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Sophomore 2 Test 2 > Psychobiology and Psychopharmacology > Flashcards

Psychobiology and Psychopharmacology Flashcards

1
Q

Acetylcholine Function

A
  1. Sleep wake cycle
  2. Muscle coordination and motor activity
  3. Pain perception
  4. Learning, memory acquisition, and retention
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2
Q

Acetylcholine and Serotonin Relationship

A

They have an inverse relationship with each other

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3
Q

Decreased levels of acetylcholine are associated with what mental illnesses?

A
  1. Alzheimer’s disease

2. Dementia

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4
Q

Increased levels of acetylcholine are associated with what mental illnesses?

A
  1. Aggression
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5
Q

Dopamine Function

A
  1. Motor coordination
  2. Metabolism
  3. Motivation, emotion, pleasure/reward system in the brain
  4. Temperature control
  5. Sexual function
  6. Increases BP
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6
Q

Decreased levels of dopamine are associated with what mental illnesses?

A
  1. Parkinson’s disease
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7
Q

Increased levels of dopamine are associated with what mental illnesses?

A
  1. Schizophrenia

2. Mania

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8
Q

Norepinephrine Function

A
  1. Associated with “fight or flight”
  2. Regulation of mood
  3. Can affect attention and learning
  4. Wakefulness
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9
Q

Decreased levels of norepinephrine are associated with what mental illnesses?

A
  1. Depression
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10
Q

Increased levels of norepinephrine are associated with what mental illnesses?

A
  1. Anxiety

2. Manic symptoms

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11
Q

Serotonin Function

A
  1. Affects sleep
  2. Appetite
  3. Hormone secretion
  4. Thermoregulation
  5. Emotions, mood, cognition
  6. Sexual behavior and libido
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12
Q

Decreased levels of serotonin are associated with what mental illnesses?

A
  1. Depression
  2. Insomnia (serotonin breaks down into melatonin)
  3. Anxiety
  4. OCD
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13
Q

Increased levels of serotonin are associated with what mental illnesses?

A
  1. Serotonin Syndrome
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14
Q

GABA Function

A

Controls spinal and cerebellar reflexes and decreases excitability of neurons in the brain

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15
Q

Decreased levels of GABA are associated with what mental illnesses?

A
  1. Seizures
  2. Anxiety
  3. Panic disorders
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16
Q

Increased levels of GABA are associated with what mental illnesses?

A

Excessive Relaxation or sedation

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17
Q

Glutamate Function

A

Widely distributed excitatory neurotransmitter in the brain with some role in learning and memory

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18
Q

Decreased levels of glutamate are associated with what mental illnesses?

A
  1. Agitation
  2. Memory loss
  3. Depression
  4. Loss of energy
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19
Q

Increased levels of glutamate are associated with what mental illnesses?

A
  1. Neurotoxicity by overstimulation of nerves
  2. Huntington’s
  3. AIDS related dementia
  4. Schizophrenia
  5. Anxiety
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20
Q

Efficacy

A

Ability of drug to produce a response

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21
Q

Potency

A

Dose of drug required to produce a specific effect

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22
Q

Tolerance

A

Gradual decrease in the action of a drug at a given dose or concentration in the blood

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23
Q

Toxicity

A

The point when concentrations of a drug in the bloodstream are high enough to become harmful or poisonous

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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
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25
Q

How does advancing age affect drug toxicity?

A

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

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26
Q

How can race affect what medications are prescribed?

A

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
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27
Q

How can gender affect what medications are prescribed?

A
  1. Women respond better than males to SSRIs

2. Women with schizophrenia require smaller doses of antipsychotics

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28
Q

Common Conventional Antipsychotics (Typical)

A
  1. Thioridazine
  2. Chlorpromazine
  3. Fluephenazine
  4. Thiothixene
  5. Haloperidol
  6. Droperidol
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29
Q

Conventional Antipsychotics: Indication for Use

A
  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
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30
Q

Conventional Antipsychotics: Mechanism of Action

A

Blocks the action of dopamine (D2, D3, D4)

  • Suppresses only the positive signs of schizophrenia (hallucinations)
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31
Q

Conventional Antipsychotics: Side Effects

A
  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
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32
Q

Extrapyramidal Symptoms

A
  1. Dystonia
  2. Akathisia
  3. Pseudoparkinsonism
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33
Q

Dystonia

A
  • 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
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34
Q

Akathisia

A
  • Restless
  • Trouble standing still
  • Paces the floor
  • Feet in constant motion, rocking back and forth
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35
Q

Pseudoparkinsonism

A
  • Stooped posture
  • Shuffling gait
  • Rigidity
  • Bradykinesia (slow movement)
  • Tremors at rest
  • Pill-rolling motion of the hand
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36
Q

Tardive Dyskinesia

A
  • 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
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37
Q

Why can extrapyramidal symptoms present when on conventional antipsychotics?

A

Occurs when there is an imbalance of acetylcholine, dopamine, and GABA in the basal ganglia as a result of blocking dopamine

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38
Q

Treatment for Acute Dystonia

A

Anticholinergic medications such as benztropine which inhibits acetylcholine and restores balance

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39
Q

Treatment for Akathisia

A

Switch medication to atypical antipsychotic or decrease the dose of medication to see if improved

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40
Q

Treatment for Pseudoparkinsonism

A

Switch medications and sometimes benztropine is given

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41
Q

Bonbon Sign

A

Appears with Tardive Dyskinesia

- The tongue rolls around in the mouth and protrudes into the cheek

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42
Q

Long Term Health Issues of Tardive Dyskinesia

A

Choking associated with loss of control of swallowing muscles and respiratory function compromised

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43
Q

Treatment for Tardive Dyskinesia

A
  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
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44
Q

Neuroleptic Malignant Syndrome

A

MEDICAL EMERGENCY

- Only occurs with antipsychotic medications

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45
Q

S/Sx of Neuroleptic Malignant Syndrome

A 
F = Fever
E = Encephalopathy
V = Vitals unstable
E = Elevated enzymes (CPK)
R = Rigidity of muscles
  • Also mental status change
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46
Q

Risk Factors for NMS

A
  1. Dehydration
  2. History of NMS
  3. Recent dosage increase of antipsychotic medications
  4. Psychomotor agitation
  5. Lithium and antipsychotics taken together
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47
Q

Restarting Antipsychotics After NMS

A

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
Q

Common Atypical Antipsychotics

A
  1. Aripiprazole
  2. Clozapaine
  3. Iloperidone
  4. Olanzapine
  5. Quetiapine
  6. Risperidone
  7. Asenapine
  8. Ziprasidone
49
Q

Atypical Antipsychotics: Indications for Use

A
  • 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
Q

Atypical Antipsychotics: Mechanism of Action

A

Blocks dopamine and serotonin receptors

51
Q

Atypical Antipsychotics: Side Effects

A
  1. Weight gain
  2. Cataracts
  3. Sexual side effects
  4. Hyperlipidemia
  5. Myocarditis
  6. Diabetes mellitus
  7. Prolonged QTC interval
  8. EPS
52
Q

Atypical Antipsychotics: Nursing Implications

A
  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
Q

What do mood stabilizers do?

A
  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
Q

Gold Standard for Mood Stabilizers

55
Q

Anticonvulsants used as mood stabilizers

A
  1. Carbamazepine
  2. Lamotrigine
  3. Divalproex sodium
56
Q

Anticonvulsants that are off label used as mood stabilizers

A
  1. Gabapentin
  2. Topimirate
  3. Oxcarbazepine
57
Q

Lithium: Mechanism of Action

A
  1. Unknown
  2. Salt and acts like sodium
  3. Increases serotonin
  4. Decreases norepinephrine
58
Q

Lithium: Indications for Use

A
  1. Treatment and prevention of acute manic episodes in bipolar
  2. Maintenance bipolar
  3. Aggression
  4. Impulsivity
  5. Antisocial personality
  6. Mania
59
Q

Lithium: Adverse Effects

A
  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
Q

Normal Serum Lithium Level

61
Q

How often are lithium levels monitored?

A
  • 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
Q

What kind of labs should be drawn prior to starting a patient on lithium?

A
  1. Renal
  2. Cardiac
  3. Thyroid
63
Q

Symptoms of Lithium Toxicity (1.5 - 2.0)

A
  1. Nausea
  2. Ataxia
  3. Tinnitus
  4. Blurred vision
  5. Severe diarrhea
64
Q

Symptoms of Lithium Toxicity (2.1 - 3.5)

A
  1. Excessive output of dilute urine
  2. Increasing tremors
  3. Muscular irritability
  4. Psychomotor retardation
  5. Mental confusion
  6. Giddiness
65
Q

Symptoms of Lithium Toxicity (Above 3.5)

A
  1. Impaired consciousness
  2. Nystagmus
  3. Seizures
  4. Oliguria/anuria
  5. Cardiac dysrhythmias (V-tach, SVT)
  6. Cardiovascular collpase
  7. Coma
66
Q

Treatment for Lithium Toxicity

A
  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
Q

If Lithium level is high but the patient shows no symptoms of toxicity

A
  • 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
Q

Lithium: Nutrition Requirements

A
  • It is important to eat a normal diet with normal salt and fluid intake (1500-3000 mL/day)
69
Q

If you have these symptoms you should stop taking Lithium

A
  1. Diarrhea
  2. Vomiting
  3. Sweating
  • These can dehydrate you and can raise lithium levels in the blood to toxic levels
70
Q

Lithium: Patient Teaching

A
  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
Q

When is divalproex administered as a mood stabilizer?

A
  1. Acute mania
  2. Maintenance treatment of bipolar disorder
  3. Migraine prophylaxis
72
Q

When is lamotrigine administered as a mood stabilizer?

A

Maintenance treatment of bipolar 1 disorder

73
Q

When is carbamazepine administered as a mood stabilizer?

A

Acute mania

74
Q

Contraindications for Antidepressants

A
  1. Acute schizophrenia
  2. Severe renal, hepatic, or cardiovascular disease
  3. Suicidal tendencies
  4. Narrow angle glaucoma
  5. Seizures
75
Q

Tricyclic Antidepressants: Indications for Use

A
  1. Depression
  2. Bipolar disorders
  3. Anxiety disorders
  4. OCD
76
Q

Tricyclic Antidepressants: Mechanism of Action

A
  • Blocks the reuptake of norepinephrine and serotonin

- The effects of tricyclics are attributed to changes in receptors rather than changes in neurotransmitters

77
Q

Tricyclic Antidepressants: Watch for Signs of

A
  1. Sedation
  2. Orthostatic hypotension
  3. Decreased sexual ability or desire
  4. Dry mouth
  5. Urinary retention
  6. Tachycardia
78
Q

MAOIs: Mechanism of Action

A
  • 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
Q

MAOIs: Indications for Use

A

Depression

** Not usually 1st line antidepressants

80
Q

Why should you avoid tyramine when taking MAOIs?

A
  • MAOIs interact with foods that are rich in tyramine

- Tyramine has a vasopressor effect that when increased causes significant hypertension crisis

81
Q

Foods to Avoid that Contain Tyramine

A
  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
Q

Drug-Drug Interactions with MAOIs

A
  1. Cough and cold medicines
  2. St. Johns Wort
  3. SSRIs/SNRIs
  4. Trycyclics
  5. General anesthesia
  6. Vasoconstrictors
83
Q

Serotonin Syndrome

A
  • 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
Q

S/Sx of Serotonin Syndrome

A
  1. Mental status changes
  2. Autonomic instability
  3. Neuromuscular hyperactivity
85
Q

Serotonin Syndrome: Autonomic Instability

A
  1. Hyperthermia
  2. Tachycardia
  3. Mydriasis (pupil dilation)
  4. Diaphoresis
  5. N/V/D
86
Q

Serotonin Syndrome: Neuromuscular Hyperactivity

A
  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
Q

Trycyclic Drugs

A
  1. Amitriptyline
  2. Doxepin
  3. Nortriptyline
  4. Imipramine
88
Q

MAOI Drugs

A
  1. Phenelzine
  2. Tranycypromine
  3. Isocarboxazid
89
Q

SSRI Drugs

A
  1. Citalopram
  2. Escitalopram
  3. Fluvoxamine
  4. Fluoxetine
  5. Paroxetine
  6. Sertraline
90
Q

Side Effects of SSRIs

A
  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
Q

Discontinuation Syndrome

A

Caused from abrupt discontinuation of SSRI and other antidepressants

92
Q

S/Sx of Discontinuation Syndrome

A
  1. Flu like symptoms
  2. Insomnia
  3. Nausea
  4. Imbalance
  5. Sensory disturbances
  6. Hyperarousal (agitation/anxiety)
93
Q

SNRI Drugs

A
  1. Venlofaxine
  2. Duloxetine
  3. Desvenlafaxine
94
Q

SNRI: Mechanism of Action

A

Acts by blocking serotonin and norepinephrine reuptake, but has side effects similar to SSRI

95
Q

SNRI: Drug-Drug Interactions

A
  1. MAOI = Serotonin Syndrome

2. Warfarin and NSAIDs = increase risk of bleeding

96
Q

Nursing Considerations for SNRIs

A

Check the patients baseline BP because these meds can raise BP

97
Q

Bupropion: Indications for Use

A
  1. Depression

2. Smoking cessation

98
Q

Bupropion: Side Effects

A
  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
Q

Mirtazapine: Indications for Use

A

Depression

100
Q

Mirtazapine: Side Effects

A
  1. Sedation
  2. Dizziness
  3. Weight gain
  4. Dry mouth
  5. Constipation
101
Q

Trazadone: Indications for Use

A
  1. Depression

2. Off Label: insomnia and anxiety

102
Q

Trazadone: Side Effects

A
  1. Sedation
  2. Weight gain
  3. N/V
  4. Dizziness
  5. Tremors
103
Q

Benzodiazepines: Indications for Use

A
  1. Panic and anxiety disorders

2. Drug of choice for short-term treatment of insomnia

104
Q

Benzodiazepines: Mechanism of Action

A

Targets GABA receptors and enhances the levels of GABA

105
Q

Benzodiazepine Drugs (FYI)

A
  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
Q

Non-Benzodiazepine Drugs

A
  1. Zolpidem
  2. Diphenhydramine
  3. Zaleplon
  4. Eszopiclone
  5. Ramelteon
  6. Buspirone
107
Q

Non-Benzodiazepine Action

A

Bind preferentially to GABA receptors and have a less widespread effect than benzodiazepines

108
Q

Benzodiazepines: Adverse Effects

A
  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
Q

Non-Benzodiazepine Drugs Used to Treat Insomnia

A
  1. Eszopiclone
  2. Zaleplon
  3. Zolpidem
110
Q

Why is propanolol used to treat anxiety?

A

Used to decrease BP and HR

111
Q

Stimulants for ADHD

A
  1. Methylphenidate (Concerta/Ritalin)
  2. Amphetamine/Dextroamphetamine (Adderall)
  3. Dexmethylphenidate (Focalin)
112
Q

Why do we give stimulants to ADHD clients?

A
  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
Q

Common Effects of Stimulants

A
  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
Q

Side Effects of Stimulants

A
  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
Q

Non-Stimulant Medication for ADHD

A

Atomoxetine (Strattera)

116
Q

Atomoxetine

A
  • 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
Q

Nursing Considerations for ADHD Drugs

A
  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

Sophomore 2 Test 2 (4 decks)

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