1. Neuron 2. Dendrites 3. Axon 4. Nerve cell 5. Pre-synaptic nerve ending 6. Synapse 7. Postsynaptic receptor

Pschopharmacology Flashcards by stephanie pielago

occurs as the drug is synthesized, released and metabolized & as it acts on the receptor sites of a neurotransmitter system

Primary effects

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results from interactions among the neurotransmitters, neuropeptides & hormones as they influence each others functions in the brain

Secondary effects

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are the final changes in the clinical symptom induced by a drug such as stabilization of anxiety & depression

Tertiary effects

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an enzyme in nerves & tissues that breaks down Norepinephrine, Dopamine & Serotonin (5HT)

Monoamine oxidase

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found abundantly thoughout the parasympathetic NS. (Increase salivation,
Excessive sweat, Diarrhea, Bradycardia)

Acetylcholine

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Inhibits nerve activity

Amino Acids- Gama Aminobutyric Acid (GABA)

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react with beta receptors in the periphery to modulate pain transmission

Peptides- Enkephalins

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is important in conceptualizing the pathology & treatment of Alzheimer’s & Parkinson’s disease

Acetylcholine

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is important in conceptualizing the pathology & treatment of Schizophrenia

Dopamine

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is important in conceptualizing the pathology & treatment of Anxiety

Gamma-aminobutyric Acid (GABA)

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is important in conceptualizing the pathology & treatment of mania & depression

Norepinephrine

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is important in conceptualizing the pathology & treatment of mania & depression

Serotonin

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Nervous System

Neuron
Dendrites
Axon
Nerve cell
Pre-synaptic nerve ending
Synapse
Postsynaptic receptor

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is the study of regulation & stabilization of emotions, behavior, & cognition through the interactions of endogenous signaling substances or chemicals in the brain

Psychopharmacology

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3 types of physiological action

respond to stimuli
conduct electrical impulse
release chemicals (neurotransmitters)

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fundamental units of brain & nervous system (NS)

Neurons

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sending of impulse from one neuron to another across synapse

Neurotransmission

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are chemical messenger that transmit signals from neuron

Neurotransmitters

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amino acid which is main inhibitory
for vision, motor control, regulation of anxiety

GABA

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amino acid which is the most plentiful
for memory and learning

Glutamate

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a MAOIs- a stress hormone
for HR, BP, muscle srength

Epinephrine

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a MAOIs- fight-flight response
for BP, HR, fat breakdown

Norepinephrine

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a MAOIs- feel good neurotransmitter
for pleasure, motivation, memory, coordination of body movement

Dopamine

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a MAOIs- mood transmitter
mood regulation & modulation, sleep, anxiety, sexuality, appetite

Serotonin

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* a peptide, which responds to pain * inhibit pain, signal transmission, promote feelings & euphoria

Endorphins/Enkephalins

* associated with motor neurons * muscle movement, memory learning

Acetylcholine

Antipsychotic Agents (Neuroleptic Drugs)

1. Typical Antipsychotics 2. Atypical Antipsychotics

Contraindications for Psychotropic Drugs

* Hypersensitivity * Bone marrow depression * Brain damage * CVD * Glaucoma * Parkinson's disease * Seizure disorder * Photosensitivity * Sever depression * Blood dyscrasias * Hx of impaired liver function * HPT * Diabetes * Peptic Ulcer * Pregnacny

Side Effects of Psychotropic Drugs

* Delirium * Agranulocytosis (Carbamazepine-Clozapine) * Sedation

* occurs in 1 to 3 weeks after taking the medication * tremors * rigidity * bradykinesia * NR: Avoid abrupt withdrawal, administer antiparkinson’s drug * give AMANTADINE- dopamine antagonist

Parkinson's Syndrome

* abnormal movements; irreversible movement of tongue (protrusion), face, trunk & extremities; drooling, shuffling gait * NO treatment except discontinue meds * NA: Vitamin E- believe to improve pt condition

Tardive Dyskinesia

* 1-2 days after, sudden spasm or contractions of face, tongue, extraocular muscles, neck (torticollosis), dx in swallowing * Remain with the client during his/her frightening symptoms * Administer antiparkinson drug (Cogentin, Benadryl, Artane, Akeniton) * Benzotropine mesylate (Cogentin) * Diponhydramine (Benadryl)

Dystonia

* 2 weeks after treatment. Characterized by motor restlessness & need to keep moving, ‘inability to sit’, pt complains of feeling jittery having a lot of ‘nervous’ energy. * Administer Antiparkinson drug * Rule out anxiety or agitation before giving anticholinergic drugs

Akathisia

occurs in days & weeks after treatment; elevated VS, rigidity, confusion, renal failure, increase creatinine phosphokinase (CPK), increase WBC, coma, death

Neuroleptic Malignant Syndrome (NMS)

* relieves insomnia * used to induce a state of natural sleep

Hypnotics

* treat daytime tension * may be used to manage withdrawal symptoms associated with alcoholism, to control convulsion & to produce skeletal, muscle relaxation

Antianxiety (Anxiolytics)

treatment of choice for anxiety, insomnia & stress-related conditions

Benzodiazepines

Librium: 5 to 10 mg TID or QID (for mild) 20 to 25 mg TID or QID PO (for severe)

Chlordiazepoxide

Valium, Diastat

Diazepam

Tranxene, Gen-xene- for acute alcohol withdrawal

Clorazaptate

Ativan, Lorazem- for pre-op sedation, insomnia related to anxiety

Lorazepam

Xanax for anxiety, panic disorder

Alprazolam

Centrax

Prazepam

Clonazepam

Klonopin

Buspar (Azasperone), 10 to 40 mg/day | Non-Benzodiazepines

Buspirone HCL

Seconal, Amytal, (Phenobarbital-Luminal) | Non-Benzodiazepines

Barbiturates

Equanil- relieves muscle tension related to anxiety | Non-Benzodiazepines

Meprobamate

Benzodiazepine & Non-Benzodiazepine

* no alcohol * drive cautiously * not abruptly discontinue meds

Sedative-Hypnotic Drugs

* Flurazepam- Dalmane- 15 to 60 mg/day * Triazolam- Halcion- 0.25 to 0.5 mg/day

Antihistamines

* Hydroxyzine HCL- Vistarel, Atarax * Hydroxyzine Pamoate- Vistaril * Diphenhydramine HCL- Benadryl

* used to diminish tachycardia, impulsivity & benign tremors a. Propanolol- Inderal b. Atenolol c. Metoprolol- Lopressor d. Nadolol

Beta Blockers

inhibit the reuptake of serotonin at the presynaptic membrane, therefore increases the availability of serotonin in the synapse & at the postsynaptic membrane, thus promoting neurotransmission in the brain

Selective Serotonin Reuptake Inhibitors (SSRI)

Paxil- may cause male sexual dysfunction, drowsiness, sweating | SSRI

Paroxetine

Zoloft- may cause male sexual dysfunction | SSRI

Sertralin

Celexa | SSRI

Citalopram

Prozac- may cause headache, nervousness | SSRI

Fluoxetine

* Do not use together with Antihypertensive, Alcohol, Gingko Biloba * May cause painful erection (priapism) * Report suicidal symptoms | Atypical Antidepressants

Trazodone- Desryl

Closely monitor patient’s Bipolar disorder, may cause manic episodes | Atypical Antidepressants

Bupropion- Wellbutrin

* may cause dizziness. (non-selective uptake inhibitor) * Monitor for suicidal ideation No alcohol, nor OTC drugs | Atypical Antidepressants

Venlafaxine HCL- Effexor

* No abrupt withdrawal of this drug * Let the tablet disintegrate in the tongue & can be swallowed by saliva or chewed | Atypical Antidepressants

Mirtrazapine- Remeron

Take before meals, food may inhibit absorption | Atypical Antidepressants

Nefazadone- Serzone

* increase the level of Neurotransmitters, serotonin or norepinephrine * Monitor BP a. Nortriptyline- Aventyl, Pamelor b. Imipramine- Tofranil- oldest antidepressant & the 1st choice c. Doxepin- Senequan, Zonalon d. Despiramine HCL- Norpramine e. Amitriptyline- Elavil, Endep

Tricyclics: Tricyclic Antidepressant (TCAs)

major therapeutic effect

improved mood

Antilirium- given IM or IV 0.5 mg at a rate of 1mg per minute; may be repeated if necessary. Used when: * If there is overdose of TCAs (an Antidote) * Overdose of Atropine

Prostigmine-Salicylate

'underused & overly feared’. May trigger Hypertensive Crisis when tyramine containing foods are taken

Monoamine Oxidase Inhibitors (MAOIs)

is an amino acid released from proteins in food when they undergo hydrolysis by fermenting, pickling, smoking & spoiling. When MAO is inhibited, tyramine may reach adrenergic nerve endings causing the release of large amounts of norepinephrine & produce hypertensive reaction

Tyramine

Signs & Symptoms of MAOIs

* Increased BP * Diaphoresis * Tachycardia * Nausea, Vomiting * Occipital Headache, stiff neck * Sudden unexplained nose bleed * Intracerebral Haemorrhage * Dilated pupils

Foods to be avoided in MAOIs

These foods contain tyramine & tryptophan which is a precursor of dopamine, norepinephrine & epinephrine * A- age cheese, avocados * B- bananas, beer and ale * C- caffeine, canned fish, chicken liver, chocolate * F- fava bean pods * G- guacamole dip * Meat- bologna, salami, sausage * Sour cream, soy sauce, wine, yeast, yogurt

new MAOI, no dietary restrictions, lower side effects

Moclobemide

Side Effects of MAOIs

* Postural light-headedness * fluid retention * drowsiness * delay in ejaculation * urinary hesitancy * muscle twitching * constipation * insomnia * dry mouth

are made of salt & regulates the activity of neurotransmitters in the brain. It alters sodium transport in nerves & muscles, it normalizes synaptic neurotransmission of norepinephrine, serotonin & dopamine | Antimanic Agents (Mood Stabilizing Drugs)

Lithium

the body does not metabolize Lithium, but is excreted in the renal system

Metabolism

* Eskalith, Lithotabs, Lithane, Lithonate, Lithobid, Cibalith S * DO NOT LIMIT SALT INTAKE IF PATIENT IS ON LITHIUM * Increase Na Intake= Increase Lithium Excretion * Decrease Na Intake= Decrease Lithium Elimination

Lithium Carbonate

Therapeutic Range of Lithium

0.5 to 1 mEq/L (acc. to Sundeen- 0.6 to 1.4 mEq/L)

Lithium Overdose

1.5 to 2.0 mEq/L

diarrhea, vomiting, drowsiness, muscular weakness, lack of coordination

Early Signs of Toxicity

ataxia, giddiness, tinnitus, blurred vision, large output of diluted urine.

Moderate to severe reaction

Nursing Intervention for Lithium

Lavage, Dialysis, Forced diuresis, parenteral Normal Saline

* Renal- BUN, Creatinine, electrolytes, 24H Creatinine Clearance, HPN, DM, diuretic use, analgesics abuse * Thyroid: TSH, T3, T4, RU (Resin Uptake) * CBC, ECG, FBS

Pre Lithium Workup

* Every 3 months- Lithium level (for the 1st 6 months) * Every 6 months- reassess renal status, lithium level, TSH * Every 12 months- reassess thyroid function, ECG

Maintenance Lithium Considerations

The Effects of Lithium is decreased by:

1. Acetazolamine- Diamox (adjunct to treatment of edema) 2. Sodium Bicarbonate- Increase sodium content 3. Caffeine- monitor electrolytes, Thyroid Profile, Liver Profile

is given if patient does not respond to Lithium or is contraindicated

Carbamazine (Tegretol, Carbitral)

Common Anticonvulsants

1. Long Acting barbiturates 2. Benzodiazepine 3. Hydantoins 4. Succinimides

* Depakene- effective in the manic phase of Bipolar disorder & Schizoaffective disorder * (Depakote, Depakene)- anticonvulsant- increase neurotransmitter GABA

Valporic Acid

Tegretol- helpful in acute mania & in long term prevention of manic episode. 600 mg/day

Carbamazepine

Treat EPS

Antiparkinson Agents

Dopaminergic Drugs

* Dopamine Precursor- Levodopa (Sinemet) * Dopamine Releaser- Amantidine Symmetrel * Dopamine Receptor agonist- Bromocriptine (Parlodel), Pergolide (Permax) * Dopamine Metabolism Inhibitor- Selegeline (Eldepryl)

Anticholinergics | commonly used

* Trihexyphenidyl- Artane * Benztropine- Cogentin * Biperidine- Akineton * Diphenylhydramine- Benadryl * Ethopropazine- Parsidol

New Treatment for Alzheimer's Disease

Tacrine

1st drug to treat mild to moderate Dementia. It prevents or slows the breakdown of acetylcholine by inhibiting the action of the metabolizing enzyme acetylcholinesterase

Tacrine (Cognex)- 10mg QID

An excess or loss of acetylcholine is thought to cause the memory problems associated with ___.

Alzheimer's Disease

* med for schizophrenia * be aware of photosensitivity

Chlorpromazine or Thioridazine

* DO NOT GIVE! * chicken liver * rice w/ gravy * ice cream

MAOIs medication

if there is toxicity give BIPERIDEN 2 mg (NMS)

Haloperidol (Haldol)

* useful in preventing mania during episodes of acute mania * NM: Monitor platelet count& WBC

Carbamazepine

* Valporic Acid to increase GABA * V-vomiting * A-alopecia * L-liver toxicity * P-pancreatitis * R-retention of fats * O-oedema, (edema) * A-appetite * T-tremor * E-enzyme inducer

Anticonvulsant