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IM 6 Test 2 > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

frontal lobe controls

A

executive functions and personality development

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2
Q

temporal lobe controls

A

language comprehension, sound processing

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3
Q

occipital lobe controls

A

vision and language formation

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4
Q

parietal lobe controls

A

sensory information, reading and math skills, and abstract thought

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5
Q

cerebellum controls

A

skeletal muscle and maintains equilibrium

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6
Q

midbrain controls

A

pupillary reflex and eye movement

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7
Q

pons control

A

processing station in auditory pathways

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8
Q

medulla oblongata controls

A

involuntary reflexes (vital signs, etc)

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9
Q

neurons

A

interconnected nerve cells

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10
Q

neurotransmitters

A

chemical messengers ebtween neurons that trigger a response from one neuron to another

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11
Q

neurotransmission

A

conduction of an electrical impulse from one end of the neuron to the other

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12
Q

synaptic transmission

A

when the electrical impulse reaches the end of the neuron, the neurotransmitter is released at the axon terminal and diffuses across the synapse to the postsynaptic neuron

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13
Q

inhibitory neurotransmitters

A

inhibits action in the post synaptic cell

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14
Q

excitatory neurotransmitters

A

promotes action in the post synaptic cell

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15
Q

Monoamines X4

A

dopamine, norepinephrine, serotonin, histamine

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16
Q

Dopamine aka and receptors

A

DA

D1, D2, D3, D4 and D5

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17
Q

DA functions

A

fine muscle movement, decision making, release of hormones from hypothalamus, integreation of emotins and thoughts

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18
Q

increase in DA -

A

schizo/psychosis, mania

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19
Q

decrease in DA

A

parkinsons and depression

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20
Q

norepinephrine aka and receptors

A

NE

a1, a1, B1 or B2

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21
Q

Ne functions

A

fight or flight response/hypervigilance

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22
Q

icnrease NE

A

mania, anxiety, psychosis - heightened arousal states

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23
Q

decrease NE

A

depression and lowered arousal states

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24
Q

serotinin aka and receptors

A

5-HT

5-HT, 5-HT2, 5-HT3, or 5-HT4

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25
Q

serotonin function

A

sleep regliation, hunger, mood, libido, hormonal activity

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26
Q

increase of serotonin

A

anxiety

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27
Q

decrease of serotonin

A

depression

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28
Q

histamine aka and receptors

A

H

H1 and H2

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29
Q

histamine functions

A

alertness, stimulates gastric secretions, inflammation response

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30
Q

decrease in histamine

A

sedation and weight gain

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31
Q

amino acids X2

A

GABA, glutamate

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32
Q

GABA receptors

A

GABAA, GABAB

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33
Q

GABA functions

A

decrease anxiety/excitement, affects pain perception, anticonvulsant/muscle relaxing properties

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34
Q

increase of GABA

A

anxiety reduction

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35
Q

decrease of GABA

A

mania, anxiety, psychosis

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36
Q

glutamate

A

excitatory neurotransmitter

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37
Q

glutamate receptors

A

NMDA, AMPA

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38
Q

glutamate functions

A

role in learning

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39
Q

increase in NMDA

A

neurotoxicity and neurodegeneration (alzheimers)

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40
Q

increase in AMPA

A

improvement of cognitive function in behavioral tasks

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41
Q

decrease in NMDA

A

psychosis

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42
Q

cholinergic

A

acetylcholine

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43
Q

acetylcholine aka and receptors

A

ACh

nicotonic and muscarinic (M1, M2, M3)

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44
Q

ACh function

A

learning/memory, mood regulation, sexual/aggressive behavior and stimulates PNS

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45
Q

ACh increase

A

depression

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46
Q

Ach decrease

A

alzheimers, parkinsons, huntington’s chorea

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47
Q

chorea

A

jerky muscle movements

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48
Q

what are antidepressants used to treat

A

major depression, panic disorder, anxiety disorders, bipolar, psychotic depression

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49
Q

fluoxetine aka

A

prozac

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50
Q

sertraline aka

A

zoloft

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51
Q

escitalopram

A

lexapro

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52
Q

fluvoxamine class

A

SSRI

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53
Q

paroxetine class

A

SSRI

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54
Q

citalopram class

A

SSRI

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55
Q

vilazodone class

A

SSRI

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56
Q

vortioxetine class

A

SSRI

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57
Q

SSRI MOA

A

inhibit reuptake of serotonin making it no longer available in the synapse

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58
Q

SSRI SE X12

A 
tremors
nausea
HA
insomnia
drowsiness
sexual dysfunction
bruxism
anxiety
dry mouth
diarrhea
hyponatremia
intense suicidal ideation
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59
Q

bruxism

A

grinding of teeth

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60
Q

which SSRI is bruxism common in

A

paroxetine

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61
Q

when and how should you take SSRI’s

A

with food in the morning at the same time every day

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62
Q

avoid X2 with SSRI’s

A

alcohol and antihistamines

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63
Q

how to stop SSRI’s

A

tapered - do not stop abruptly or r/o withdrawal/discontinuation syndrome

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64
Q

how long does it take SSRI’s to be therapeutic

A

1-3 weeks to start to be therapeutic, potentially 2-3 months for full effects in some meds

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65
Q

what can occur if SSRI’s are taken with other serotonin blocking agents

A

serotonin toxicity

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66
Q

what are serotonin blocking agents X7

A 
SSRI
MAOI
Li
triptan
buspirone
tramadol
OTC cough/cold medications
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67
Q

CYP450 enzyme inhibitors/inducers and SSRI’s

A

use cautiously

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68
Q

EX of CYP450 enzyme inhibitors/inducers

A

ketoconazole or rifampin

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69
Q

discontinuation syndrome s/s X9

A 
anxiety
insomnia
vivid dreams
HA
dizziness
fatigue
flu like symptoms
brain shocks
return of depression symptoms
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70
Q

how long can discontinuation syndrome last

A

months

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71
Q

SSRI blackbox warning

A

increased risk of suicide

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72
Q

Serotonin Syndrome S/s

A

SHIVER

Shivering/shaking
Hyperreflexia and myoclonus (rhabdomyolysis)
Increased Temp
Vital sign instability (tachycardia/pnea and labile BP)
Encephalopathy - agitaiton, delirium and confusion
Restlessness and incoordination
Sweating

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73
Q

cause of serotonin syndrome

A

r/t over-action of the central serotonin receptors caused by too high of a dose of SSRI’s or by other drug interactions

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74
Q

nursing interventions for serotonin syndrome X4

A

d/c drug
keep safe environment
monitor physical/mental status
provide reassurance to patient

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75
Q

drugs for serotonin syndrome X4

A

serotonin receptor blockade
dantrolene/diazepam - muscle rigidity
cyproheptadine

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76
Q

imipramine class

A

TCA

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77
Q

amitriptyline class

A

TCA

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78
Q

doxepin class

A

TCA

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79
Q

desipramine class

A

TCA

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80
Q

nortriptyline class

A

TCA

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81
Q

clomipramine class

A

TCA

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82
Q

maprotiline class

A

TCA

83
Q

protriptyline class

A

TCA

84
Q

trimipramine class

A

TCA

85
Q

Amoxapine class

A

TCA

86
Q

which 2 TCA’s are approved for ages 8+

A

imipramine, clomipramine

87
Q

TCA MOA

A

inhibit reuptake of serotonin and NE and blocks cholinergic receptors

88
Q

TCA SE X9

A 
sedation
weight gain
toxicity
decreased seizure threshold
orthostatic hypotension
anticholinergic effects
mydriasis
sweating
sexual dysfunction
89
Q

mydriasis

A

pupil dilation

90
Q

anticholinergic effects

A

cant see (dry eye)
cant pee - urinary retention
cant spit - dry mouth
cant shit - constpiation

91
Q

what should be avoided on TCA

A

alcohol

92
Q

when should TCA’s be taken

A

in the evening

93
Q

PT ed TCA OD

A

lethal in OD d/t lipid solubility

94
Q

driving and TCA

A

use caution

95
Q

how long does it take for TCA’s to be affective

A

4-8 weeks

96
Q

CI for TCA’s

A

pt hx of SI/SA

97
Q

isocarboxazid class

A

MAOI

98
Q

phenelzine class

A

MAOI

99
Q

tranylcypromine class

A

MAOI

100
Q

selegiline class

A

MAOI

101
Q

which MAOI comes in a patch

A

selegiline

102
Q

MAOI MOA

A

inhibits enzyme that degrades NE, DA and serotonin

103
Q

SE MAOI X5

A

SERIOUS TYRAMINE INTERACTIONS

muscle cramps
weight gain
sexual dysfunction
anticholinergic effects

104
Q

MAOI OD

A

lethal

105
Q

MAOI and driving

A

use caution

106
Q

when to notify MD on MAOI

A

before taking ANY (Rx or OTC) medication

107
Q

MAOI diet

A

TYRAMINE FREE DIET

continues 2 weeks after drug d/c

108
Q

Tyramine free diet -

A 
avoid:
aged cheeses and meats
yeast
soy
beer
wine
avocados
banana/banana peels
109
Q

HTN crisis symptoms X11

A 
N/V
Chills
fever
sweating
severe HTN
restlessness
nuchal rigidity
dilated pupils
motor agitation
occipital HA
severe nosebleeds
110
Q

venlafaxine class

A

SNRI

111
Q

duloxetine class

A

SNRI

112
Q

SNRI MOA

A

increase serotonin and NE

113
Q

SNRI SE

A

few anticholinergic effects

114
Q

mirtazapine class

A

SNDI

115
Q

SNDI MOA

A

increase serotonin and NE - combined with SSRI’s to augment efficacy or counteract serotonergic SE

116
Q

chlorpromazine class

A

1st gen antipsychotic

117
Q

haloperidol class

A

1st gen antipsychotic

118
Q

loxapine perphenazine class

A

1st gen antipsychotic

119
Q

thioridazine class

A

1st gen antipsychotic

120
Q

clozapine class

A

2nd gen antipsychotic

121
Q

cariprazine class

A

2nd gen antipsychotic

122
Q

amisulpride class

A

2nd gen antipsychotic

123
Q

brexpiprazole class

A

2nd gen antipsychotic

124
Q

aripiprazole class

A

2nd gen antipsychotic

125
Q

ziprasidone class

A

2nd gen antipsychotic

126
Q

asenapine class

A

2nd gen antipsychotic

127
Q

sertindole class

A

2nd gen antipsychotic

128
Q

loperidone class

A

2nd gen antipsychotic

129
Q

quetiapine class

A

2nd gen antipsychotic

130
Q

lurasidone class

A

2nd gen antipsychotic

131
Q

lumateperone class

A

2nd gen antipsychotic

132
Q

olanzapine class

A

2nd gen antipsychotic

133
Q

paliperidone class

A

2nd gen antipsychotic

134
Q

riperidone class

A

2nd gen antipsychotic

135
Q

1st gen MOA

A

dopamine receptor antagonist

lesser degree acetylcholine, histamine and NE

control of positive symptoms

136
Q

2nd gen MOA

A

serotonin-dopamine antagonists

less blockade of dopamine + stron serotonin antagonist

lesser degree Ach, histamine and NE

control of both positive and negative symptoms

137
Q

1st gen SE X10

A 
anticholinergic effects***
weight gain
sexual/reproductive organ issues
increased prolactin levels
seizures
sedation
tachycardia/prolonged QT interval***
orthostatic hypotension
EPS/Tardive dyskinesia***
138
Q

2nd gen SE

A 
less anticholinergic effects
weight gain
T2DM
dyslipidemia
anxiety
HA
sedation
139
Q

fga PT ED

A

limit sun exposure, use sunscreen and wear glasses
prevent constipation
use sugar free candies for dry mouth
may take 2-4 weeks for full effect

140
Q

SGA pt ed

A

observe for signs for T2DM

141
Q

EPS X3

A

acute dystonia, akathisia, pseudoparkinsonism

142
Q

acute dystonia

A

severe spasms of the muscles of the tongue, head and neck and eyes fixed upwards

143
Q

akasthisia

A

internal restlessness and external restless pacing

144
Q

pseudoparkinsonism

A

stiffening of muscular activity in the face, body, arms, and legs, salivation, shuffling gait, tremor and bradykinesia

145
Q

Tardive dyskinesia is X EPS

A

late eps

146
Q

neuroleptic malignant syndrome (NMS) s/sx

A 
tachycardia/pnea
muscle rigidity - elevated CPK
drooling
sudden high fever
diaphoresis
labile BP
decreased LOC up to coma
147
Q

NMS Treatment

A

stop med immediately
increase fluid intake
treat fever rapidly
treat BP and dysrhythmias

148
Q

meds for NMS

A

dantrolene or bromocriptine

149
Q

alprazolam class

A

benzo

150
Q

oxazepam class

A

benzo

151
Q

triazolam class

A

benzo

152
Q

lorazepam class

A

benZO

153
Q

diazepam class

A

benzo

154
Q

clonazepam class

A

benzo

155
Q

chlordiazepoxide

A

benzo

156
Q

benzo MOA

A

promote GABA activity by minding to a recepter on the GABAA receptor complex

157
Q

what are benzos good for

A

short term anxiety and acute anxiety

158
Q

what med should you not combine benzos with

A

opioids

159
Q

benzo SE X6

A 
sedation
dizziness
fatigue
impaired driving
impaired cognitive function
CNS depression
160
Q

what should you avoid on benzos

A

alcohol - can potentiate effects

161
Q

why shouldn’t you abruptly stop benzos

A

withdrawal can be fatal

162
Q

short term benzo withdrawal syndrome

A

anxiety, insomnia, sweating, tremors and dizziness

163
Q

long term benzo withdrawal syndrome

A

panic, paranoia, delirium, HTN, muscle twitches and seizures

164
Q

buspirone MOA

A

stimulating serotonin receptors on nerves

165
Q

buspirone SE X6

A 
dizziness
nausea
HA
nervousness
lightheadedness
excitement
166
Q

what med to avoid with buspirone

A

MAOI w/n 14 days

167
Q

how long does it take to reach therapeutic elvels with buspirone

A

2-4 weeks

168
Q

is buspirone addictive

A

no

169
Q

benzo v. buspirone onset

A

benzo - rapid

buspirone - delayed

170
Q

benzo v. buspirone use in

A

benzo - many anxiety disorders

buspirone - FDA approved for GAD ONLY

171
Q

benzo v. buspirone sedation

A

benzo - sedating

buspirone - nonsedating

172
Q

benzo v. buspirone dependence/withdrawal

A

benzo - definitive dependence and withdrawal

buspirone - no dependence or withdrawal

173
Q

benzo v. buspirone tolerance

A

benzo - tolerance varies with increased age

buspirone - no change with age

174
Q

benzo v. buspirone PRN usage

A

benzo - may be PRN

buspirone - not suitable for PRN

175
Q

other med classes for anxiety X5

A 
antidepressants
antihistamines
anticonvulsants
antipsychotics - low doses
beta blcokers
176
Q

kava-kava for anxiety

A

NO - may cause psychosis

177
Q

valerian root for anxiety

A

probably not

178
Q

melatonin for anxiety

A

maybe

179
Q

lithium class

A

mood stabilizers

180
Q

valproate used for

A

mood stabilizers

181
Q

lamotrigine used for

A

mood stabilizers

182
Q

carbamazepine used for

A

mood stabilizers

183
Q

oxcarbazepine off label used for

A

mood stabilizing

184
Q

gabapentin off label used for

A

mood stabilizing

185
Q

topiramate off label used for

A

mood stabilizing

186
Q

lithium MOA

A

unknown - believed to inhibit release of dopamine and NE

187
Q

lithium SE X9

A 
GI distress
hand tremors
polyuria with mild thirst
weight gain
goiter/hypothyroidism
renal toxicity
hypotension
bradydysrhythmias
electrolyte imbalances
188
Q

early lithium toxicity level

A

<1.5

189
Q

early lithium toxicity

A 
thirst
slurred speech
N/V/D
polyuria
muscle weakness
190
Q

advanced lithium toxicity level

A

1.5-2

191
Q

advance Li toxicity

A 
coarse tremors
confusion
EEG changes
incoordination
worsening GI upset
hyperirritability in muscles
192
Q

severe Li toxicity level

A

2-2.5

193
Q

severe Li toxicity

A 
clonic movements
large amount of dilute urine
seizures
stupor
severe hypotension
ataxia
tinnitus
194
Q

lethal Li toxicity range

A

> 2.5

195
Q

lethal Li toxicity

A 
rapid progression
coma
dysrhythmias
circulatory collapse
oliguria
proteinuria
possible death
196
Q

when do Li effects start

A

5-7 days with max effect in 2-3 weeks

197
Q

pregnancy and Li

A

do not take

198
Q

how do you decrease GI upset with Li

A

take with food

199
Q

sodium and Li

A

keep it even

200
Q

anticonvulsants in Mood stabilization MOA

A

potentiates the inhibitory effect of GABA

201
Q

valproic acid and valproate AE

A

blood dyscrasias, hepatotoxicity, pancreatitis

202
Q

carbamazepine AE

A

agranulocytosis and aplastic anemia

notify MD if you have a sore throat

203
Q

anticonvulsant pt ed

A

report pregnancy
monitor blood levels
DO NOT STOP ABRUPTLY
take as Rx

IM 6 Test 2 (5 decks)

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