disease?

A
  • replacement therapy
  • Levodopa = drug of choice
32
Q

Why don’t we give dopamine to Parkinson’s patients?

A

cannot cross the BBB

33
Q

Why is Levodopa successful in treating Parkinson’s disease?

A
  • precursor to dopamine that can cross the BBB
  • orally effective (large doses)
  • decreases tremor and akinesia
34
Q

Drugs that interact with Levodopa:

A
  • Pyridoxine (Vit. B6) increases peripheral metabolism of levodopa -> DA (reverses effect)
  • Carbidopa, a peripheral decarboxylase inhibitor, decreases peripheral metabolism of leveopda
  • therefore, most effective treatment for Parkinson’s dz = sinemet (carbidopa:levodopa)
35
Q

Anesthetic considerations for patients on antiparkinsonian drugs:

A
  • hemodynamic instability
  • gastric aspiration
  • laryngospasm
  • postop cognitive dysfxn
  • upper airway obstruction
  • sensitive to CV and resp depressant effects of anesthetics
  • caution with Fentanyl & Neostigmine
  • continue PD meds the AM of sx
36
Q

How is dopamine related to psychosis?

A
  • increase in DA
  • located in the limbic system
  • treatment is to block DA receptors
  • adverse effects = parkinsonism
37
Q

MOA of SSRIs:

A

selectively block neuronal reuptake of serotonin at presynaptic membranes with little effect on other neurochemical systems

38
Q

How long does it take SSRIs to work?

A

1-4 weeks (maybe up to 12 weeks for some patients)

39
Q

Most important advantage of SSRIs compared to TCAs?

A

relative safety when taken in an overdose

40
Q

List some common SSRIs:

A
  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Citalopram
41
Q

MOA of SNRIs:

A

inhibit NE transporter as well as SERT

42
Q

Which antidepressant class is preferred for patients with heart dz?

A

SNRIs

43
Q

Body processes regulated by serotonin:

A
  • GI motility
  • genital arousal
  • vascular tone
  • hematopoeisis
  • PLT aggregation
  • parts of the inflammatory response
44
Q

SE of SNRIs:

A
  • nausea
  • dry mouth
  • somnolence
  • HA
  • sexual dysfxn
45
Q

One way SNRIs are superior to SSRIs:

A

chronic pain treatment

46
Q

MOA of TCAs:

A

inhibit synaptic reuptake of NE and serotonin at presynaptic terminals; also affect other neurochemical systems (histaminergic and cholinergic)

47
Q

SE of TCAs:

A
  • postural hypotension
  • cardiac dysrhythmias (contraindicated in prolonged QT)
  • urinary retention
48
Q

Major TCA:

A

Amitriptyline

49
Q

MOA of MAOIs:

A

heterogenous group that block the enzyme that metabolizes biogenic amines (monamine oxidase A & B), increasing the bioavailability of catecholamines and serotonin in the CNS and peripheral ANS

50
Q

MAIOs are typically (first/second/third) line treatment, except in which patient population?

A

typically second/third except in atypical depression (first line)

51
Q

List 2 MAOIs:

A

phenelzine & tranylcyrpromine

52
Q

Major SE of MAOIs:

A

HTN crisis
- treat clinically with a peripheral vasodilator
- patients should promptly report serious HA, N/V, CP

53
Q

Lithium toxicity s/s:

A
  • skeletal muscle weakness
  • ataxia
  • sedation
  • widened QRS
  • AV heart block
  • hypotension
  • seizures
54
Q

Cause of neuroleptic malignant syndrome:

A

rapid increase or over administration of high doses of antipsychotics (esp haldol)

55
Q

4 main syndromes characterized “extrapyramidal syndromes”:

A

1) acute dystonia
2) akathisia
3) parkinsonism
4) tardive dyskinesia

56
Q

s/s of discontinuation syndromes:

A
  • N/V
  • anorexia
  • general somatic distress
  • insomnia
  • anxiety
  • agitation
57
Q

Drugs that can cause serotonin syndrome:

A
  • SSRIs
  • atypical & cyclic antidepressants
  • MAOIs
  • opiates
  • antibiotics
    etc
58
Q

s/s of serotonin syndrome:

A
  • agitation
  • delirium
  • autonomic hyperactivity
  • hyperreflexia
  • clonus
  • hyperthermia
59
Q

What causes mortality with serotonin syndrome?

A

rhabdomyolysis (renal failure, hyperK+, DIC, ARDS)

60
Q

Which neuropharmacological drug potentiates the action of NDMRs & succs?

A

Lithium

61
Q

Most common antidepressants used for chronic pain:

A
  • TCAs
  • SSRIs
  • SNRIs
62
Q

Effect of rhodiola:

A

relieve occasional anxiety and support body during stress

63
Q

Effect of valerian root:

A

promotes relaxation to relieve nervousness, tension, occasional anxiety

64
Q

Effect of winter cherry:

A

thought to relieve intermittent anxiety

Pharm (19 decks)

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