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EPPP > Neurotransmitters & Medication > Flashcards

Neurotransmitters & Medication Flashcards

1
Q

What are the 4 conventional antipsychotics?

A

Chlorophyll filled Thor’s hands (CFTH)
1) Chlorpromazine
2) Fluphenazine
3) Thiothixene
4) Haloperidol

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2
Q

What are the 4 atypical antipsychotics?

A

“CORQ” - Clozapine, Olanzapine, Respirdone, and Quetiapine

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3
Q

What are the 5 tricyclic antidepressants?

A

Amitriptyline, Doxepin, Imipramine, Clomipramine, and Nortriptyline

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4
Q

What are the 4 SSRIs?

A

Fluoxetine, Fluvoxamine, Paroxetine, and Sertraline

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5
Q

What are the 3 MAOIs?

A

Isocarboxazid, Phenelzine, and Tranylcypromine

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6
Q

What are the 6 anxiolytics (benzodiazepines)?

A

Diazepam, Alprazolam, Oxazepam, Triazolam, Chlordiazepoxide, and Lorazepam

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7
Q

What are the two types of acetylcholine receptors?

A

Muscarinic and nicotinic

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8
Q

What is acetylcholine’s function in the peripheral nervous system?

A

To cause muscular contractions via the neuromuscular junctions

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9
Q

What are common tricyclic side effects?

A

1) Sedation
2) Cardiotoxicity
3) Ataxia
4) Impaired concentration
5) Agitation
6) Severe hypotension
7) Fever
8) Cardiac arrhythmia
9) Delirium
10) Seizures
11) Coma

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10
Q

What are acetylcholine’s 3 functions in the central nervous system?

A

1) REM sleep
2) Regulation of the sleep-wake cycle
3) Learning/memory

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11
Q

What are the main side effects of conventional antipsychotics?

A

1) Anticholinergic effects - dry mouth, blurred vision, urinary retention, constipation, tachycardia, and delayed ejaculation
2) Extrapyramidal effects - parkinsonism, akathisia, and acute dystonia (muscle spasms in the head/neck)
3) Neuroleptic malignant syndrome (rapid onset of motor, mental, and autonomic symptoms including muscle rigidity, tachycardia, hyperthermia, and altered consciousness)

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12
Q

What are the functions of dopamine (a catecholamine)?

A

Dopamine is associated with personality, mood, memory, and sleep.

1) Schizophrenia - Caused by elevated or oversensitivity to dopamine
2) Tourette’s - Caused by elevated or oversensitivity to dopamine in the caudate nucleus
3) Parkinson’s - Caused by degeneration of dopamine receptors in the substantia nigra underlying tremors, muscle rigidity, and other motor symptoms
4) Drug reinforcement - Dopamine reinforces stimulant, opiate, alcohol, and nicotine use by elevating dopamine in the mesolimbic system (areas in the midbrain and limbic system)

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13
Q

What are the functions of norepinephrine?

A

Norepinephrine plays an important role in mood, attention, dreaming, learning, and certain autonomic functions (like blood pressure)

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14
Q

What are the functions of serotonin?

A

Serotonin usually exerts an inhibitory effect and has been implicated in mood, hunger, temperature regulation, sexual activity, arousal, sleep, aggression, and migraine headache.

1) Elevated serotonin = Schizophrenia, ASD, and food restriction associated with Anorexia Nervosa
2) Low levels = Aggression, depression, suicide, Bulimia Nervosa, PTSD, and Obsessive-Compulsive Disorder
3) Serotonin & dopamine = Social phobia

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15
Q

What are the functions of GABA?

A

GABA is an inhibitory neurotransmitter and plays a role in eating, seizure, anxiety disorders, motor control, vision, and sleep.

1) Low levels = Anxiety disorders
2) Huntington’s = Degeneration of GABA cells in the basal ganglia

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16
Q

What are the functions of glutamate?

A

Glutamate is excitatory and plays a role in learning/memory via long-term potentiation. Excessive glutamate (excitotoxicity) produces seizures, stroke-related brain damage, Huntington’s, Alzheimer’s, and other neurodegenerative disorders

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17
Q

What are the functions of endorphins?

A

Endorphins are inhibitory neuromodulators that lower the sensitivity of postsynaptic neurons and can prevent the release of substance P, which explains their analgesic properties.

Endorphins are associated with pleasurable experiences (e.g., the “runner’s high”), emotions, memory and learning, and sexual behavior too.

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18
Q

What are catecholamines?

A

Dopamine, norepinephrine, and epinephrine made by adrenal glands located on the kidneys and released in response to stress or stimulus

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19
Q

What is the catecholamine hypothesis?

A

The catecholamine hypothesis predicts that some forms of depression are due to lower-than-normal levels of norepinephrine

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20
Q

What are anticholinergic effects?

A

Anticholinergic effects include:
1) Dry mouth
2) Blurred vision
3) Urinary retention
4) Constipation
5) Tachycardia
6) Delayed ejaculation

Anticholinergic effects are commonly caused by any antipsychotic

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21
Q

What are conventional antipsychotics used to treat?

A

1) Schizophrenia (particularly positive symptoms)
2) MDD with mania, delusions, and hallucinations
3) Organic psychoses

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22
Q

What are atypical (novel) antipsychotics used to treat?

A

1) Schizophrenia and other disorders with psychotic symptoms
2) Bipolar that is not responsible to mood stabilizers
3) Depression and suicidality
4) Alcohol and drug addiction
5) Hostility
6) Motor symptoms associated with Huntington’s, Parkinson’s, etc.

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23
Q

How do atypical antipsychotics work?

A

They block D4 and other dopamine receptors as well as receptors for serotonin and glutamate

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24
Q

How do conventional antipsychotics work?

A

They block D2 dopamine receptors

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25
Q

What are the main side effects of atypical antipsychotics?

A

1) Anticholinergic effects
2) Lowered seizure threshold
3) Sedation
4) Neuroleptic malignant syndrome
5) Agranulocytosis

  • They are less likely than conventional antipsychotics to cause extrapyramidal effects - parkinsonism, akathisia, and acute dystonia (muscle spasms in the head/neck)
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26
Q

What is neuroleptic malignant syndrome?

A

Rapid onset of motor, mental, and autonomic symptoms including muscle rigidity, tachycardia, hyperthermia, and altered consciousness

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27
Q

What are tricyclics used to treat?

A

Tricyclics are particularly useful for treating depression with vegetative and somatic symptoms (e.g., decreased appetite, weight loss, sleep disturbances, psychomotor retardation, and anhedonia). Tricyclics can also be used to treat:
1) Panic disorder
2) Agoraphobia
3) Bulimia
4) OCD
5) Enuresis (especially imipramine)
6) Neuropathic pain (especially amitriptyline and nortriptyline)

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28
Q

How do tricyclics work?

A

Tricyclics block the reuptake of norepinephrine, serotonin, and/or dopamine

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29
Q

What are SSRIs used to treat?

A

1) Depression (particularly melancholic depression)
2) Obsessive-compulsive symptoms
3) Bulimia
4) Panic disorder
5) PTSD

30
Q

How do SSRIs compare to tricyclics?

A

In comparison to tricyclics, SSRIs are:
1) Less cardiotoxic
2) Safer in overdose
3) Less likely to produce cognitive impairment
4) Have faster onset (substantial improvement in 2 - 4 weeks)

31
Q

What is serotonin syndrome?

A

Serotonin syndrome involves neurological effects (headache, nystagmus, tremor, dizziness, unsteady gait), changes in mental state (irritability, confusion, delirium), cardiac arrhythmia, coma, and death

32
Q

What are MAOIs (monoamine oxidase inhibitors) used to treat?

A

Non-endogenous and atypical depressions that involve anxiety, hypersomnia, hyperphagia, and interpersonal sensitivity

33
Q

How do MAOIs work?

A

MAOIs upregulates dopamine, norepinephrine, and serotonin by inhibiting the enzyme monoamine oxidase, which is involved in deactivating dopamine, norepinephrine, and serotonin

34
Q

What is a tyramine-induced hypertensive crisis and what causes it?

A

A tyramine-induced hypertensive crisis includes a severe headache, stiff neck, rapid heart rate, nausea, vomiting, sweating, and sensitivity to light.

It is caused by taking an MAOI with barbiturates, amphetamines, antihistamines, or foods containing the amino acid tyramine (e.g., aged cheeses and meats, beer, red wine, chicken liver, avocados, bananas, fava beans, and soy sauce).

35
Q

What is bupropion and what is it used for?

A

Bupropion (Wellbutrin) is a norepinephrine dopamine reuptake inhibitor (NDRI) and treats:
1) MDD
2) The depressive phase of Bipolar Disorder
3) Smoking cessation

36
Q

What is venlafaxine and what is it used for?

A

Venlafaxine (Effexor) is a serotonin norepinephrine reuptake inhibitor (SNRI) and treats:
1) Major Depressive Disorder
2) Generalized Anxiety Disorder
3) Social Anxiety Disorder
4) OCD
5) Pain syndromes including fibromyalgia, headaches, back pain, and peripheral neuropathic pain

37
Q

What is duloxetine?

A

Duloxetine (Cymbalta) is a serotonin norepinephrine reuptake inhibitor (SNRI) and treats:
1) Major Depressive Disorder
2) Generalized Anxiety Disorder
3) Pain syndromes including fibromyalgia, headaches, back pain, and peripheral neuropathic pain

38
Q

What is lithium used to treat?

A

1) Bipolar disorder (particularly classic bipolar without irritable/dysphoric mood or rapid cycling)
2) Gout
3) Diabetes
4) Epilepsy
5) Mania

39
Q

How does lithium work?

A

Likely effects reuptake of serotonin and norepinephrine

40
Q

What are the main side effects of lithium?

A

1) Gastrointestinal issues (e.g., nausea, vomiting, diarrhea, a metallic taste, and weight gain)
2) Fine hand tremor and shakiness
3) Fatigue
4) Restlessness
5) Polyuria (excessive urine production)
6) Polydipsia (excessive thirst)

41
Q

What are signs of lithium toxicity and what precautions are needed with lithium?

A

Lithium toxicity involves diarrhea, ataxia, drowsiness, slurred speech, confusion, coarse tremors, seizures, coma, and death.

People should avoid fluctuations in their salt intake and avoid diuretics (caffeine, alcohol, etc.). People should avoid taking lithium if they have cardiovascular, kidney, liver, thyroid, or gastrointestinal problems.

42
Q

What are the 3 anticonvulsants?

A

Carbamazepine, valproic acid (Depakote), and clonazepam (Klonopin)

43
Q

What are anticonvulsants used to treat?

A

Anticonvulsants have been used to treat:
1) Seizures
2) Mood instability (particularly effective for mania with dysphoric mood and rapid cycling)

44
Q

How do anticonvulsants work?

A

Likely affect levels of serotonin

45
Q

What are the main side effects of anticonvulsants?

A

1) Dizziness
2) Ataxia
3) Visual disturbances
4) Anorexia
5) Nausea
6) Rash
7) Agranulocytosis
8) Aplastic anemia

Carbamazepine is contraindicated for people with abnormalities in cardiac conduction.

46
Q

How do barbiturates work?

A

Barbiturates exert their effects by interrupting impulses to the reticular activating system

47
Q

What are the main side effects of barbiturates?

A

1) Slurred speech
2) Nystagmus
3) Dizziness
4) Irritability
5) Impaired motor and cognitive performance.
6) Ataxia
7) Confusion
8) Agitation
9) Respiratory depression
10) Death

48
Q

What unique side effects can occur with abrupt barbiturate cessation?

A

REM rebound and nightmares

49
Q

How do benzodiazepines work?

A

Benzodiazepines stimulate the inhibitory action of the neurotransmitter GABA

50
Q

What are benzodiazepines used for?

A

The benzodiazepines are prescribed for:
1) Anxiety
2) Sleep disturbances
3) Seizures
4) Cerebral palsy
5) Disorders involving muscle spasms
6) Alcohol withdrawal

51
Q

What are the main side effects of benzodiazepines?

A

1) Drowsiness/lethargy
2) Dizziness
3) Slurred speech
4) Ataxia
5) Impaired psychomotor ability
6) Irritability and hostility
7) Paradoxical excitation or agitation
8) Increased appetite and weight gain
9) Rash
10) Blood dyscrasias
11) Impaired sexual functioning
12) Disorientation and confusion
13) Sleep disturbances
14) Anterograde amnesia
15) Depression

52
Q

What is the likely cause of psychological benzodiazepine dependence?

A

The resulting relaxation, euphoria, and sense of well-being

53
Q

What is azapirone and what is it used to treat?

A

Azapirone (buspirone) is the first anxiolytic that reduces anxiety without sedation or addiction, likely because it must be taken for several weeks before it is effective.

54
Q

How do beta-blockers work?

A

Beta-blockers block beta-adrenergic receptors, which respond to epinephrine and norepinephrine

55
Q

What are the main side effects of beta-blockers?

A

1) Bradycardia
2) Shortness of breath
3) Arterial insufficiency (usually of the Raynaud’s type)
4) Nausea
5) Diarrhea
6) Depression
7) Dizziness
8) Sexual dysfunction
9) Trouble sleeping
10) Numbness or tingling

Propranolol should not be used by people with obstructive pulmonary disease

56
Q

What are narcotic-analgesics used to treat?

A

1) Diarrhea
2) Cough suppressants
3) Short-lived “rush” or sense of euphoria
4) Tranquility
5) Drowsiness
6) Apathy
7) Decreased physical activity
8) Impaired attention and memory

57
Q

How do narcotic-analgesics work?

A

Narcotics work by acting on opioid receptors in the spinal cord and various regions of the brain including the amygdala, thalamus, and hypothalamus

58
Q

What are the main side effects of narcotics?

A

1) Constricted pupils and decreased visual acuity
2) Increased perspiration
3) Constipation
4) Nausea
5) Vomiting
6) Respiratory depression

59
Q

What are the 3 types of narcotics and their subtypes?

A

1) Natural opioids (opium, morphine, and codeine)
2) Semi-synthetic derivatives of morphine (heroin, Percodan, Dilaudid)
3) Pure synthetics (Demerol, Darvon, methadone)

60
Q

What symptoms are associated with narcotic overdose?

A

Overdose (toxicity) can produce slow and shallow breathing, muscle rigidity, catalepsy, clammy skin, decreased blood pressure and pulse rate, convulsions, coma, and death

61
Q

What are the withdrawal symptoms for narcotics?

A

Withdrawal symptoms resemble those associated with a bad case of the flu - stomach cramps, nausea, vomiting, weakness, fever, muscle and joint pain, sweating, and insomnia

62
Q

How does narcotic dependence usually develop?

A

1) Psychological dependence develops due to sense of euphoria
2) Physical dependence develops by the time tolerance to the euphoric effects develop
3) Dependence is maintained to avoid withdraw symptoms

63
Q

What are psychostimulants used to treat?

A

1) Amphetamines - Narcolepsy and Attention-Deficit Hyperactivity Disorder (ADHD)
2) Methylphenidate - ADHD

64
Q

How do psychostimulants work?

A

Psychostimulant drugs potentiate the release of norepinephrine and dopamine and block their reuptake

65
Q

What are the main side effects of psychostimulants?

A

1) Restlessness
2) Insomnia
3) Poor appetite
4) Tremor
5) Unusual or inconsistent heart beat
6) Abdominal pain
7) Growth suppression
8) A psychotic state that resembles paranoid Schizophrenia
9) Dysphoria (anxiety, irritability, depression, euphoria, sadness)

Methylphenidate is contraindicated for individuals with anxiety and tension, anorexia, severe hypertension or angina pectoris, a history of functional psychosis, a history of drug abuse, or pre-existing tics.

66
Q

What are the withdraw symptoms for sedative-hypnotics?

A

1) Tremors
2) Anxiety
3) Nausea
4) Vomiting
5) Paranoia
6) Hallucinations
7) Delirium
8) Seizures

67
Q

How does disulfiram work?

A

Disulfiram inhibits alcohol metabolism, causing an accumulation of acetaldehyde and unpleasant reactions (e.g., severe nausea, vomiting, sweating, headache, tachycardia, and hypotension)

68
Q

How does naltrexone work?

A

Naltrexone is an opioid receptor antagonist and blocks the craving for and reinforcing effects of alcohol

69
Q

What are the side effects of disulfiram?

A

1) Drowsiness
2) Depression
3) Disorientation
4) Headache
5) Restlessness
6) Impotence
7) Blood dyscrasias

70
Q

What are the side effects of naltrexon?

A

1) Abdominal cramping
2) Nausea
3) Vomiting
4) Insomnia
5) Nervousness
6) Headache
7) Joint
8) Muscle pain

71
Q

What are the 3 main types of genetic tests?

A

1) Cytogenetics involves the examination of chromosomes and their abnormalities
2) Biochemical testing utilizes techniques that examine the protein instead of the gene
3) Direct molecular DNA testing analyzes a gene sequence of interest

EPPP (8 decks)

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