Physio and Psychopharm Flashcards
Dopamine (MMSLR)
Mood, Movement, Sleep, Learning, Reinforcement effects of drugs
Abnormal levels related to:
- Parkinson’s
- Huntington’s
- Tourette’s
- ADHD
- Depression
- Schizophrenia
Acetylcholine (MAAM)
Muscles (skeletal, smooth, cardiac), Attention, Arousal, Memory
- Low levels in the hippocampus associated with memory loss in Alzheimer’s
- Cholinesterase Inhibitors - Reduce the breakdown of Acetylcholine and temporarily reverse or slow down memory loss with mild to moderate Alzheimer’s disease
Glutamate (MMEL)
Movement, Memory, Emotions, Learning
- Involved in LTP - essential for the formation of long-term memories
- Excessive glutamate = excitotoxicity:
- Stroke
- Seizures
- TBI
- Huntington’s
- ALzheimer’s
Norepinephrine (SLAAMM)
Sleep, learning, Attention, Arousal, Memory, Mood
Abnormal levels associated with:
- ADHD
- Mania
- Depression
Loss of norepinephrine neurons in the Locus Coeruleus is linked to the non-motor sxs of Parkinson’s:
- Depression
- Cognitive deficits
- Sleep disturbances
**Catecholamine Hypothesis: some forms of depression are due to deficiency of norepinephrine while mania is due to excessive levels
Serotonin (HAAMPSS)
Hunger, Arousal, Aggression, Mood, Pain, Sleep, Sex
Low levels:
- Depression
- Increased risk for suicide
- OCD
- Bulimia
- Migraines
Excessive levels:
- Schizophrenia
- Autism
- Anorexia
GABA (MMMS)
Memory, Mood, Motor Control, Sleep
Abnormally low levels of GABA:
- Anxiety
- Mania
- Insomnia
- Seizure disorders
- Parkinson’s disease
- Huntington’s disease
*Benzos enhance GABA and reduce anxiety and induce sleep
Locus Coeruleus
- Nucleus in the pons
- Involved with physiological responses to stress and panic
Endorphins
- Inhibitory neurotransmitters
- Effects are similar to opioid drugs
- Contribute to feelings of pleasure, well-being, and reduce perception of pain
- Produced by the pituitary gland in the hypothalamus during running and exercise
Hindbrain Structures
Cerebellum
Pons
Medulla Oblongata
Medulla
- Involuntary throat and mouth movements - swallowing, coughing, sneezing
- Regulates vital autonomic NS: respiration, HR, BP, digestion
Brain injuries, certain diseases, and other drugs can disrupt the functioning of the medulla and result in death
Pons
- Connects the 2 parts of the cerebellum (helps coordinate movements on 2 sides of body)
- Connected medulla to cerebellum
- Connects cerebellum to forebrain
Involved in:
- Arousal
- Sleep
- Regulation of respiration
Cerebellum
- Coordinates and sequences complex voluntary movements initiated in the motor cortex
- Maintains posture and balance
- Processes and stores procedural memories
Damage can cause ataxia:
- Lack of muscle control
- Impaired balance and coordination
- Slurred speech
- Blurred or double vision
Midbrain Structures
Reticular Activating System, Substantia Nigra, and Superior and inferior colliculi
Reticular Activating System
- Alerts cortex to incoming sensory info
- Role in: Sleep & wakefulness, Attention, Behavioral arousal, consciousness
Lesions in the RAS can cause: comatose state
Extends from the medulla to the midbrain
Direct electrical stimulation of the RAS or stimulation by sensory input can awaken a sleeping person and cause an awake person to become more alert
Substantia Nigra
Plays a role in:
- Reward seeking behaviors
- Drug addiction
- Motor control (thru connection to basal ganglia)
Degeneration of dopamine-producing cells in the Substantia Nigra contributes to the motor sxs associated with Parkinson’s Disease:
- Slowed movement
- Tremors
- Muscle rigidity
- & other motor sxs
Frontal Lobe
- Execeutive cognitive functions
- Expressing emotions
- Speech production (Broca’s area)
Damage to Dorsolateral area
- Damage to dorsolateral:
- Perseverative responses (inappropriate repetition)
- Depression, decreased range of emotions
- Impaired attention, working memory, judgment, abstract thinking
Damage to orbitofrontal area
Disinhibited syndrome:
- Behavioral disinhibition, distractibility, emotion lability, inappropriate euphoria, and acquired sociopathy (risk taking behaviors, lack of empathy and insight, and a persistent need for immediate gratification)
Damage to mediofrontal area
Apathetic-Akinetic syndrome:
- Decreased motor behavior and verbal output
- Lack of motivation and goal-directed activities
- Apathy and indifference
Broca’s Area
Damage results in Broca’s aphasia (expressive aphasia)
- Slow, labored speech (primarily nouns & verbs)
- Impaired repetition
- Anomia (inability to recall the names of familiar objects)
- Relatively intact comprehension of written and spoken language
Parietal Lobe & Damage
- Somatosensory cortex
Processes sensory info related to: touch, pressure, temp, pain, body position
Result of damage depends on the location:
- Somatosensory Agnosias:
- Tactile agnosia - inability to recognize objects by touch
- Asomatognosia - Lack of recognition of one or more parts of the body
- Anosognosia - denial of one’s own illness or disability - Contralateral Neglect - neglect of one side of the body
- Gerstmann’s Syndrome:
- Usually caused by damage to the dominant (usually left) hemisphere:- Finger agnosia
- Right/Left disorientation
- Agraphia - loss of writing skills
- Acalculia - loss of math skills
Temporal Lobe
- Auditory cortex & Wernicke’s area
Damage to auditory cortex:
- Auditory agnosia - impairments in sound perception and identification
- Auditory hallucinations
- Cortical deafness (unresponsive to all sounds)
Wernicke’s area:
- Lives in dominant hemisphere
- Damage is Wernicke’s Aphasia or Receptive Aphasia
- Impaired comprehension of written and spoken language
- Impaired repetition
- Anomia
- Speech is fluent! but incoherent and meaningless
Arcuate Fasciculus
Bundle of axons that connects Broca’s and Wernicke’s area
Damage - Conduction Aphasia!
- Comprehension is relatively intact
- Fluent speech w/ many errors
- Anomia
- Impaired repetition
Occipital Lobe
- Visual cortex
- Damage to visual cortex:
- Visual agnosia - patients cannot recognize objects (w/ anomia, they recognize but cannot name them)
- Visual hallucinations
- Achromatopsia (loss of color vision)
- Cortical blindness (loss of vision)
- Damage (bilateral lesions) to the occipitotemporal junction
- Prosopagnosia - Inability to recognize the faces of familiar people
Structural Neuroimaging Techiques
- CAT scan - uses x-rays to obtain images of horizontal slices of the brain
- costs less than an MRI
- provides images more rapidly
- doesn’t require motionlessness
- can be used with pacemakers, metal - MRI - using strong magnetic fields and radio waves
- cross-sectional images of the brain
- produces 3 dimensional and more detailed images
- doesn’t require the use of radiation
- can be used for brain and other parts of the body
Functional Neuroimaging Techniques
PET, SPECT, fMRI
- PET - patient is injected with radioactive tracer that is taken up by active brain cells
- SPECT - similar to PET but easier and less expensive - but less detailed images
- fMRI - similar to MRI but provides information on changes in blood oxygenation and flow
TBI
Open vs. Closed
- Consequences of open injury depend on its location and severity
Closed injuries can share several characteristics:
- Cause more widespread damage
- Loss or alternation of consciousness
- Combo of emotional, cognitive, behavioral, and physical sxs
- Anterograde and retrograde amnesia are common
- Duration of anterograde (post-traumatic) amnesia is an indication of severity of TBI and a good predictor of recovery
- Most ppl and esp with mild TBI, experience significant recovery from sxs in the first 3 months and more recovery in the 1st year
- However, many ppl continue to have some sxs indefinitely, esp those with moderate to severe injuries
- Severe MDD is the most common diagnosis regardless of severity of injury
Cerebrovascular Accident (CVA) & risk factors
Stroke!
*Caused by sudden interruption of blood flow to the brain
Risk factors:
- Hypertension
- Cigarette smoking
- Alcohol use
- Atrial fibrillation (irregular heartbeat can lead to blood clots)
- Atherosclerosis (plaque build-up in the arteries)
- Diabetes
- High cholesterol
Cerebrovascular Accident Sxs & Artery
Middle Cerebral Artery:
*Most often involved!
- Supplies blood to the frontal lobe & lateral temporal and parietal lobe
Sxs:
- Contralateral sensory loss
- Weakness or paralysis (esp. in arm or face)
- Impaired vision
- DOMINANT hemisphere - Aphasia (inability to understand or express speech)
- NON-DOMINANT - Contralateral neglect & apraxia (inability to perform correct movement)
Aterior Cerebral Artery - Supplies blood to frontal lobe and parietal lobes Sxs: - Contralateral sensory loss - Weakness or paralysis, esp. in the leg - Impaired insight and attention - Impaired speech - Confusion - Apathy
Posterior Cerebral Artery
- Supplies blood to temporal and occipital lobes
Sxs:
- Memory deficits
- Unilateral cortical blindness
- Color agnosia (inability to name colors)
- Other visual impairments
Huntington’s Disease
- Caused by autosomal dominant gene
- Linked to abnormal levels in the basal ganglia of:
- GABA
- Glutamate
- Dopamine
- Onset of sxs is between 30-50
SEQUENCE of sxs:
- Affective
- Cognitive
- Motor
Initial sxs:
- Depression
- Apathy
- Or other affective sxs
Followed by:
- Forgetfulness (short term memory loss)
- Impaired concentration
- Impaired judgment
- Other cog sxs
& then:
- Clumsiness
- Fidgeting
- Facial twitches
- Other motor sxs
As the disease progresses…
- Athetosis - (slow, writhing movements)
- Chorea (abnormal involuntary rapid jerky movements in arms, legs, and trunk)
- Person may eventually develop mild or major neurocognitive disorder
- *Motor sxs become severe, person has trouble speaking and swallowing
Athetosis and Chorea
Sxs as Huntington’s Disease progresses
- Athetosis - (slow, writhing movements)
- Chorea (abnormal involuntary rapid jerky movements in arms, legs, and trunk)
Parkinson’s Disease
- Caused by a loss of dopamine-producing cells in the substantia nigra (which in turn affects the basal ganglia)
- Cause of the degeneration is not known - but some cases may be related to exposure to some toxins or chemicals
Primary sxs:
- Impaired balance & equilibrium
- Muscle rigidity
- Slowed voluntary movement
- Tremors (begins in hands, pill rolling)
Many ppl also experience:
- Depression (up to 50%)
- Anxiety (up to 40%)
- Delusions and/or hallucinations (usually in later stages of disorder)
- Some ppl may eventually develop mild or major neurocogitive disorder
- No cure for Parkinson’s but tremors and other motor sxs are temporarily alleviated in the early stages with Aldopa!
- Aldopa acts as a dopamine agonist and increases dopamine
- Offspring have a 50% chance of inheriting it
Seizure Disorders
Caused by abnormal electrical activity in the brain
FOCAL ONSET VS. GENERALIZED ONSET
Focal Onset:
- Begin in a localized area in one side of the brain and affect one side of the body
- They may spread and become generalized seizures
Sxs:
- Depend on the origins of the seizure, may include:
- Abnormal sensations
- Hallucinations
- Sense of deja vu
- And/or automatisms (repetitive movements - grunts, founds, walking in circles)
Focal Onset AWARE VS. IMPAIRED AWARENESS SEIZURES
Focal Onset AWARE Seizures (AKA Simple Partial Seizures)
- Don’t affect consciousness
- Usually last less than 2 minutes
Focal Onset Impaired Awareness Seizures (AKA Complex Partial Seizures)
- Cause a change in consciousness
- May begin with an Aura
- Usually last 1-2 minutes
GENERALIZED ONSET SEIZURES:
- Affect both sides of the brain
- MOTOR VS NON-MOTOR SEIZURES
Generalized onset MOTOR Seizures:
- AKA Tonic-Clonic Seizures or Grand Mal
- Change in consciousness
- Tonic Phase (stiffening of muscles in face and limbs)
- Followed by Clonic phase (Jerky, rhythmic movements)
- After - they may be depressed, confused, fatigued, and non memory of event
Generalized onset NON-MOTOR seizures
- AKA absent seizures and Petit Mal Seizures
- Loss of consciousness that lasts 10-20 seconds
- Blank or absent stare
- For some ppl, eye fluttering, head nodding, hand movements
- When seizure ends, person often continues doing what he or she was doing
First generation/Traditional/Conventional Antipsychotics Names
- Chlorpromazine (Thorazone)
- Haloperidol (Haldol)
- Thioridazine (Mellaril)
- Fluphenazine (Prolixin)
FLU-CHLOR-HALO-THIOR
First generation/Traditional/Conventional Antipsychotics Attributes
- Chlorpromazine (Thorazone)
- Haloperidol (Haldol)
- Thioridazine (Mellaril)
- Fluphenazine (Prolixin)
- Used to tx Schizophrenia and other disorders with psychotic sxs and are more effective for positive sxs than negative!
- Exert their effect by BLOCKING DOPAMINE (supported the dopamine hypothesis of Schizophrenia)
- Dopamine antagonists
Major Side Effects:
- ANTICHOLINERGIC effects (Block acetylcholine)
- Dry mouth, blurred vision
- Constipation & Urinary retention
- Tachycardia (high ass HR)
- Confusion
- Impaired attention & concentration - EXTRAPYRAMIDAL Effects
1) Parkinsonism (resting tremor, muscle rigidity, slowed movement)
2) Dystonia - uncontrollable muscle spasms in head and neck
3) Akathisia - restlessness and pacing
4) Tardive Dyskinesia
* Potentially life threatening, usually begins after months or years
- Usually repetitive movements of tongue, face, jaw
- Over time, may affect limbs and trunk
* Irreversible for some pts
* TREATED by gradually waning off and switching to 2nd gen (OR dopamine depleting or GABA enhancing drug)
* For some, getting off the drug may not lessen sxs and it might get worse before they decrease - NEUROLEPTIC MALIGNANT SYNDROME
* *Rare, life-threatening side effect
1) Muscle rigidity
2) Hyperthermia
3) Autonomic dysfunction - unstable BP, Tachycardia, rapid breathing
4) Altered mental state - confusion, disorientation, agitation
- Have person stop taking the drug at the first sign of sxs
- Providing medical tx and supportive care for specific sxs
First generation/Traditional/Conventional Antipsychotics Attributes
- Chlorpromazine (Thorazone)
- Haloperidol (Haldol)
- Thioridazine (Mellaril)
- Fluphenazine (Prolixin)
- Used to tx Schizophrenia and other disorders with psychotic sxs and are more effective for positive sxs than negative!
- Exert their effect by BLOCKING DOPAMINE (supported the dopamine hypothesis of Schizophrenia)
- Dopamine antagonists
Major Side Effects:
- ANTICHOLINERGIC effects (Block acetylcholine)
- Dry mouth, blurred vision
- Constipation & Urinary retention
- Tachycardia (high ass HR)
- Confusion
- Impaired attention & concentration - EXTRAPYRAMIDAL Effects
1) Parkinsonism (resting tremor, muscle rigidity, slowed movement)
2) Dystonia - uncontrollable muscle spasms in head and neck
3) Akathisia - restlessness and pacing
4) Tardive Dyskinesia
* Potentially life threatening, usually begins after months or years
- Usually repetitive movements of tongue, face, jaw
- Over time, may affect limbs and trunk
* Irreversible for some pts
* TREATED by gradually waning off and switching to 2nd gen (OR dopamine depleting or GABA enhancing drug)
* For some, getting off the drug may not lessen sxs and it might get worse before they decrease - NEUROLEPTIC MALIGNANT SYNDROME
* *Rare, life-threatening side effect
1) Muscle rigidity
2) Hyperthermia
3) Autonomic dysfunction - unstable BP, Tachycardia, rapid breathing
4) Altered mental state - confusion, disorientation, agitation
- Have person stop taking the drug at the first sign of sxs
- Providing medical tx and supportive care for specific sxs
First generation/Traditional/Conventional Antipsychotics Attributes
- Chlorpromazine (Thorazone)
- Haloperidol (Haldol)
- Thioridazine (Mellaril)
- Fluphenazine (Prolixin)
- Used to tx Schizophrenia and other disorders with psychotic sxs and are more effective for positive sxs than negative!
- Exert their effect by BLOCKING DOPAMINE (supported the dopamine hypothesis of Schizophrenia)
- Dopamine antagonists
Major Side Effects:
- ANTICHOLINERGIC effects (Block acetylcholine)
- Dry mouth, blurred vision
- Constipation & Urinary retention
- Tachycardia (high ass HR)
- Confusion
- Impaired attention & concentration - EXTRAPYRAMIDAL Effects
1) Parkinsonism (resting tremor, muscle rigidity, slowed movement)
2) Dystonia - uncontrollable muscle spasms in head and neck
3) Akathisia - restlessness and pacing
4) Tardive Dyskinesia
* Potentially life threatening, usually begins after months or years
- Usually repetitive movements of tongue, face, jaw
- Over time, may affect limbs and trunk
* Irreversible for some pts
* TREATED by gradually waning off and switching to 2nd gen (OR dopamine depleting or GABA enhancing drug)
* For some, getting off the drug may not lessen sxs and it might get worse before they decrease - NEUROLEPTIC MALIGNANT SYNDROME
* *Rare, life-threatening side effect
1) Muscle rigidity
2) Hyperthermia
3) Autonomic dysfunction - unstable BP, Tachycardia, rapid breathing
4) Altered mental state - confusion, disorientation, agitation
- Have person stop taking the drug at the first sign of sxs
- Providing medical tx and supportive care for specific sxs
First generation/Traditional/Conventional Antipsychotics Attributes
- Chlorpromazine (Thorazone)
- Haloperidol (Haldol)
- Thioridazine (Mellaril)
- Fluphenazine (Prolixin)
- Used to tx Schizophrenia and other disorders with psychotic sxs and are more effective for positive sxs than negative!
- Exert their effect by BLOCKING DOPAMINE (supported the dopamine hypothesis of Schizophrenia)
- Dopamine antagonists
Major Side Effects:
- ANTICHOLINERGIC effects (Block acetylcholine)
- Dry mouth, blurred vision
- Constipation & Urinary retention
- Tachycardia (high ass HR)
- Confusion
- Impaired attention & concentration - EXTRAPYRAMIDAL Effects
1) Parkinsonism (resting tremor, muscle rigidity, slowed movement)
2) Dystonia - uncontrollable muscle spasms in head and neck
3) Akathisia - restlessness and pacing
4) Tardive Dyskinesia
* Potentially life threatening, usually begins after months or years
- Usually repetitive movements of tongue, face, jaw
- Over time, may affect limbs and trunk
* Irreversible for some pts
* TREATED by gradually waning off and switching to 2nd gen (OR dopamine depleting or GABA enhancing drug)
* For some, getting off the drug may not lessen sxs and it might get worse before they decrease - NEUROLEPTIC MALIGNANT SYNDROME
* *Rare, life-threatening side effect
1) Muscle rigidity
2) Hyperthermia
3) Autonomic dysfunction - unstable BP, Tachycardia, rapid breathing
4) Altered mental state - confusion, disorientation, agitation
- Have person stop taking the drug at the first sign of sxs
- Providing medical tx and supportive care for specific sxs
First generation/Traditional/Conventional Antipsychotics Attributes
- Chlorpromazine (Thorazone)
- Haloperidol (Haldol)
- Thioridazine (Mellaril)
- Fluphenazine (Prolixin)
- Used to tx Schizophrenia and other disorders with psychotic sxs and are more effective for positive sxs than negative!
- Exert their effect by BLOCKING DOPAMINE (supported the dopamine hypothesis of Schizophrenia)
- Dopamine antagonists
Major Side Effects:
- ANTICHOLINERGIC effects (Block acetylcholine)
- Dry mouth, blurred vision
- Constipation & Urinary retention
- Tachycardia (high ass HR)
- Confusion
- Impaired attention & concentration - EXTRAPYRAMIDAL Effects
1) Parkinsonism (resting tremor, muscle rigidity, slowed movement)
2) Dystonia - uncontrollable muscle spasms in head and neck
3) Akathisia - restlessness and pacing
4) Tardive Dyskinesia
* Potentially life threatening, usually begins after months or years
- Usually repetitive movements of tongue, face, jaw
- Over time, may affect limbs and trunk
* Irreversible for some pts
* TREATED by gradually waning off and switching to 2nd gen (OR dopamine depleting or GABA enhancing drug)
* For some, getting off the drug may not lessen sxs and it might get worse before they decrease - NEUROLEPTIC MALIGNANT SYNDROME
* *Rare, life-threatening side effect
1) Muscle rigidity
2) Hyperthermia
3) Autonomic dysfunction - unstable BP, Tachycardia, rapid breathing
4) Altered mental state - confusion, disorientation, agitation
- Have person stop taking the drug at the first sign of sxs
- Providing medical tx and supportive care for specific sxs
Second Generation Antipsychotics (AKA Atypical) Names
- Clozapine (Clozaril)
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
And…
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Aripiprazole (Abilify)
- Paliperidone (Invega)
Second Generation Antipsychotics (AKA Atypical) Attributes
Used to treat schizophrenia and other disorders with psychotic sxs
- Some are also used for monotherapy or as an adjunctive treatment for bipolar disorder or MDD
- As effective or more effective than FGA for tx of positive sxs and more affective for tx of negative sxs!
- SGA may be effective when FGA aren’t (esp Clozapine)
- SGAs exert their effects by REDUCING DOPAMINE AND SEROTONIN
- Dopamine and Serotonin antagonists OR inverse agonists
- And affect several neurotransmitters (dopamine, serotonin, norepinephrine, and glutamate!)
SIDE EFFECTS:
- Anticholinergic effects
- Neuroleptic Malignant Syndrome
- Risk for and severity is less than FGA!
- Metabolic Syndrome
- Weight gain, high BP, insulin resistance, increased risk for diabetes and heart disease
- Agranulocytosis
- Potentially life threatening
- Dangerously low white blood cell count - requires regular blood monitoring
- Clozapine and to a lesser extent the other atypicals
3 advantages of SGA:
1) Alleviate positive AND negative sxs 2) Typically effective when FGA fail 3) Less likely to cause Tardive dyskinesia
SSRIs names
- Fluoxetine (Prozac, Sarafem)
- Sertraline (Zoloft)
- Citalopram (Celexa)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
SSRI attributes
Considered to be the first line psychopharmacological tx to treat depression!
- Have a faster onset than tricyclics (and are now prescribed more than tricyclics)
- Less severe cholinergic effects
- BUT are more likely to cause serotonin syndrome than tricyclics when combined with other serotinergic agents
ALSO CAN TREAT:
- Premenstrual Dysphoric Disorder
- OCD
- Panic disorder
- GAD
- PTSD
- Bulimia
- Premature ejaculation
Exert their effects by block the reuptake of Serotonin - Increases serotonin! Serotonin agonist
SIDE EFFECTS:
- Mild cholinergic effects
- Gastrointestinal issues
- Insomnia
- Nausea and vomiting
- Anxiety
- Headaches
- Sexual dysfunction
ADVANTAGES OVER TRICYCLICS:
1) Produce fewer anticholinergic side effects
2) Less cardiotoxic
3) Safer in overdose
4) Faster onset of therapeutic effects
Disadvantages of some SSRIS - Can cause a withdrawal or discontinuation syndrome when decreased or abruptly stopped:
- Dizziness
- Headache
- Numbness or tingling
- Anxiety, agitation, irritability
- Mood lability
- Impaired concentration
- Sleep disturbances
- Flu like sxs
- *SEROTONIN SYNDROME
- Combining SSRI with MAOI or other serotonergic drug can cause it
- Potentially fatal!
- Extreme agitation
- Confusion
- Autonomic instability
- Hyperthermia
- Tremor
- Seizures
- Delirium
TREATMENT FOR SEROTONIN SYNDROME:
- Immediate withdrawal of the serotonergic drugs
- Medical treatment for its symptoms
SNRI Names
- VennDiagram w/ SSRIs
1. Venlafaxine (Effexor)
2. Duloxetine (Cymbalta)
3. Desvenlafaxine (Pristiq)
SNRI attributes
Used to treat:
- Depression
- Anxiety
- Chronic Pain & several other dxs
- Evidence that they are similar to SSRIs in effectiveness to treat depression
- *And May be more effective than SSRIs for severe depression!
Exert their effects by blocking reuptake of Serotonin and Norepinephrine
SIDE EFFECTS (similar to SSRIs!)
- Mild anticholinergic effects
- Insomnia
- Headaches
- Sexual dysfunction
Because of their effects on norepinephrine, can ELEVATE BP!! Might be contraindicated for pts with hypertension or heart problems
Also can cause a discontinuation syndrome
And combining an SNRI with an MAOI or other serotonergic drug can cause serotonin syndrome!
Tricyclic Antidepressant Names
- Amitriptyline
- Imipramine
- Clomipramine
- Nortriptyline
- Doxepin
Tricyclic Attributes
**Cardiotoxic!!
Used to treat: depression, anxiety, panic disorder, OCD, and neuropathic pain
EXERT THEIR EFFECTS BY inhibiting uptake of norepinephrine, serotonin, and dopamine
*Most useful for typical depression: Anhedonia and vegetative sxs (appetite and sleep)
SIDE EFFECTS:
- Anticholinergic effects
- Gastrointestinal issues
- Confusion and memory problems
- Tremor
- Impaired sexual functioning
- Hypertension
- Tachycardia
Because they’re CARDIOTOXIC and can be lethal in overdose, prescribe with caution ppl with heart disease or SI!!
Caridotoxic because you can’t ride a tricycle with heart problems!
MAOIs names
o Phenelzine (Nardil) o Isocarboxazid (Marplan) o Tranylcypromine (Parnate)
MAOI
- Used to treat atypical depression!
- Include phobic features
- Hypersomnia
- Mood reactivity
- Rejection sensitivity
EXERT THEIR EFFECTS - block the action of enzymes that break down norepinephrine, serotonin, and dopamine and increase these neurotransmitters
SIDE EFFECTS:
- Anticholinergic effects
- Orthostatic hypertension
- Daytime sleepiness
- Insomnia
- Headache
- Confusion
- Tremor
- Sexual dysfunction
CAN CAUSE A FATAL HYPERTENSIVE CRISIS: - When taken in conjunction with other drugs (amphetamines, antihistamines) or foods containing tyramine (cheese, meat, beer, ripe bananas) - Sxs: - Severe throbbing headache - Sharp increase in BP - Stiff Neck - Rapid HR - Nausea and vomiting - Sweating - Photo sensitivity - Confusion & dizziness Extreme cases - Heart Attack or Stroke!
Mood Stabilizers names
- Lithium
- Several anticonvulsant drugs:
- Carbamazepine
- Valproic acid
Mood Stabilizer attributes
Lithium is tx of choice to treat bipolar disorder (first line for acute mania and classic bipolar dx - w/out rapid cycling)
- Reduces manic sxs and levels out mood swings
BUT anticonvulsant drugs may be more effective when lithium is not & useful for:
- Atypical forms of mania
- Mania with dysphoric mood or rapid cycling
- Acute mania
- How lithium and anticonvulsant drugs exert their therapeutic effects is not well understood
o But both have been linked to alterations in several neurotransmitters:
Dopamine
Glutamate
Norepinephrine
Serotonin
- Side effects of Lithium: o Nausea o Increased thirst & frequency of urination o Blurred vision o Fine Hand tremor o Vomiting o Metallic taste o Weight gain o Fatigue o Impaired memory and concentration - **Blood lithium levels must be monitored to avoid lithium toxicity: o Confusion o Slurred Speech o Ataxia o Course tremor o Vomiting o Diarrhea o **And can lead to: Seizures Coma Death - **Several factors can precipitate toxicity, including: o An overdose of the drug o Sodium depletion o And simultaneous use of some other drugs: Diuretic Non-steroidal anti-inflammatory agent - Side effects of anticonvulsant drugs (Carbamazepine): o Nausea & vomiting o Dizziness o Slurred speech o Ataxia o Tremor o Sleepiness o Lethargy o Visual disturbances o Impaired concentration - To maintain therapeutic levels of Carbamazepine and to avoid toxicity: o Blood levels must be monitored! - **Blood levels must be monitored to avoid liver failure when taking the anticonvulsants: carbamazepine or valproic acid o And to avoid Agranulocytosis and aplastic anemia when taking carbamazepine
Benzos
- Central nervous system depressants
- Stimulate the inhibitory action of GABA
- Barbiturates and benzos increase GABA
Most common side effects:
- Drowsiness, lethargy
- Slurred speech
- Ataxia
- Impaired cognitive and psychomotor functioning
Abrupt cessation of a Benzo may produce:
- Rebound excitability
o Produces levels of anxiety, insomnia & other sxs that were more intense than prior to taking the benzo
Psychostimulants
- Mimic or increase the activity of dopamine and norepinephrine
- used to treat ADHD:
Methylphenidate
- Alleviates the core sxs of ADHD - inattention, hyperactivity, and impulsivity
- Less evidence for its long-term benefits for academic achievement and social interactions
Pemoline
- Methylphenidate side effects: o Decreased appetite o Abdominal pain o Insomnia o Anxiety and irritability o *Some children experience growth suppression
- But this sx can be alleviated by providing drug holidays over summer and winter vacations
