PDA neuropsycohparm Flashcards
What are the two classification of mood disorders in the DSM-5?
bipolar and related disorders
depressive disorders
What are the requirements for a major depressive episode?
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
What is the monoamine theory of depression?
results from functionally defficient monomaine transmission
based on pharm evidence
simple monoamine hypothesis no longer tenable as explanation
What are the effects of tricyclic antidepressants on noradrenergic transmission?
block norepi reuptake
What is the restated monoamine hypothesis?
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
What are the classes of anti-depressants?
SSRI SNRI (serotonin-norepi reuptake inhibitors) atypical drugs tricyclic antidepressants MAO inhibitors
What are the symptoms of SSRI withdrawal?
dizziness, light-headedness, vertigo or faint feeling shock like paresthesia anxiety diarrhea fatigue gait instability headache insomnia irritability nausea or vomitting tremor visual disturbances
What are approved uses of SSRI’s?
major depression OCD panic disorder social anxiety disorder PTSD Generalized anxiety disorder PMS-now PDD hot flashes
What are SSRI’s?
fluoxetine-first SSRI on market
Setraline-similar in action; shorterhalf life
What is the main SNRI drug?
block both 5-HT and NE reuptake
duloxetine-(12-18 hour half life)
What is duloxetine used to treat?
depression, neuropathic pain, fibromyalgia, back pain, and osteoarthritis, caution with liver disease
What are the common atypical antidepressants?
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
What is the tricyclic antidepressants?
first highly effective drug for tx of depression. Block NE and 5HT reuptake
long plasma half life
What drug interactions occur with tricyclic antidepressants?
guanethidine-blocks guanethidine uptake
sympathomiimetic drugs-particulary indrect acting agents
effects absorption and metabolism
What are the therapeutic uses of tricyclic antidepressants?
major depressive disorder
enursis in childhood\
chonic pain-(amitriptyline)
OCD-clomipramine and SSRIs
What is the role of MAO inhibition in treating depressant?
action takes about 2 weeks
may trigger hypomainia in bipolar
corrects sleep disorder in depressed patient
produce normal stimulation
What are other treatments for depression?
Electroconvulsive shock therapy
transcranial magnetic stimulation
What drugs are nonspecifci blockers of NE and 5-HT reuptake?
Imipramine, amitriptyline
SSRI
fluoxetine, sertaline, paroxetine, citalopram, escitalopram
What is a SNRI?
Venlafaxine, Duloxetine
What are monoamine oxidase inhibitors
phenelzine
Other monoamine mechanisms
bupropion, mirtazapine
What are the symptoms of schizophrenia?
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
What is the dopamine hypothesis?
Schizophrenia results from hyperactivity of dopaminergic neruosn or their receptors particulary with terminals in limbic area
MA-all effective antipsychotics interact with dopamine
What are hte dopaminergic pathways?
mesolimbic tract
mesocortical tract
nigrostriatal pathway
tuberonifundibular tract
atypical antipsychotics are what?
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
Actions of antipsychotic drugs?
decrease in psychotic behavior, sedation, extrapyradmial effects
orthostatic hypertension, anticholinergic, allergic and idiosyncratic effects, neuroendocrin effects
decreased seizure threshold, weight gain
What atypical antipsychotic has cardiac effects?
Thioridazine
What is neruoleptic malignant syndrome?
Potentially lethal hypodopaminergic side effect of antipsychotic drugs; hyperthermia
What is phenothiazine?
original antipsychotic, currently less commonly used
What is haloperidol used for?
not chemically related to phenothiazine but it is a pharm similar to high-potency piperazine derivative; typical antipsychotic
What is the difference of atypical drugs?
Need for better antipsychotic drugs, more acceptable side-effect profile, more efficacious in tx negative symptpms of schizophrenia
What is clozapine?
block D4 and 5-HT2; muscarinic antagonists. Improve positive symptoms even in pts not helped by other drugs
improves negatives symptoms
lower seizure thresholds
What is olanzapine?
related to colzapine potent 5-HT2 antagonist D1 and 2 antagonist few extrapyramidal symptoms less seizure incidence than clozapine no agranulocytosis
What is risperidone?
Combined D2 adn 5HT2 antagonist
greater reduction in negative symptoms and less extrapyramidal symptoms
less seizure activity
WHat is the DSM4 criteria for manic episodes?
inflated self-esteem/grandiosity decreased need for sleep talkativeness flight of ideas/racing thoughts distractability increased goal-directed activity excessive involvement in pleasureable activities
What is lithium?
monovalent cation; one of few psychotherapeutic drugs that has no behavioral effects in “normals”
blocks manic behavior
What has an effect on Lithium levels?
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
Side effects and toxic raections of Lithium?
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
What are the clinical uses of lithium?
treat mania na dpreven recurrences of bipolar disease
may be useful in preventing recurrences of unipolar depression
cluster headaches
Alternatives to lithium are what?
carbamazepine
Valproic acid
haloperidol
olanzapine and fluoxetine
What is Carbamazepine mechanism of action?
Mechanism of action similar to phenytoin; blocks sodium channel at therapeutic concentration
; doesn’t appear to interact with GABA systems
What is the mechanism of action of valproic acid?
blocks repetitive neuronal firing; may reduce t type Ca2+ currents; increase GABA concentrations
What is the clinical uses of Valproic acid?
absence seizures
absence seizures with concomitant-gernalized tonic-clonic seizures
generalized tonic-clonic seizures and partial seizures
myoclonic seizures
What are the side effects of valproic acid?
GI upset, weight gain, hair loss, idiosyncratic hepatotoxicity, tetraogenicity-spinal bifida
What are the DSM-5 anxiety disorders?
Key syndrome is excessive fear and anxiety;
ANS fight or flight sympoms
muscle tesnsion and vigilance
What are the disorders in anxiety classification?
separation anxiety disorder selective mutism specific phobia social anxiety disorder panic disorder agoraphobia GAD
Generalized anxiety disorder classifications are what?
generalized persistent anxiety for at least 1 month duration
absence of specific symptoms and patterns
Tx of anxiety and insomnia is done with what classes of drugs?
benzos SSRIs Buspirone classical antihistamines Barbituates
What is mechanism of action of Buspirone?
partial agonist for 5HT1A inhibition of adenylate cyclase and opens K+ channels
What are hte three common benzodiazepines used to treat anxiety?
diazepam, alprazolam, Lorazepam
What drugs have desmethyldiazepam and oxazepam as active metabolites?
Chlordiazepoxide, Diazepam, Prazepam, Clorazepate
What are the CNS effects of benzothiazepines?
decreased anxiety, sedation, hypnosis, muscle relaxation, anterograde amnesia, anticonvulsant action,
minimal CV and respiratory actions at Tx dose
What are the clinical uses of diazepam?
anxiety states, sleep disorders, muscle relaxant, seizure treatment, IV sedation and anesthesia
What benzothiazepine is used for alcohol withdrawal?
chlordiazepoxide
What benzothiazepine is used for acute manic episodes?
clonazepam
What are the benzodiazepine withdrawal symptoms?
anxiety, insomnia, irritability, headache, hyperacusis, hallucinations, seizures
What drugs used as hypnotics?
flurazepam
Triazolam
lorazepam
zolpidem
What non-benzodiazepine binds BDZ receptor on GABA complex?
Zolpidem
What two GABAergic agents are used treat skeletal muscles?
Diazepam
Baclofen
What alpha2 adrenergic agonists that is used to relate to clonidine?
Tizanidine
