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Psychopharmacology Flashcards

1
Q

Components of CNS

A 
brain and spinal cord
cerebrum
cerebellum
brain stem
limbic system
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2
Q

Cerebrum

A

cerebral hemispheres

  • frontal
  • temporal
  • parietal
  • occipital
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3
Q

Frontal Lobe

A

Prefrontal cortex (PFC)
“executive center”
-regulation of attention, behavior, and emotion, decision making
-cognition, perception, affect, behavior (predominant dysfunction in the PFC w/ schizophrenia)
-inattention, impulsivity, motor hyperactivity (weaker function and structure of PFC w/ ADHD)

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4
Q

Temporal Lobe

A

center for sense of smell and hearing

deficits of auditory processing (w/ schizophrenia)

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5
Q

Occipital Lobe

A

language generation
visual interpretation (depth perception)
memory processing

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6
Q

Parietal Lobe

A

interpret sensations of taste and touch

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7
Q

Cerebellum

A

coordination of movements

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8
Q

Limbic System

A

includes: thalamus, hypothalamus, hippocampus, and amygdala

emotional regulation

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9
Q

Neurobiologic Causes of Mental Illness

A
  • genetics
  • stress and the immune system (inflammatory response)
  • infection (viral theories and schizophrenia)

chemical imbalance

  • serotonin and depression
  • dopamine and schizophrenia
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10
Q

Neurotransmitters

A 
dopamine
serotonin
norepinephrine
epinephrine 
histamine
acetylcholine
glutamate
GABA
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11
Q

Serotonin

A

derived from: tryptophan

involved in: control of food intake, sleep and wakefulness, temperature regulation, pain control, sexual behavior, and regulation of emotions

role in: anxiety, schizophrenia, and mood disorders

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12
Q

SSRI

A

selective serotonin reuptake inhibitors

block the reuptake of serotonin from the synaptic cleft, and thus this NT stays longer in the gap than normal > increase in serotonergic activity

hallmark med = fluoxetine (Prozac)

equally as efficacious as TCAs, but w/ fewer SEs

takes 4-6wks to see full therapeutic effect

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13
Q

Dopamine

A

involved in: control of complex movements, motivation, cognition, regulation of emotional responses

antipsychotics block dopamine receptors > reduce dopamine activity

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14
Q

Histamine

A

function: chemical messenger responsible for allergic response, control of gastric secretions, cardiac stimulations, alertness
implications: schizophrenia, sleep disorders, Alzheimer’s

psychiatric medications (diphenhydramine, hydroxyzine, Doxepin, amitriptyline (TCA), antipsychotics) block histamine and result in:
-weight gain, sedation, hypotension, constipation, cognitive
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15
Q

Acetylcholine

A
  • controls sleep and wakefulness

- implications in Alzheimer’s disease

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16
Q

Glutamate

A

workin in an excitatory capacity in the brain

major mediator of cognition, memory, and learning

implication in Alzheimer’s

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17
Q

GABA (Gamma-aminobutyric acid)

A

involved in the inhibition of vigilance, anxiety, muscle tension and memory enhancement

implication: anxiety, sleep
* benzodiazepines: increase GABA function and induce sleep

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18
Q

Norepinephrine/Epinephrine

A

attention, learning, memory, sleep, wakefulness

implications: mood, person’s ability to concentrate, anxiety

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19
Q

Brain Imaging

A

Computed tomography (CT) - radiation

Magnetic resonance imaging (MRI) - risk from magnetic field

Positron emission tomography (PET) - radiation

Single-photon emission computed tomography (SECT) - radiation

  • brain imagining alone cannot be used to dx a mental health condition
  • used to r/o another medical condition
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20
Q

Psychopharmacology Med Classes

A 
Antipsychotics
Antidepressants
Mood stabilizers
Anxiolytics
Simulants
Medications for substance use disorders
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21
Q

Efficacy

A

maximal therapeutic effect that a drug can achieve

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22
Q

Potency

A

amount of drug needed to achieve maximum effect

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23
Q

Half-life

A

amount of time for half of the drug to be removed from the bloodstream

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24
Q

Off label use

A

use of a drug for a condition not approved by the FDA

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25
Black box warning
separate warning which contains serious or life-threatening side effects
26
Discontinuation withdrawal
many medications need to be tapered before stopped (shorter half life might need to give more often)
27
Antipsychotics: Use
- psychosis (positive symptoms) - mood stabilization off label: anxiety, insomnia, aggressive behavior
28
Antipsychotic Meds
first generation (older, more associated w/ TD and EPS SEs) - chlorpromazine (Thorazine) - perphenazine (Trilafon) - fluphenazine (Prolixin)* - haloperidol (Haldol)* second generation: have more metabolic SEs - clozapine (Clozaril) - risperidone (risperdal)* - olanzapine (Zyprexa)* - quetiapine (Seroquel) - Ziprasidone (Geodon) - Paliperidone (Invega)* - Iloperidone (Fanapt) - asenapine (Saphris) - lurasidone (Latuda) second generation meds that can used for mood disorder like bipolar depression: -aripiprazole (Abilify)* *available as depot
29
Depot Injection
long acting injectables (LAI) six antipsychotic meds are available as depot
30
Antipsychotics: Black Box Warnings
elderly patients with dementia related psychosis: increased mortality risk w/ conventional (first generation) or atypical antipsychotics most deaths d/t cardiovascular or infectious events
31
EPS
Dystonia: seen in the neck, emergency, give IM benztropine Drug-induced parkinsonism: tremors, shuffling gait, flat affect/ mask like face, slower movements in general Akathisia: restlessness, can't sit, pt will report this subjectively as well TD: oral/facial movements (tongue protruding) -in assessment of this ensure they do not have denture or gum and then distract them by having them touch their thumb to each finger. *EPS is assessed via AIMS exam
32
Medications Used to Treat EPS
benztropine (2-8mg per day) | benadryl
33
NMS
neuroleptic malignant syndrome infrequent/rare potentially life-threatening condition s/sx: - fever - rigid muscles - altered consciousness
34
SE of Antipsychotics
- EPS - TD - elevated prolactin > breast enlargement or tenderness (can happen in men) and decreased libido * common w/ risperidone (Risperdal) - weight gain * most significant w/ clozaril and olanzapine
35
Clozaril: SE
- wide Qtc (at risk for dysrhytmias) - weight gain (metabolic syndrome) - lower seizure threshold - agranulocytosis! (look at ANC values) - myocarditis (at onset of tx) - constipation! - low risk for EPS baseline EKG before initiating tx used when failed 4-6wk trial of two different antipsychotics at max dose
36
Antidepressants: Uses
depression, anxiety, OCD off label uses: chronic pain, migraines
37
Antidepressants: Types
1. Tricyclic - SE: sedation, orthostatic HTN, anticholinergic 2. SSRI 3. MAOIs - SE: hypertensive crisis w/ foods containing tyramines, many drug interactions 4. Other antidepressants
38
TCA
- desipramine (Norpramin): used for children w/ bedwetting issues - amitriptyline (Elavil) - nortriptyline (Pamelor) - Doxepin - Mirtaxapine - Clomipramine: more efficacious w/ treating OCD
39
MAOIs
Monoamine Oxidase Inhibitors -phenelzine (Nardil) potentially life-threatening hypertensive crisis w/ foods containing tyramine
40
Other Antidepressants
- bupropion (Wellbutrin) - Venlafaxine - Desvenlafaxine - Duloxetine - Trazodone (Nefazodone - avoided b/c of life-threatening liver damage that can occur) - Vilazodone
41
SSRI/SNRI: SE
- GI upset at onset of tx - Sexual SE (anorgasmia, impotence, decreased libido) - sleep disturbances (take in morning to reduce this) - weight gain - akathisia - sweating - paroxetine (more sedation) - withdrawal syndrome - monitor for increases in BP
42
TCA: SE
anticholinergic effects: dry mouth, blurred vision, urinary retention, constipation, tachycardia cholinergic blockade and cardiac toxicity in overdose situations drug levels can be obtained don't give to someone who is high risk for suicide unless safety measures can be ensured (like handing them out daily to them)
43
Bupropion
Wellbutrin - inhibit dopamin uptake - aid to quit smoking - used for depression and ADHD - sex and drug - weight loss - SEIZURE RISK (don't use w/ seizure hx/ eating disorder)
44
Trazodone
sleep | priapism
45
Serotonin Syndrome: S/Sx
in order of appearance: - diarrhea - restlessness - extreme agitation - hyperreflexia - autonomic instability - myoclonus - seizures - rigidity - delirium, coma, death
46
Antidepressants: Black Box Warning
increased risk for suicidality in children, adolescents, and young adults w/ MDD or other psychiatric disorders - observe all pt's clinical worsening, sucidality, or unusual behavior changes - may advise families or caregivers to closely observe and communicate w/ the prescriber as needed
47
Mood Stabilizers
used in tx of bipolar disorder - lithium - valproic acid - gabapentin (used for neuropathic pain, anxiety, adjunct in opioid and alcohol withdrawal) - carbamazepine (Tegratol) - Topiramate - Oxcarbamazepine (Trileptal) - lamotrigine * drug levels are important w/ mood stabilizers - can get 12 hours after last dose
48
Lithium
-gold standard -suicide protective -serum levels needed monitor renal and thyroid function (hypothyroid) -avoid use of NSAIDs to prevent toxic accumulation black box warning: NARROW THERAPEUTIC RANGE (0.8-1.2)
49
Lithium: SEs
``` tremor polydipsia metallic taste fatigue acne alopecia worsens psoriasis ``` ``` toxic effects: severe diarrhea vomiting drowsiness muscle weakness lack of coordination ataxia ```
50
Carbamazepine: SEs
- interferes w/ birth control - hyponatremia - check LFT's - sedation - teratogenesis (risk to developing fetus so this med might be avoided in women of child bearing age) - grapefruit juice = inhibitory > increase in blood levels black box warning: aplastic anemia, agranulocytosis
51
Lamotrigine
black box warning: steven's Johnson's rash pt education start low and go slow w/ dosing
52
Valproic Acid: SE
can obtain level black box warning: hepatotoxicity (check liver fxn), congenital malformations (caution in use w/ females or reproductive age), pancreatitis most sedating so person might take at bedtime bone marrow suppression (check CBC)
53
Topiramate: SE
weight loss dizziness sedation increased risk for renal calculi
54
Anxiolytics
uses: pain, OCD, social anxiety, GAD benzodiazepines: - alprazolam - chlordiazepoxide - clonazepam - diazepam (long half-life, used for alcohol withdrawal) - oxazepam - lorazepam non-benzodiazepines: - buspirone - beta blockers - centrally acting alpha blockers - anticonvuslants
55
Benzodiazepines: SEs
- CNS depression (sedation, ataxia, decreased cognitive function) - risk of combination of CNS depressants - potentiation of the effects of alcohol - special considerations in the elderly - withdrawal secondary to dependency (potentially lethal - seizure, DTs) - pregnancy category D - controlled substance - lorazepam used for alcohol WD in pts with liver dysfunction b/c no active metabolites
56
Zolpidem
benzo like med used for sleep black box warning: sleep walking, sleep-driving, engagement in activities while not fully awake
57
Stimulants
use: ADHD, narcolepsy methylphenidate (Concerta) amphetamine dextroamphetamine nursing interventions: - give early in the day (no later than 1600) - monitor weight - caffeine use - monitor for tics
58
Other ADHD Medications
- bupropion - atomoxetine (SNRI - FDA approved for ADHD) * black box warning: increased risk for suicidality in children/adolescents w/ ADHD - guanefacine
59
Stimulants: SE
- anorexia - weight loss - nausea - irritability -precautions: psychosis, severe anxiety, cardiovascular hx, substance use
60
Medications for Alcohol Use
Disulfiram - aversion therapy (prevent) *works by making pt violently ill when they drink alcohol Naltrexone - craving Acamprosate - reduction in withdrawal symptoms
61
Medications for Opioid use Disorder
buprenophine - agonist/antagonist methadone - agonist naltrexone - antagonist
62
Medications for Tobacco Use Disorder
bupropion (branded as Zyban) - attenuating the effects of nicotine withdrawal NRT Varenicline: - nicotine receptor agonist > promotes release of dopamine to stimulate the pleasurable effects of nicotine - reduces craving and withdrawal - don't give with NRT
63
Medications for Stimulant Use Disorder
no FDA approved meds for stimulant use disorder

Psych (18 decks)

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