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Block7 > PDA neuropsycohparm > Flashcards

PDA neuropsycohparm Flashcards

1
Q

What are the two classification of mood disorders in the DSM-5?

A

bipolar and related disorders

depressive disorders

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2
Q

What are the requirements for a major depressive episode?

A 
5 of the below
diminished interst or pleasure
weight change
insomnia/hypersomia
fatigue
feelings of worthlessness
innappropiate guilt
agitation/retardation
difficulty concentrating
preoccupation with death/suicidal ideation
depressed mood
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3
Q

What is the monoamine theory of depression?

A

results from functionally defficient monomaine transmission
based on pharm evidence
simple monoamine hypothesis no longer tenable as explanation

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4
Q

What are the effects of tricyclic antidepressants on noradrenergic transmission?

A

block norepi reuptake

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5
Q

What is the restated monoamine hypothesis?

A

depression is due to biogenic amine receptor or transmission imbalance. Various drugs that we are discussing today, act to change the imbalance and restor a more normal affect

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6
Q

What are the classes of anti-depressants?

A 
SSRI
SNRI (serotonin-norepi reuptake inhibitors)
atypical drugs
tricyclic antidepressants
MAO inhibitors
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7
Q

What are the symptoms of SSRI withdrawal?

A 
dizziness, light-headedness, vertigo or faint feeling
shock like
paresthesia
anxiety
diarrhea
fatigue
gait instability
headache
insomnia
irritability
nausea or vomitting
tremor
visual disturbances
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8
Q

What are approved uses of SSRI’s?

A 
major depression
OCD
panic disorder
social anxiety disorder
PTSD
Generalized anxiety disorder
PMS-now PDD
hot flashes
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9
Q

What are SSRI’s?

A

fluoxetine-first SSRI on market

Setraline-similar in action; shorterhalf life

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10
Q

What is the main SNRI drug?

A

block both 5-HT and NE reuptake

duloxetine-(12-18 hour half life)

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11
Q

What is duloxetine used to treat?

A

depression, neuropathic pain, fibromyalgia, back pain, and osteoarthritis, caution with liver disease

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12
Q

What are the common atypical antidepressants?

A

Bupropion-approved for nicotine withdrawal and SAD; weakly blocks NE and dopamine uptake.
Mirtazapine-blocks presynaptic alpha2 receptors in braine increases appeptide in AIDS pts

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13
Q

What is the tricyclic antidepressants?

A

first highly effective drug for tx of depression. Block NE and 5HT reuptake
long plasma half life

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14
Q

What drug interactions occur with tricyclic antidepressants?

A

guanethidine-blocks guanethidine uptake
sympathomiimetic drugs-particulary indrect acting agents
effects absorption and metabolism

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15
Q

What are the therapeutic uses of tricyclic antidepressants?

A

major depressive disorder
enursis in childhood\
chonic pain-(amitriptyline)
OCD-clomipramine and SSRIs

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16
Q

What is the role of MAO inhibition in treating depressant?

A

action takes about 2 weeks
may trigger hypomainia in bipolar
corrects sleep disorder in depressed patient
produce normal stimulation

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17
Q

What are other treatments for depression?

A

Electroconvulsive shock therapy

transcranial magnetic stimulation

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18
Q

What drugs are nonspecifci blockers of NE and 5-HT reuptake?

A

Imipramine, amitriptyline

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19
Q

SSRI

A

fluoxetine, sertaline, paroxetine, citalopram, escitalopram

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20
Q

What is a SNRI?

A

Venlafaxine, Duloxetine

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21
Q

What are monoamine oxidase inhibitors

A

phenelzine

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22
Q

Other monoamine mechanisms

A

bupropion, mirtazapine

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23
Q

What are the symptoms of schizophrenia?

A 
1 positive, 2 minimum for 1 month
positive:
delusions
hallucinations
disorganized speech
other
grossly disorganized or catatonic behavior
blunted affect
poor abstract
poverty of thought
social withdrawal
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24
Q

What is the dopamine hypothesis?

A

Schizophrenia results from hyperactivity of dopaminergic neruosn or their receptors particulary with terminals in limbic area
MA-all effective antipsychotics interact with dopamine

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25
Q

What are hte dopaminergic pathways?

A

mesolimbic tract
mesocortical tract
nigrostriatal pathway
tuberonifundibular tract

26
Q

atypical antipsychotics are what?

A

most of hte newer drugs such as clozapine, risperidone; have additional effect in addition to DA receptor blockade
block 5-HT2 receptor in forebrain often with greater potency than for DA receptors

27
Q

Actions of antipsychotic drugs?

A

decrease in psychotic behavior, sedation, extrapyradmial effects
orthostatic hypertension, anticholinergic, allergic and idiosyncratic effects, neuroendocrin effects
decreased seizure threshold, weight gain

28
Q

What atypical antipsychotic has cardiac effects?

A

Thioridazine

29
Q

What is neruoleptic malignant syndrome?

A

Potentially lethal hypodopaminergic side effect of antipsychotic drugs; hyperthermia

30
Q

What is phenothiazine?

A

original antipsychotic, currently less commonly used

31
Q

What is haloperidol used for?

A

not chemically related to phenothiazine but it is a pharm similar to high-potency piperazine derivative; typical antipsychotic

32
Q

What is the difference of atypical drugs?

A

Need for better antipsychotic drugs, more acceptable side-effect profile, more efficacious in tx negative symptpms of schizophrenia

33
Q

What is clozapine?

A

block D4 and 5-HT2; muscarinic antagonists. Improve positive symptoms even in pts not helped by other drugs
improves negatives symptoms
lower seizure thresholds

34
Q

What is olanzapine?

A 
related to colzapine
potent 5-HT2 antagonist
D1 and 2 antagonist
few extrapyramidal symptoms
less seizure incidence than clozapine
no agranulocytosis
35
Q

What is risperidone?

A

Combined D2 adn 5HT2 antagonist
greater reduction in negative symptoms and less extrapyramidal symptoms
less seizure activity

36
Q

WHat is the DSM4 criteria for manic episodes?

A 
inflated self-esteem/grandiosity
decreased need for sleep
talkativeness
flight of ideas/racing thoughts
distractability
increased goal-directed activity
excessive involvement in pleasureable activities
37
Q

What is lithium?

A

monovalent cation; one of few psychotherapeutic drugs that has no behavioral effects in “normals”
blocks manic behavior

38
Q

What has an effect on Lithium levels?

A

Na levels; increased Na secretion causes increase in Li levels;
thiazide diuretics, losses of fluids or electrolytes
ACE inhibitors and Angiotensin 2 receptor blockers can also raise Li levels

39
Q

Side effects and toxic raections of Lithium?

A

fatigue and muscular weakness
tremor-may be treated with beta-blcokers
GI symptoms; slurred speech and ataxia
serious toxicity at plasma lvels about 2 to 3 times levels

40
Q

What are the clinical uses of lithium?

A

treat mania na dpreven recurrences of bipolar disease
may be useful in preventing recurrences of unipolar depression
cluster headaches

41
Q

Alternatives to lithium are what?

A

carbamazepine
Valproic acid
haloperidol
olanzapine and fluoxetine

42
Q

What is Carbamazepine mechanism of action?

A

Mechanism of action similar to phenytoin; blocks sodium channel at therapeutic concentration
; doesn’t appear to interact with GABA systems

43
Q

What is the mechanism of action of valproic acid?

A

blocks repetitive neuronal firing; may reduce t type Ca2+ currents; increase GABA concentrations

44
Q

What is the clinical uses of Valproic acid?

A

absence seizures
absence seizures with concomitant-gernalized tonic-clonic seizures
generalized tonic-clonic seizures and partial seizures
myoclonic seizures

45
Q

What are the side effects of valproic acid?

A

GI upset, weight gain, hair loss, idiosyncratic hepatotoxicity, tetraogenicity-spinal bifida

46
Q

What are the DSM-5 anxiety disorders?

A

Key syndrome is excessive fear and anxiety;
ANS fight or flight sympoms
muscle tesnsion and vigilance

47
Q

What are the disorders in anxiety classification?

A 
separation anxiety disorder
selective mutism
specific phobia
social anxiety disorder
panic disorder
agoraphobia
GAD
48
Q

Generalized anxiety disorder classifications are what?

A

generalized persistent anxiety for at least 1 month duration

absence of specific symptoms and patterns

49
Q

Tx of anxiety and insomnia is done with what classes of drugs?

A 
benzos
SSRIs
Buspirone
classical antihistamines
Barbituates
50
Q

What is mechanism of action of Buspirone?

A

partial agonist for 5HT1A inhibition of adenylate cyclase and opens K+ channels

51
Q

What are hte three common benzodiazepines used to treat anxiety?

A

diazepam, alprazolam, Lorazepam

52
Q

What drugs have desmethyldiazepam and oxazepam as active metabolites?

A

Chlordiazepoxide, Diazepam, Prazepam, Clorazepate

53
Q

What are the CNS effects of benzothiazepines?

A

decreased anxiety, sedation, hypnosis, muscle relaxation, anterograde amnesia, anticonvulsant action,
minimal CV and respiratory actions at Tx dose

54
Q

What are the clinical uses of diazepam?

A

anxiety states, sleep disorders, muscle relaxant, seizure treatment, IV sedation and anesthesia

55
Q

What benzothiazepine is used for alcohol withdrawal?

A

chlordiazepoxide

56
Q

What benzothiazepine is used for acute manic episodes?

A

clonazepam

57
Q

What are the benzodiazepine withdrawal symptoms?

A

anxiety, insomnia, irritability, headache, hyperacusis, hallucinations, seizures

58
Q

What drugs used as hypnotics?

A

flurazepam
Triazolam
lorazepam
zolpidem

59
Q

What non-benzodiazepine binds BDZ receptor on GABA complex?

A

Zolpidem

60
Q

What two GABAergic agents are used treat skeletal muscles?

A

Diazepam

Baclofen

61
Q

What alpha2 adrenergic agonists that is used to relate to clonidine?

A

Tizanidine

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