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Physchopharmacology Flashcards

1
Q

What are some psychotropic medications

A

Sedative hypotonic (anti-anxiety)
Anti-depressants
Antipsychotics
Treatments of dementia

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2
Q

Primary goals of the sedative Sedative Hypotonic; Anti anxiety drugs

A

Want to relax the patient
Have good quality sleep
Decrease their anxiety

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3
Q

How do we monitor their sleeping patterns

A

Look at electrocardiogram (EKG)

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4
Q

What are the primary agents for Sedative Hypotonic/Anti anxiety drugs

A

Benzodiazepine and many others

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5
Q

What is one thing we must monitor with anti anxiety drug dosage

A

Do not want to much sedation or sleep so they are still able to perform functions

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6
Q

Explain the Sedative hypotonic Benzodiazepine drugs

A

Popular 20-30 years ago

Were essentially sleeping pills

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7
Q

Explain the antidepressant Benzodiazepine drugs

A

These will have a less sedative effect unless it has a high dosage.
More focused for anxiety can be used for sleep

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8
Q

Types of Sedative hypotonic Benzodiazepine drugs

A

Estazolam
Quazepam
Temazepam
Triazolam (housien)

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9
Q

Types of Anti-Depressant Benzodiazepine drugs

A

Diazepam(Valium)
Chlordiazepoxide
Iorazepam
Alprazolam

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10
Q

How do Benzodiazepines work

A

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

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11
Q

What are the new sedative hypnotic drugs

A

Z- drugs (zolpidem and Zalepion)
Eszopiclone(lunesta)
Ramelteon (Rozerem)

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12
Q

Explain how the the z drugs differ and are similar to the benzodiazepines

A

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)

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13
Q

Explain Eszopiclone (lunesta)

A

Works similar to benzodiazepine. Will bind to GABA receptor cite. chemically different

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14
Q

Explain Ramelteon

A

It is a melatonin receptor agonist

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15
Q

What are some of the benifits of the newer sedative hypnotic drugs

A

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

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16
Q

What are the newer anti-anxiety drugs

A

Azapirones: Buspirone (BuSpar)

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17
Q

How do the Azapirones work

A

Stimulate serotonin receptors in CNS

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18
Q

What are the benefits of Azapirones

A

May decrease anxiety with less sedation and less dependence

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19
Q

What are some drawbacks of the Azapirones

A

There is a slow onset and only moderate efficacy

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20
Q

Who would Azapirones work best for

A

Older patients with anxiety

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21
Q

What can be used with patients who have anxiety and depression

A

Use antidepressants as an anxiolytic (inhibit anxiety)

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22
Q

What are some benifits of using an antidepressant as an anxiolytic

A

Has less addictive effects may have less side effects

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23
Q

What does -quetiapine mean

A

Anti psychotic

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24
Q

What does gabapentin do

A

Anti Seizure

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25
What is pregabalin
Anti seizure
26
What is hydroxygine
Anti-histamine
27
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
28
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
29
What disease may be associated with sedative hypnotic/anti-anxiety drugs
Alzheimer may be linked with benzodiazepines | Numbs the brain
30
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
31
How can we make the sedative hypnotic/anti-anxiety drugs more effective
Pair the drugs with non pharmacy treatment such as physical therapy
32
What is the ideal situation while using sedative hypnotic/anti-anxiety drugs
Getting quality sleep with less anxiety | Becoming more active and participating socially
33
Define Depression
Sadness that is incapacitating (can't enjoy life, family or job)
34
How common is depression
Is the most common mental illness based on incidence and prevalence
35
What is the basis of neurochemical study of depression
If we understand the neurochemistry of depression we can better treat the pt
36
What is the current theory in neurophysiology on depression
Caused by a deficit of biogenic amines or neurotransmitters in the CNS
37
What are some biogenic amines that would cause depression if they were in deficit
Norepinephrine Dopamine Serotonin
38
What is the strategy of anti depression drugs
Prolong the effects of the biogenic amines
39
What are the types of antidepressants
Tricyclics Monoamine oxidase (MAO) inhibitors Second generation drugs Selective serotonin reuptake Inhibitors (SSRI) Serotonin-norenepherine Reuptake Inhibitor (SNRI)
40
What are some SSRI's
Prozac Zoloft Lexapro Celexa
41
What are some SNRI.
Pristiq Cymbalta Effexor
42
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
43
What is the goal of SNRI
Works only on the serotonin and NEP. | No effect on dopamine
44
What are Tricyclics
Oldest form of antidepressants | Not well known but very effective
45
What are the names of some tricyclic drugs
Elavil Ascending Norpramin
46
What are the MAO drugs used for
Used as a last resort for ant depression
47
What do the drugs nefaodone and Trazodone do
Block serotonin receptors and serotonin uptake
48
What does the drug bupripion do
It is a Norepinephrine and dopamine reuptake inhibitor
49
What does the drug mirtazapine do
May clock the presynaptic but is very complicated
50
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)
51
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
52
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
53
Adverse effects of Tricyclics
Sedation Anticholinergic (dry mouth, seizures, could be fatal) Orthostatic hypertension (sudden increase in blood pressure when someone stands up)
54
Adverse effects of MAO inhibitors
CNS excitation | Increase blood pressure (especially those who eat femented foods)
55
Adverse effects of Second generation drugs
These are generally better tolerated but can have some GI issues with overdose
56
Which second generation drugs are more tolerable
SSRI and SNRI
57
What is Serotonin syndrome
Occurs when the serotonin receptors are over stimulated
58
What are some symptoms of serotonin syndrome (5)
``` High blood pressure and HR Shivering Dyskinesia Muscle pain GI problems ```
59
Is serotonin syndrome reversible
Usually if it is caught early | If unchecked it could be fatal
60
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)
61
How long do we wait before the antidepressant is deemed ineffective
6 weeks
62
What drug is used to treat bipolar syndrome
Lithium
63
What is the mechanism of action for lithium
Unclear, thought to prevent manic episode | May stabilize neurons (neuroprotective)
64
How is lithium eliminated
Remains intact and eliminated through kidneys
65
What is lithium toxicity
Accumulation of lithium in the kidney
66
Symptoms of mild lithium toxicity (4)
Metallic taste Fine Tremor in hands Nausea Generalized weakness
67
Symptoms of moderate lithium toxicity (5)
``` Vomiting Diarrhea Increased tremors Dizziness/incoordination Blurred vision ```
68
Symptoms of severe lithium toxicity
``` Confusion Hallucinations Nystagmus (involuntary eye movement) Dysarthia (motor speech) Fasciculation (muscle twitching) ```
69
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
70
What are anti-manic effects
Prevent swing from manic to depressed
71
What are some other bipolar treatments
Anti-seizure | Antipsychotic
72
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
73
What is psychosis
More severe than depression or anxiety May see or hear things Have fragmented thoughts
74
What causes psychosis
Increase dopamine acting on the CNS as well as other NTs
75
How do antipsychotic drugs work
They block the dopamine receptors in the CNS specifically the D2 receptors
76
How much dopamine is blocked with antipsychotic drugs
Not all of the dopamine, just enough | Called normalize dopamine
77
Why are the new antipsychotic drugs called atypical agents
They do not have the typical side effects as the traditional drugs
78
What NT may antipsychotic drugs improve
Serotonin
79
What are some adverse side effects of the traditional antipsychotic drugs
Orthostatic hypertension Sedation Anticholinergic effects
80
What are some adverse side effects of atypical antipsychotic drugs
Weight gain | Disturbed fat and sugar digestion
81
What is the primary concern of antipsychotic drugs
Motor side effects (MOST IMPORTANT)
82
What are some extrapyramidal side effects of antipsychotic drugs (4)
Tardive Dyskinesia Psuedoparkinsonism Akathisia Other dystonias or dyskensisa of extremities ( Chorea Athletoid)
83
What is Tardive Dyskinesia
Oral facial movements; lips, tongue, jaw, grimacing | *Could be permanent even if found early
84
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
85
What is akathisia
Severe restlessness
86
What causes Tardive Dyskinesia
Denervation will occur and then new synapses are formed
87
What is the prevalence of Tardive Dyskinesia
1/4 of patients with long term antipsychotic drugs
88
What puts you at risk for Tardive Dyskinesia
Genetic issues Mood disorders Using antipsychotic drugs over 6 months
89
What is neuroleptic malignant syndrome
Cancerous Can occur with all antipsychotic drugs Can be fatal
90
What are some symptoms of neuroleptic malignant syndrome (4)
Rigidity Catatonia(unresponsive) Tremors Fever
91
What is Alzheimer's disease
Irreversible dementia | Due to shrinking of the brain
92
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 ```
93
What are the goals when treating dementia
Improve their cognitive and intellectual abilities | Improve their behavior
94
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
95
How do indirect Cholinergic drugs effect dementia
Will not directly effect the ACH receptor | Inhibits enzyme that breaks down ACH
96
What enzyme will break down ACH
Cholinesterase
97
What are the Cholinergic stimulants in Alzheimer disease
Aricept Razadyne Exelon Cognex
98
What are some indications to use Cholinergic stimulants
To improve cognition Behavior function Memory
99
What determines the efficacy of Cholinergic stimulants
If it helps them retain more cognitive information in the early stages of Alzheimer's
100
When will Cholinergic stimulants be ineffective in treating AD
When there is rapid progression of the disease. | Due to not producing neurotransmitters
101
What is memantine
New form of AD drug which blocks NMDA-glutamate receptors in the brain
102
What does glutamate do to the brain
Excitatory amino acid that is used in memory and learning
103
What is the mechanism of Memantine
During AD glutamate activity is disrupted. Drug will normalize glutamate influence
104
What is a potential problem of memantine
Too little or too much dosage could be harmful and actually advance the disease.
105
What are some drugs used to modify or improve behavior
Antidepressants Anti-Anxiety agents Antipsychotic
106
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
107
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

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