Psychobiology and Psychopharmacology Flashcards
1
Q
Acetylcholine Function
A
- Sleep wake cycle
- Muscle coordination and motor activity
- Pain perception
- Learning, memory acquisition, and retention
2
Q
Acetylcholine and Serotonin Relationship
A
They have an inverse relationship with each other
3
Q
Decreased levels of acetylcholine are associated with what mental illnesses?
A
- Alzheimer’s disease
2. Dementia
4
Q
Increased levels of acetylcholine are associated with what mental illnesses?
A
- Aggression
5
Q
Dopamine Function
A
- Motor coordination
- Metabolism
- Motivation, emotion, pleasure/reward system in the brain
- Temperature control
- Sexual function
- Increases BP
6
Q
Decreased levels of dopamine are associated with what mental illnesses?
A
- Parkinson’s disease
7
Q
Increased levels of dopamine are associated with what mental illnesses?
A
- Schizophrenia
2. Mania
8
Q
Norepinephrine Function
A
- Associated with “fight or flight”
- Regulation of mood
- Can affect attention and learning
- Wakefulness
9
Q
Decreased levels of norepinephrine are associated with what mental illnesses?
A
- Depression
10
Q
Increased levels of norepinephrine are associated with what mental illnesses?
A
- Anxiety
2. Manic symptoms
11
Q
Serotonin Function
A
- Affects sleep
- Appetite
- Hormone secretion
- Thermoregulation
- Emotions, mood, cognition
- Sexual behavior and libido
12
Q
Decreased levels of serotonin are associated with what mental illnesses?
A
- Depression
- Insomnia (serotonin breaks down into melatonin)
- Anxiety
- OCD
13
Q
Increased levels of serotonin are associated with what mental illnesses?
A
- Serotonin Syndrome
14
Q
GABA Function
A
Controls spinal and cerebellar reflexes and decreases excitability of neurons in the brain
15
Q
Decreased levels of GABA are associated with what mental illnesses?
A
- Seizures
- Anxiety
- Panic disorders
16
Q
Increased levels of GABA are associated with what mental illnesses?
A
Excessive Relaxation or sedation
17
Q
Glutamate Function
A
Widely distributed excitatory neurotransmitter in the brain with some role in learning and memory
18
Q
Decreased levels of glutamate are associated with what mental illnesses?
A
- Agitation
- Memory loss
- Depression
- Loss of energy
19
Q
Increased levels of glutamate are associated with what mental illnesses?
A
- Neurotoxicity by overstimulation of nerves
- Huntington’s
- AIDS related dementia
- Schizophrenia
- Anxiety
20
Q
Efficacy
A
Ability of drug to produce a response
21
Q
Potency
A
Dose of drug required to produce a specific effect
22
Q
Tolerance
A
Gradual decrease in the action of a drug at a given dose or concentration in the blood
23
Q
Toxicity
A
The point when concentrations of a drug in the bloodstream are high enough to become harmful or poisonous
24
Q
Therapeutic Index
A
Ratio of the maximum nontoxic dose to the minimum effective dose
- Always start at the lowest possible dosage and then work your way up if needed
25
How does advancing age affect drug toxicity?
Elderly population is vulnerable to drug toxicity due to decreasing kidney function. The kidney isn't excreting the drug, so it stays in the body too long
26
How can race affect what medications are prescribed?
Asians lack Cytochrome P450 which aids in metabolizing medications so they require smaller doses of alprazolam, haloperidol, and beta blockers
* Also African Americans do not respond will to ACE inhibitors
27
How can gender affect what medications are prescribed?
1. Women respond better than males to SSRIs
| 2. Women with schizophrenia require smaller doses of antipsychotics
28
Common Conventional Antipsychotics (Typical)
1. Thioridazine
2. Chlorpromazine
3. Fluephenazine
4. Thiothixene
5. Haloperidol
6. Droperidol
29
Conventional Antipsychotics: Indication for Use
1. Most common indication is schizophrenia
2. Mania, autism, disorganized thinking, agitations, Tourette's syndrome, intractable hiccups
3. Psychotics symptoms associated with head trauma, tumor, stroke, alcohol withdrawal
30
Conventional Antipsychotics: Mechanism of Action
Blocks the action of dopamine (D2, D3, D4)
* Suppresses only the positive signs of schizophrenia (hallucinations)
31
Conventional Antipsychotics: Side Effects
1. Anticholinergic effects
2. Hypotension/Orthostatic hypotension
3. Antihistamine effects: sedation and weight gain
4. Lowers the seizure threshold
5. Photosensitivity
6. Increased Prolactin level (galactorrhea)
7. Extrapyramidal symptoms
8. Tardive dyskinesia
9. Neuroleptic Malignant Syndrome
32
Extrapyramidal Symptoms
1. Dystonia
2. Akathisia
3. Pseudoparkinsonism
33
Dystonia
- Facial grimacing
- Involuntary upward eye movement
- Muscle spasms of the tongue, face, neck, and back (back muscle spasms cause trunk to arch forward)
- Laryngeal spasms
34
Akathisia
- Restless
- Trouble standing still
- Paces the floor
- Feet in constant motion, rocking back and forth
35
Pseudoparkinsonism
- Stooped posture
- Shuffling gait
- Rigidity
- Bradykinesia (slow movement)
- Tremors at rest
- Pill-rolling motion of the hand
36
Tardive Dyskinesia
- Protrusion and rolling of the tongue
- Sucking and smacking movement of the lips
- Chewing motion
- Facial dyskinesia (involuntary movement of the face)
- Involuntary movement of the body and extremeties
- Constant eye blinking
- Bonbon sign
37
Why can extrapyramidal symptoms present when on conventional antipsychotics?
Occurs when there is an imbalance of acetylcholine, dopamine, and GABA in the basal ganglia as a result of blocking dopamine
38
Treatment for Acute Dystonia
Anticholinergic medications such as benztropine which inhibits acetylcholine and restores balance
39
Treatment for Akathisia
Switch medication to atypical antipsychotic or decrease the dose of medication to see if improved
40
Treatment for Pseudoparkinsonism
Switch medications and sometimes benztropine is given
41
Bonbon Sign
Appears with Tardive Dyskinesia
| - The tongue rolls around in the mouth and protrudes into the cheek
42
Long Term Health Issues of Tardive Dyskinesia
Choking associated with loss of control of swallowing muscles and respiratory function compromised
43
Treatment for Tardive Dyskinesia
1. The best management is PREVENTION
- Use the lowest possible dose of antipsychotic medications over time that will minimize the target symptoms without EPS or TD
2. Change antipsychotic medication to a second generation antipsychotic
44
Neuroleptic Malignant Syndrome
MEDICAL EMERGENCY
| - Only occurs with antipsychotic medications
45
S/Sx of Neuroleptic Malignant Syndrome
```
F = Fever
E = Encephalopathy
V = Vitals unstable
E = Elevated enzymes (CPK)
R = Rigidity of muscles
```
* Also mental status change
46
Risk Factors for NMS
1. Dehydration
2. History of NMS
3. Recent dosage increase of antipsychotic medications
4. Psychomotor agitation
5. Lithium and antipsychotics taken together
47
Restarting Antipsychotics After NMS
At least 2 weeks should be allowed to elapse after recovery from NMS before low-potency conventional antipsychotics or atypical antipsychotics should be titrated gradually after a test dose; and patients should be carefully monitored for early signs of NMS
48
Common Atypical Antipsychotics
1. Aripiprazole
2. Clozapaine
3. Iloperidone
4. Olanzapine
5. Quetiapine
6. Risperidone
7. Asenapine
8. Ziprasidone
49
Atypical Antipsychotics: Indications for Use
- Drugs of choice for psychosis, schizophrenia, mania, and autism
- Associated with less EPS and TD
* Treats both positive and negative symptoms associated with schizophrenia
50
Atypical Antipsychotics: Mechanism of Action
Blocks dopamine and serotonin receptors
51
Atypical Antipsychotics: Side Effects
1. Weight gain
2. Cataracts
3. Sexual side effects
4. Hyperlipidemia
5. Myocarditis
6. Diabetes mellitus
7. Prolonged QTC interval
8. EPS
52
Atypical Antipsychotics: Nursing Implications
1. Weight with BMI: weight gain can be extreme (this can influence their compliance)
2. Waist circumference: increase abdominal visceral fat
3. Baseline of patient and family history for dyslipidemia, HTN, CVD, DM, hyperglycemia
4. LABS: serum glucose (fasting), lipid profile (HDL/LDL)
53
What do mood stabilizers do?
1. Relieve symptoms during manic and depressive episodes of bipolar disorder
2. Prevent recurrence of manic and depressive episodes
3. Do not worsen symptoms of mania or depression, or accelerate the rate of cycling
54
Gold Standard for Mood Stabilizers
Lithium
55
Anticonvulsants used as mood stabilizers
1. Carbamazepine
2. Lamotrigine
3. Divalproex sodium
56
Anticonvulsants that are off label used as mood stabilizers
1. Gabapentin
2. Topimirate
3. Oxcarbazepine
57
Lithium: Mechanism of Action
1. Unknown
2. Salt and acts like sodium
3. Increases serotonin
4. Decreases norepinephrine
58
Lithium: Indications for Use
1. Treatment and prevention of acute manic episodes in bipolar
2. Maintenance bipolar
3. Aggression
4. Impulsivity
5. Antisocial personality
6. Mania
59
Lithium: Adverse Effects
1. Cardiac dysrhythmias
2. Seizures
3. Weight gain
4. N/V and GI upset
5. Fine hand tremors
6. Dry mouth
7. Polyuria
8. Thyroid enlargement
9. Goiter
10. Hypothyroidism
11. Fatigue and lethargy
60
Normal Serum Lithium Level
0.6 - 1.2
61
How often are lithium levels monitored?
- Lithium levels are monitored every 1-3 days at the beginning of therapy, then once every several months after that
- Levels must be drawn 12 hours after last dose taken because lithium peak is 4-12 hours
62
What kind of labs should be drawn prior to starting a patient on lithium?
1. Renal
2. Cardiac
3. Thyroid
63
Symptoms of Lithium Toxicity (1.5 - 2.0)
1. Nausea
2. Ataxia
3. Tinnitus
4. Blurred vision
5. Severe diarrhea
64
Symptoms of Lithium Toxicity (2.1 - 3.5)
1. Excessive output of dilute urine
2. Increasing tremors
3. Muscular irritability
4. Psychomotor retardation
5. Mental confusion
6. Giddiness
65
Symptoms of Lithium Toxicity (Above 3.5)
1. Impaired consciousness
2. Nystagmus
3. Seizures
4. Oliguria/anuria
5. Cardiac dysrhythmias (V-tach, SVT)
6. Cardiovascular collpase
7. Coma
66
Treatment for Lithium Toxicity
1. Hold next lithium dose and toxicity will usually resolve within 24-48 hours
2. In severe cases hemodialysis is effective for removing drug from the body
67
If Lithium level is high but the patient shows no symptoms of toxicity
- Make sure and ask the patient when they took the last dose of Lithium
- Labs need to be drawn 12 hours after the last dose
68
Lithium: Nutrition Requirements
- It is important to eat a normal diet with normal salt and fluid intake (1500-3000 mL/day)
69
If you have these symptoms you should stop taking Lithium
1. Diarrhea
2. Vomiting
3. Sweating
* These can dehydrate you and can raise lithium levels in the blood to toxic levels
70
Lithium: Patient Teaching
1. Nutrition
2. When to stop taking it (dehydration, toxicity)
3. Do not take diuretics
4. Take with meals
5. Kidney, thyroid function should be routinely monitored
6. If discontinued, it needs to be tapered
7. Do not take if pregnant or breastfeeding
71
When is divalproex administered as a mood stabilizer?
1. Acute mania
2. Maintenance treatment of bipolar disorder
3. Migraine prophylaxis
72
When is lamotrigine administered as a mood stabilizer?
Maintenance treatment of bipolar 1 disorder
73
When is carbamazepine administered as a mood stabilizer?
Acute mania
74
Contraindications for Antidepressants
1. Acute schizophrenia
2. Severe renal, hepatic, or cardiovascular disease
3. Suicidal tendencies
4. Narrow angle glaucoma
5. Seizures
75
Tricyclic Antidepressants: Indications for Use
1. Depression
2. Bipolar disorders
3. Anxiety disorders
4. OCD
76
Tricyclic Antidepressants: Mechanism of Action
- Blocks the reuptake of norepinephrine and serotonin
| - The effects of tricyclics are attributed to changes in receptors rather than changes in neurotransmitters
77
Tricyclic Antidepressants: Watch for Signs of
1. Sedation
2. Orthostatic hypotension
3. Decreased sexual ability or desire
4. Dry mouth
5. Urinary retention
6. Tachycardia
78
MAOIs: Mechanism of Action
- Inhibit monoamine oxidase (MAO) that breaks down the neurotransmitters serotonin, norepinephrine, and others
- By inhibiting MAO, serotonin and norepinephrine activity is increased in the nerve synapse
79
MAOIs: Indications for Use
Depression
** Not usually 1st line antidepressants
80
Why should you avoid tyramine when taking MAOIs?
- MAOIs interact with foods that are rich in tyramine
| - Tyramine has a vasopressor effect that when increased causes significant hypertension crisis
81
Foods to Avoid that Contain Tyramine
1. Avocados
2. Bananas
3. Beef or chicken liver
4. Brewer's yeast
5. Broad beans
6. Caffeine
7. Cheese, especially aged except for cottage cheese
8. Meat extracts and tenderizers
9. Overripe fruit
10. Papaya
11. Pickled herring
12. Raisins
13. Red wine, beer, sherry
14. Sausage, bologna, pepperoni, salami
15. Sour cream
16. Soy sauce
17. Yogurt
82
Drug-Drug Interactions with MAOIs
1. Cough and cold medicines
2. St. Johns Wort
3. SSRIs/SNRIs
4. Trycyclics
5. General anesthesia
6. Vasoconstrictors
83
Serotonin Syndrome
- Can occur when MAOIs and SSRIs/SNRIs are used together OR too close together
- If switching from MAOI to SSRI (or vice versa) MUST not be given within 2 weeks (14 days) of each other
84
S/Sx of Serotonin Syndrome
1. Mental status changes
2. Autonomic instability
3. Neuromuscular hyperactivity
85
Serotonin Syndrome: Autonomic Instability
1. Hyperthermia
2. Tachycardia
3. Mydriasis (pupil dilation)
4. Diaphoresis
5. N/V/D
86
Serotonin Syndrome: Neuromuscular Hyperactivity
1. Hyperkinesia
2. Hyperreflexia
3. Trismus (lockjaw)
4. Myoclonus (twitching/jerking)
5. Cogwheel rigidity (jerky feeling in your arm or leg that you can sense when rotating that limb or joint)
6. Bruxism (teeth grinding)
87
Trycyclic Drugs
1. Amitriptyline
2. Doxepin
3. Nortriptyline
4. Imipramine
88
MAOI Drugs
1. Phenelzine
2. Tranycypromine
3. Isocarboxazid
89
SSRI Drugs
1. Citalopram
2. Escitalopram
3. Fluvoxamine
4. Fluoxetine
5. Paroxetine
6. Sertraline
90
Side Effects of SSRIs
1. HA
2. Nausea
3. Lethargy
4. Fatigue
5. Insomnia
6. Sexual dysfunction
7. Weight gain
* Do NOT take with MAOIs or abruptly stop taking medication
91
Discontinuation Syndrome
Caused from abrupt discontinuation of SSRI and other antidepressants
92
S/Sx of Discontinuation Syndrome
1. Flu like symptoms
2. Insomnia
3. Nausea
4. Imbalance
5. Sensory disturbances
6. Hyperarousal (agitation/anxiety)
93
SNRI Drugs
1. Venlofaxine
2. Duloxetine
3. Desvenlafaxine
94
SNRI: Mechanism of Action
Acts by blocking serotonin and norepinephrine reuptake, but has side effects similar to SSRI
95
SNRI: Drug-Drug Interactions
1. MAOI = Serotonin Syndrome
| 2. Warfarin and NSAIDs = increase risk of bleeding
96
Nursing Considerations for SNRIs
Check the patients baseline BP because these meds can raise BP
97
Bupropion: Indications for Use
1. Depression
| 2. Smoking cessation
98
Bupropion: Side Effects
1. Lowers seizure threshold so do not use in patients with seizures
2. Weight loss
* Be sure to check patient's baseline BP because this med can raise BP
99
Mirtazapine: Indications for Use
Depression
100
Mirtazapine: Side Effects
1. Sedation
2. Dizziness
3. Weight gain
4. Dry mouth
5. Constipation
101
Trazadone: Indications for Use
1. Depression
| 2. Off Label: insomnia and anxiety
102
Trazadone: Side Effects
1. Sedation
2. Weight gain
3. N/V
4. Dizziness
5. Tremors
103
Benzodiazepines: Indications for Use
1. Panic and anxiety disorders
| 2. Drug of choice for short-term treatment of insomnia
104
Benzodiazepines: Mechanism of Action
Targets GABA receptors and enhances the levels of GABA
105
Benzodiazepine Drugs (FYI)
1. Triazolam
2. Oxazepam
3. Temazepam
4. Lorazepam
5. Alprazolam
6. Chlordiazepoxide
7. Diazepam
8. Halazepam
9. Clorazepate
10. Prazepam
11. Clonazepam
12. Flurazepam
106
Non-Benzodiazepine Drugs
1. Zolpidem
2. Diphenhydramine
3. Zaleplon
4. Eszopiclone
5. Ramelteon
6. Buspirone
107
Non-Benzodiazepine Action
Bind preferentially to GABA receptors and have a less widespread effect than benzodiazepines
108
Benzodiazepines: Adverse Effects
1. Drowsiness, sedation
2. Psychomotor and cognitive impairment
3. Vertigo
4. Confusion
5. Increased appetite and weight gain
6. Alterations in sexual function
7. Rashes are uncommon
8. Some women fail to ovulate
9. Adictive
109
Non-Benzodiazepine Drugs Used to Treat Insomnia
1. Eszopiclone
2. Zaleplon
3. Zolpidem
110
Why is propanolol used to treat anxiety?
Used to decrease BP and HR
111
Stimulants for ADHD
1. Methylphenidate (Concerta/Ritalin)
2. Amphetamine/Dextroamphetamine (Adderall)
3. Dexmethylphenidate (Focalin)
112
Why do we give stimulants to ADHD clients?
1. They cause the release of norepinephrine and dopamine into the synapse and block the reuptake of these neurotransmitters
2. Stimulants produce a paradoxical calming of the increased motor activity characteristics of ADHD
3. Kids with ADHD are low in dopamine and they constantly self-stimulate by wiggling, talking out of turn, running around, etc. by giving them stimulants that increase dopamine they can focus and they don't need to self-stimulate
113
Common Effects of Stimulants
1. Enhanced alertness, awareness, wakefulness, endurance, productivity, and motivation
2. Increased arousal
3. Increase HR and BP
4. A perception of a diminished requirement for food and sleep
5. Can improve mood and relieve anxiety
114
Side Effects of Stimulants
1. Insomnia
2. Decreased appetite
3. HA
4. Stomach aches
5. Mood changes
6. Increase HR and BP
7. Tics
8. Psychosis
9. Seizures
115
Non-Stimulant Medication for ADHD
Atomoxetine (Strattera)
116
Atomoxetine
- A norepinephrine reuptake inhibitor initially developed to be an antidepressant
- 2nd line ADHD agent in ADHD: Only after stimulants failed or when side effects of stimulants are intolerable
- Lower efficacy but fewer and less severe side effects
117
Nursing Considerations for ADHD Drugs
1. Weigh client at least weekly
2. Reduce anorexia by encouraging client to take meds after meals
3. Administer last dose of the day at least 6 hours before bed to prevent insomnia
4. Encourage a "drug holiday" on weekends or when out of school
5. Avoid OTC medications due to drug interactions
