Physchopharmacology Flashcards
What are some psychotropic medications
Sedative hypotonic (anti-anxiety)
Anti-depressants
Antipsychotics
Treatments of dementia
Primary goals of the sedative Sedative Hypotonic; Anti anxiety drugs
Want to relax the patient
Have good quality sleep
Decrease their anxiety
How do we monitor their sleeping patterns
Look at electrocardiogram (EKG)
What are the primary agents for Sedative Hypotonic/Anti anxiety drugs
Benzodiazepine and many others
What is one thing we must monitor with anti anxiety drug dosage
Do not want to much sedation or sleep so they are still able to perform functions
Explain the Sedative hypotonic Benzodiazepine drugs
Popular 20-30 years ago
Were essentially sleeping pills
Explain the antidepressant Benzodiazepine drugs
These will have a less sedative effect unless it has a high dosage.
More focused for anxiety can be used for sleep
Types of Sedative hypotonic Benzodiazepine drugs
Estazolam
Quazepam
Temazepam
Triazolam (housien)
Types of Anti-Depressant Benzodiazepine drugs
Diazepam(Valium)
Chlordiazepoxide
Iorazepam
Alprazolam
How do Benzodiazepines work
Increase the inhibitory effects of GABA by binding to receptor
Allows Cl to enter and the neuron becomes harder to excite
Inhibit NT’s and decrease excitation of CNS
What are the new sedative hypnotic drugs
Z- drugs (zolpidem and Zalepion)
Eszopiclone(lunesta)
Ramelteon (Rozerem)
Explain how the the z drugs differ and are similar to the benzodiazepines
They are chemically different but they will both bind to the GABA receptors.
Will bind to other subunits
May have less problems with discontinuing (less rebound)
Explain Eszopiclone (lunesta)
Works similar to benzodiazepine. Will bind to GABA receptor cite. chemically different
Explain Ramelteon
It is a melatonin receptor agonist
What are some of the benifits of the newer sedative hypnotic drugs
Have been used for treating insomnia(long term effects not established yet)
Having these drug options offer patients the ability to find the drug that works best for them
What are the newer anti-anxiety drugs
Azapirones: Buspirone (BuSpar)
How do the Azapirones work
Stimulate serotonin receptors in CNS
What are the benefits of Azapirones
May decrease anxiety with less sedation and less dependence
What are some drawbacks of the Azapirones
There is a slow onset and only moderate efficacy
Who would Azapirones work best for
Older patients with anxiety
What can be used with patients who have anxiety and depression
Use antidepressants as an anxiolytic (inhibit anxiety)
What are some benifits of using an antidepressant as an anxiolytic
Has less addictive effects may have less side effects
What does -quetiapine mean
Anti psychotic
What does gabapentin do
Anti Seizure
What is pregabalin
Anti seizure
What is hydroxygine
Anti-histamine
What are some side effects of the sedative hypnotic/anti-anxiety drugsdrugs (5)
Sleeping (hangover effect, confused, nauseous)
Agitated
Anterograde: loss of memory (short term memory)
Rebound effect (insomnia, increased anxiety)
Tolerance/Dependence
What are some complex behaviors that can occur from sedative hypnotic/anti-anxiety drugs
Sleep eating/walking/ even driving
Due to the dosage being too high
What disease may be associated with sedative hypnotic/anti-anxiety drugs
Alzheimer may be linked with benzodiazepines
Numbs the brain
What are some concerns with sedative hypnotic/anti-anxiety drugs
They treat the symptoms but do not treat the cause of insomnia or anxiety
Do the benefits outweigh the sedation
How can we make the sedative hypnotic/anti-anxiety drugs more effective
Pair the drugs with non pharmacy treatment such as physical therapy
What is the ideal situation while using sedative hypnotic/anti-anxiety drugs
Getting quality sleep with less anxiety
Becoming more active and participating socially
Define Depression
Sadness that is incapacitating (can’t enjoy life, family or job)
How common is depression
Is the most common mental illness based on incidence and prevalence
What is the basis of neurochemical study of depression
If we understand the neurochemistry of depression we can better treat the pt
What is the current theory in neurophysiology on depression
Caused by a deficit of biogenic amines or neurotransmitters in the CNS
What are some biogenic amines that would cause depression if they were in deficit
Norepinephrine
Dopamine
Serotonin
What is the strategy of anti depression drugs
Prolong the effects of the biogenic amines
What are the types of antidepressants
Tricyclics
Monoamine oxidase (MAO) inhibitors
Second generation drugs
Selective serotonin reuptake Inhibitors (SSRI)
Serotonin-norenepherine Reuptake Inhibitor (SNRI)
What are some SSRI’s
Prozac
Zoloft
Lexapro
Celexa
What are some SNRI.
Pristiq
Cymbalta
Effexor
What is the goal of SSRI
Works on the limbic system
Is a famous anti-depressant
Will have little to no effect on NEP or dopamine
What is the goal of SNRI
Works only on the serotonin and NEP.
No effect on dopamine
What are Tricyclics
Oldest form of antidepressants
Not well known but very effective
What are the names of some tricyclic drugs
Elavil
Ascending
Norpramin
What are the MAO drugs used for
Used as a last resort for ant depression
What do the drugs nefaodone and Trazodone do
Block serotonin receptors and serotonin uptake
What does the drug bupripion do
It is a Norepinephrine and dopamine reuptake inhibitor
What does the drug mirtazapine do
May clock the presynaptic but is very complicated
How do the antidepressant drugs work
They will prolong the effects of the amine neurotransmitter by
1) inhibiting the NT reuptake (SSRI/SNRI)
2) Preventing the NT breakdown (MAO inhibitor)
How will MAO inhibitors prevent the breakdown of NT’s
1) They will recycle the NT by reuptaking them into the presynaptic neuron
2) Inhibit the enzymes that break down the NT’s
How will tricyclics and 2nd generation drugs work on NT
They cause the NT to remain in the synapse so they activate the receptors on the postsynaptic neuron over and over
Adverse effects of Tricyclics
Sedation
Anticholinergic (dry mouth, seizures, could be fatal)
Orthostatic hypertension (sudden increase in blood pressure when someone stands up)
Adverse effects of MAO inhibitors
CNS excitation
Increase blood pressure (especially those who eat femented foods)
Adverse effects of Second generation drugs
These are generally better tolerated but can have some GI issues with overdose
Which second generation drugs are more tolerable
SSRI and SNRI
What is Serotonin syndrome
Occurs when the serotonin receptors are over stimulated
What are some symptoms of serotonin syndrome (5)
High blood pressure and HR Shivering Dyskinesia Muscle pain GI problems
Is serotonin syndrome reversible
Usually if it is caught early
If unchecked it could be fatal
What are some concerns with anti depressants
May be 1-2 weeks before we see effects
Could become more depressed if they are not getting better fast enough
Could cause harm to themselves (mood swing)
How long do we wait before the antidepressant is deemed ineffective
6 weeks
What drug is used to treat bipolar syndrome
Lithium
What is the mechanism of action for lithium
Unclear, thought to prevent manic episode
May stabilize neurons (neuroprotective)
How is lithium eliminated
Remains intact and eliminated through kidneys
What is lithium toxicity
Accumulation of lithium in the kidney
Symptoms of mild lithium toxicity (4)
Metallic taste
Fine Tremor in hands
Nausea
Generalized weakness
Symptoms of moderate lithium toxicity (5)
Vomiting Diarrhea Increased tremors Dizziness/incoordination Blurred vision
Symptoms of severe lithium toxicity
Confusion Hallucinations Nystagmus (involuntary eye movement) Dysarthia (motor speech) Fasciculation (muscle twitching)
How will lithium toxicity progress
It could be slow or rapid
Need to monitor closely
Need to catch early or it will damage the cerebellum
What are anti-manic effects
Prevent swing from manic to depressed
What are some other bipolar treatments
Anti-seizure
Antipsychotic
What are some drawbacks of using drugs other than lithium to treat bipolar disorders
May cause some movement disorders or other side effects associated with Anti-seizure or antipsychotic drugs
What is psychosis
More severe than depression or anxiety
May see or hear things
Have fragmented thoughts
What causes psychosis
Increase dopamine acting on the CNS as well as other NTs
How do antipsychotic drugs work
They block the dopamine receptors in the CNS specifically the D2 receptors
How much dopamine is blocked with antipsychotic drugs
Not all of the dopamine, just enough
Called normalize dopamine
Why are the new antipsychotic drugs called atypical agents
They do not have the typical side effects as the traditional drugs
What NT may antipsychotic drugs improve
Serotonin
What are some adverse side effects of the traditional antipsychotic drugs
Orthostatic hypertension
Sedation
Anticholinergic effects
What are some adverse side effects of atypical antipsychotic drugs
Weight gain
Disturbed fat and sugar digestion
What is the primary concern of antipsychotic drugs
Motor side effects (MOST IMPORTANT)
What are some extrapyramidal side effects of antipsychotic drugs (4)
Tardive Dyskinesia
Psuedoparkinsonism
Akathisia
Other dystonias or dyskensisa of extremities ( Chorea Athletoid)
What is Tardive Dyskinesia
Oral facial movements; lips, tongue, jaw, grimacing
*Could be permanent even if found early
What is Psuedoparkinsonism
Decrease in dopamine activity
We want to decrease it but in a different par of the brain
May go away after taken off drug
What is akathisia
Severe restlessness
What causes Tardive Dyskinesia
Denervation will occur and then new synapses are formed
What is the prevalence of Tardive Dyskinesia
1/4 of patients with long term antipsychotic drugs
What puts you at risk for Tardive Dyskinesia
Genetic issues
Mood disorders
Using antipsychotic drugs over 6 months
What is neuroleptic malignant syndrome
Cancerous
Can occur with all antipsychotic drugs
Can be fatal
What are some symptoms of neuroleptic malignant syndrome (4)
Rigidity
Catatonia(unresponsive)
Tremors
Fever
What is Alzheimer’s disease
Irreversible dementia
Due to shrinking of the brain
What will change in the CNS (3)
Neuronal structure Neuronal function (Loss of neuronal activity) Will not be a minor change, will be profound throughout the entire brain
What are the goals when treating dementia
Improve their cognitive and intellectual abilities
Improve their behavior
How to improve function in patients with dementia
Neuronal changes decrease acetylcholine activity in brain
Effects the higher part of the cortex (involved in memory)
Cholinergic stimulants used to increase ACH activity either indirectly or directly
How do indirect Cholinergic drugs effect dementia
Will not directly effect the ACH receptor
Inhibits enzyme that breaks down ACH
What enzyme will break down ACH
Cholinesterase
What are the Cholinergic stimulants in Alzheimer disease
Aricept
Razadyne
Exelon
Cognex
What are some indications to use Cholinergic stimulants
To improve cognition
Behavior function
Memory
What determines the efficacy of Cholinergic stimulants
If it helps them retain more cognitive information in the early stages of Alzheimer’s
When will Cholinergic stimulants be ineffective in treating AD
When there is rapid progression of the disease.
Due to not producing neurotransmitters
What is memantine
New form of AD drug which blocks NMDA-glutamate receptors in the brain
What does glutamate do to the brain
Excitatory amino acid that is used in memory and learning
What is the mechanism of Memantine
During AD glutamate activity is disrupted. Drug will normalize glutamate influence
What is a potential problem of memantine
Too little or too much dosage could be harmful and actually advance the disease.
What are some drugs used to modify or improve behavior
Antidepressants
Anti-Anxiety agents
Antipsychotic
What role did the government play in antipsychotic drugs
Placed regulations on the use of drugs due to OD
-Can’t just use antipsychotic just because the pt’s behavior is “unacceptable
What is symptom specific medication, and what disease is it associated with
Using the type of medication based on the problems the patient presents with.
Alzheimer’s
