Neuropsych Drugs Part 2

Question 1

What are symptoms of manic bipolar disorder?

Answer 1

Increased talkativeness, Increased distraction, inflated self-esteem, racing thoughts

Question 2

How does Lithium work?

Answer 2

Lithium prevents the recycling of IP2 back to inositol, essentially stopping the secondary messenging causing manic symptoms.
(IP3 is the active substrate)

Question 3

What is Lithium primarily used for?

Answer 3

Treating Mania, preventing recurrent bipolar disease, and cluster headaches

Question 4

What are unique characteristics of Lithium?

Answer 4

There is a narrow therapeutic window and is effected by sodium levels. Diuretics can cause lithium levels to increase due to excretion of sodium. Also with ACE/ANGII inhibitors.

Question 5

What are side effects of Lithium?

Answer 5

Early side effects - fatigue, weakness, ataxia, GI symptoms
Toxicity - impaired consciousness, rigidity, and hyper-reflexive. Contraindicated in pregnancy.
Need to regularly monitor levels

Question 6

What can be used as an alternative to Lithium?

Answer 6

Carbamazepine

Question 7

How does Carbamazepine work?

Answer 7

They both block sodium channel by inhibiting repetitive action potentials

Question 8

Why is Lithium first line therapy over Carbamazepine?

Answer 8

Carbamazepine, induces cytochromes and has unpredictable absorption. Dose dependant sedation, diplopia, ataxia, and GI symptoms. Tetragenic
- More side effects and interactions -

Question 9

What is primarily used to prevent seizures?

Answer 9

Valproic Acid and Divalproex

Question 10

How do Valproic Acid and Divalproex work?

Answer 10

Inhibits repeative firing of APs via sodium channels, increased concentration of GABA and reduces Ca+2 currents. (Increases threshold for seizure)

Question 11

What are symptoms of general anxiety disorder?

Answer 11

Symptoms persistent for 1 month. ANS stimulation - tachy, jittery, dry mouth, sweaty, nervous.

Question 12

What are the type of neurotransmitters present during the major phases of sleep?

Answer 12

Slow wave - Serotonin

REM Sleep - Norepinephrine

Question 13

How do benzodiazepines work?

Answer 13

They bind to the BDZ binding site on GABA receptors causing MORE FREQUENT and INCREASED binding of GABA. Causing inhibition - hyperpolarization
–Enhances GABA Action–

Question 14

What is an antagonist to Benzodiazepines?

Answer 14

Flumazenil

Question 15

What is a non-benzodiazepine that can be used for anxiety disorder?

Answer 15

Buspirone
Binds 5HT1A receptors agonist
Less sedating - alternative to benzodiazepines

Question 16

What are the three benzodiazepines used to treat anxiety?

Answer 16

Diazepam, Lorazepam, and Alprazolam

Question 17

What are the differences between Diazepam and Lorazepam?

Answer 17

Diazepam - more lipophilic, fast onset, rapid redistribution, short acting, and has active metabolite with fluctuating half life (can build up with repeative doses)
Lorazepam - slower onet, slow absorbance/redistribution, longer acting, No active metabolites

Question 18

What benzodiazepine has the metabolite oxazepam?

Answer 18

Diazepam - the metabolite is still active and can cause increased side effects as repeat doses

Question 19

What are side effects of benzodiazepines?

Answer 19

Decreases CNS effects, lowers anxiety, increases sedation, anticonvulsant.
Minimal CV and Respiratory effects
Amnesia after IV administration– used with sedation

Question 20

What can happen if benzodiazepines are used with other CNS depressors?

Answer 20

If taken with ethanol or antihistamines can cause additive effects of each other.

Question 21

What are the most common uses for benzodiazepines?

Answer 21

Anxiety, sleep disorder, muscle relaxants, seizure treatment, alcohol withdraw, and sedation/anesthesia

Question 22

What is key when stopping the use of benzodiazepines?

Answer 22

You should gradually reduce the dose and switch to long acting drugs.
Benzodiazepines can cause dependence - opposite of their effects, anxiety, insomina, irritability, HA, hallucinations, seizures

Question 23

What are the three benzodiazepine hypnotic agents?

Answer 23

Flurazepam, Triazolam, and Lorazepam

Question 24

How do the benzodiazepines affect sleep?

Answer 24

Decrease threshold to sleep, increases stage 1/2 sleep and Decreases stage 3/4 and REM sleep.
Rebound insomnia upon withdrawal

Question 25

Side effects of benzodiazepine hypnotic agents?

Answer 25

Daytime sedation, dependence forming, rebound insomnia, ataxia, INCREASES DEATH RATE

Question 26

What is a nonbenzodiazepine hypnotic agent?

Answer 26

Zolpidem. Binds BDZ receptor on GABA, but stage 3/4 and REM sleep are Less effected

Question 27

What are the effects of barbiturates?

Answer 27

CNS Sedation, hyperpolarization, anticonvulsion, RESPIRATORY depression, tolerance, dependence

Question 28

What can happen if there is abrupt stopping of barbiturates? or taking too much?

Answer 28

CNS symptoms including agitation, tremor, insomnia, and life threatening seizures.
Acute toxicity can cause respiratory depression, coma, and stupor

Question 29

What is a barbiturate hypnotic agent?

Answer 29

Pentobarbital - also used for anti-convulsion

Question 30

What is another hypnotic agent used in older people that has a pungent taste?

Answer 30

Chloral Hydrate - less effects on sleep stages than benzo/barb and has similar effects to barbiturates.

Question 31

What is the benzodiazepine used for muscle relaxant?

Answer 31

Diazepam - binds GABA in the spinal cord reducing tone

Question 32

What muscle relaxant interferes with Glu release from presynaptic neurons binding at GABA-B?

Answer 32

Baclofen - GABA analog binding to GABA-B causing hyperpolarization of the presynaptic neuron, limiting excitatory release. Less sedation than diazepam

Question 33

What muscle relaxant binds at Alpha2 receptors?

Answer 33

Tizanidine - agonizes alpha2 preventing NE release, can cause drowsiness and hypotension