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DPT 530 > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

what s/s are common to neurologic/psychiatric disorder?

A

delusions

hallucinations

mania

depression

anxiety

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2
Q

what are delusions?

A

false beliefs despite evidence to the contrary

ie: thinking someone is stealing your money or that the TV is talking to you

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3
Q

in what conditions are delusions common?

A

delirium, AD, vascular dementia, schizophrenia, and PD (drug-induced)

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4
Q

are delusions in PD bc of the disease itself or the drugs used to treat it?

A

drug-induced

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5
Q

what are hallucinations?

A

sensory perceptions experiences w/o corresponding sensory stimuli

can be visual, auditory, or olfactory

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6
Q

when there is a decreased sensitivity in the temperoparietal junctions, what can result?

A

auditory hallucinations

ppl perceive their inner voice as someone talking to them

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7
Q

what is mania?

A

excessive excitement, euphoria, delusions, and overactivity

false sense of grandiosity about themselves

ie. thinking you can fly or fight a tiger

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8
Q

what conditions have mania as a common symptom?

A

bipolar disorder or drug induced mania

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9
Q

what drugs can cause mania?

A

steroids, stimulants, and antidepressants

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10
Q

what is depression?

A

hopelessness and sense of worthlessness w/aberrant thoughts and behavior

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11
Q

dementia is a common symptom of what conditions?

A

dementia, PD, MS, epilepsy

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12
Q

what is anxiety?

A

tension or uneasiness that accompanies anticipating danger

tense skeletal muscles

on alert all the time

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13
Q

anxiety is the result of overactive____ symptoms

A

autonomic

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14
Q

what are sedative-hypnotic and anxiolytic drugs used to treat?

A

drugs for generalized anxiety disorder, panic disorder, OCD PTSD

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15
Q

t/f: sedative-hypnotic drugs called benzodiazepines affect all GABA-R subunits

A

true

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16
Q

what drugs are very effective for short term panic, anxiety, and sleep?

A

benzos

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17
Q

what are the sedative-hypnotic and anxiolytic drugs?

A

benzodiazepines

barbiturates

non-benzo sedative-hypnotics

opioid analgesics

antidepressants

anticonvulsants

antihistamines

beta-adrenergic anatagonists (beta blockers)

Azapirones

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18
Q

benzos can also be used to break ___ and manage side effects from ___

A

catatonia, antipsychotics

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19
Q

what is catatonia?

A

abnormal movement/static posture often seen w/schizophrenia

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20
Q

t/f: benzos in lower doses have a calming effect

A

true

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21
Q

higher doses of benzos can be used for what?

A

sedation, hypnosis, sleep, and general anesthetics

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22
Q

what is the mechanism of action for benzos?

A

they bind to GABA and open chloride channels, inhibiting neuronal activity

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23
Q

is GABA excitatory or inhibitory?

A

inhibitory

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24
Q

what are some names of benzos?

A

Alprazolam (Xanax)

Diazepam (Valium)

Lorazepam (Ativan)

Clonazepam (Klonopin)

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25
Q

what are barbiturates?

A

very potent and addictive sedative-hypnotic drugs that have specificity for midbrain RF neurons and limbic structures

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26
Q

barbiturates potentiate what effects?

A

GABA

may potentiate glycinergic effect

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27
Q

barbiturates decrease the influence of what?

A

glutamate (excitatory)

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28
Q

barbiturates upregulate ____ effects and downregulate ____ effects

A

inhibitory, excitatory

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29
Q

t/f: barbiturates are safer than benzos

A

false, they are very fatal with overdose

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30
Q

barbiturates end in…

A

-barbital

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31
Q

what are the names of some barbiturates?

A

Amobarbital (Amytal)

Pentobarbital (Nembutal)

Phenobarbital (Luminal)

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32
Q

what are non-benzo sedative-hypnotics?

A

less sedative drugs that affect GABAa receptors in the brain

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33
Q

t/f: non-benzo sedative-hypnotics have less risk of producing side effects when discontinued

A

true

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34
Q

what are the names of some non-benzo sedative-hypnotics?

A

Zolpidem (Ambien)-very common

Zaleplon (Sonata)

Eszopiclone (Lunestra)

Ramelteon (Rozerem)

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35
Q

how do beta blockers help with anxiety?

A

they reduce sympathetic influence and help with fast beating heart

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36
Q

what are the 2 antianxiety drugs?

A

benzos

azapirones

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37
Q

what is the therapeutic classification of azapirones?

A

anxiolytic, antidepressant, antipsychotic

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38
Q

what are azapirones used to treat?

A

panic disorders, OCD, PTSD, general anxiety, depression, etc

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39
Q

azapirones are a common add on to what drugs?

A

SSRIs and SNRIs

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40
Q

t/f: azapirones can reduce the psychomotor symptoms of PD meds

A

true

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41
Q

azapirones increase the effects of ___

A

serotonin

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42
Q

what antianxiety med is a partial serotonin agonist?

A

azapirones

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43
Q

t/f: azapirones are safer for anxiety than benzos

A

true, esp long term

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44
Q

what is the only prescribed azaprione on the market in the US?

A

Buspirone (Buspar)

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45
Q

azapirones have ___ efficacy, but ____ risk of tolerance and dependence

A

moderate, lower

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46
Q

do benzos or azapirones have less sedation and psychomotor side effects?

A

azapirones

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47
Q

what are the side effects of sedative-hypnotic and anxiolytic drugs?

A

GI discomfort

dry mouth, sore throat

muscular incoordination and balance loss

residual (“hangover”) effect

anterograde amnesia

small TI

nocturnal behaviors

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48
Q

what is the residual (“hangover”) effect?

A

still feeling the sedative effects after discontinuation

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49
Q

what is anterograde amnesia?

A

cannot form new memories

short term memory loss

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50
Q

what is the TI of benzos and barbiturates?

A

about 10:1

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51
Q

abrupt cessation of sedative-hypnotics or anxiolytics can cause what side effects?

A

rebound anxiety

seizures

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52
Q

t/f: sedative-hypnotics and anxiolytics can exacerbate existing problems like balance issues in older populations or worsened dementia in AD

A

true :(

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53
Q

what are the PT implications of sedative-hypnotics and anxiolytics?

A

be aware that there is a high prevalence of disorder and meds in older adults and pts with physical health concerns

sedation (make sure pt is alert and awake-fall risk)

pt safety (fall risk with gait training, treadmill walking-guard well)

scheduling

nonpharmacological interventions for anxiety and sleep

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54
Q

what are some nonpharmacolgoical interventions for anxiety and sleep?

A

mindfulness, mediation, sleep hygiene, relaxation techniques, reduced blue light b4 bed, increased physical exercise, yoga

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55
Q

what are drugs used to treat affective disorders?

A

antidepressants

56
Q

what are the theories of depression?

A

monoamine deficiency hypothesis

neurogenesis hypothesis

57
Q

what is the monoamine deficiency hypothesis?

A

the thought that depression results from lack of some monoamine like serotonin, NE, and/or dopamine

58
Q

what is the role of serotonin?

A

mood, sleep, appetite, attention, learning, libido, pain, temp regulation

59
Q

what is the role of NE?

A

concentration, arousal, learning, and memory

60
Q

what is the role of dopamine?

A

movement, working memory, attention, reward-motivated behavior

61
Q

what is the neurogenesis hypothesis?

A

the theory that depression is caused by the amount of dentate neurons a person has

based on genetics and early life stresses a person will have more or less dentate neurons and therefore be more susceptible to crossing the critical threshold leading to depression

62
Q

what are the types of antidepressants?

A

MAOIs

TCAs

SSRIs

SNRIs

63
Q

what are monoamine oxidase inhibitors (MAOIs)?

A

antidepressants that work by inhibiting the enzyme that is located at amine synapses

64
Q

there are drug and food interactions w/___ (a type of monoamine)

A

tyramine

65
Q

what foods contain tyramine?

A

soy products, wine, cheese, citrus/tropical fruits, aged/pickled foods

66
Q

how do MAOIs work?

A

they increase BP?

67
Q

what are the names of MAOIs?

A

Isocarboxazid (Marplan)

Phenelzine (Nardil)

Selegiline (Emsam)

Tranylcypromine (Parnate)

68
Q

what are tricyclic antidepressants (TCAs)?

A

antidepressants that block reuptake of amine NTs

69
Q

t/f: TCAs are not used as much any more

A

true

70
Q

t/f: TCAs have many drug interaction

A

true

71
Q

t/f: TCAs are highly lethal when overdosed

A

true

72
Q

what are the names of some TCAs?

A

Amitriptyline (Elavil, Endep)

Doxepin (Silenor)

73
Q

TCAs are commonly used to treat what kind of pain in small doses?

A

neuropathic pain

74
Q

what are SSRIs?

A

selective serotonin reuptake inhibitors

75
Q

what is the 1st line of defense for depression?

A

SSRIs

76
Q

t/f: SSRIs are generally well tolerated

A

true

77
Q

what are the names of some SSRIs?

A

Fluoxetine (Prozac)

Sertraline (Zoloft)

Escitalopram (Lexapro)

Citalopram (Celexa)

Paroxetine (Paxil)

78
Q

what are SNRIs?

A

serotonin NE reuptake inhibitors

79
Q

are SSRIs or SNRIs newer, with increased efficacy and overall tolerability to TCAs?

A

SNRIs

80
Q

you should take SNRIs for more than _ months once effective

A

9

81
Q

stopping SNRIs sooner than 9 months can increase the chance of what?

A

recurrent depression

82
Q

what are the names of some SNRIs?

A

Duloxetine (Cymbalta)

Venlafaxine (Effexor)

83
Q

what are the side effects of antidepressants?

A

GI disturbances (nausea and diarrhea)

dry mouth

irritability

sedation/insomnia

HTN (MAOIs)

sexual dysfunction, bruxism (teeth grinding), headaches (SSRIs)

hyponatremia

serotonin syndrome

84
Q

what is hyponatremia?

A

low sodium that may cause electrolyte imbalances and heart symptoms

85
Q

t/f: serotonin syndrome is an emergency

A

true

86
Q

what causes serotonin syndrome?

A

combining SSRIs/SNRIs with st John’s wart

87
Q

what are the s/s of serotonin syndrome?

A

diarrhea, aggitation, sweating, shivering, seizures, confusion, arryhthmias, unconsciousness, etc

88
Q

abrupt discontinuation of antidepressants can result is what symptoms?

A

flu like symptoms (fever, nausea, balance issues, sensory disturbances)

89
Q

abrupt cessation of meds after taking them for _ weeks is likely to cause side effects

A

6

90
Q

t/f: the longer you are on an antidepressant, the more likely you are to experience symptoms from abrupt cessation

A

true

91
Q

mild s/s of abrupt cessation of antidepressants usually last ___ weeks and disappear quickly when _____

A

1-2, put back on the meds

92
Q

what antidepressants are generally the safer options?

A

SSRIs and SNRIs

93
Q

t/f: antidepressants and psychological therapies have similar success rates

A

true

94
Q

about 60% of people respond to antidepressants within __ months, but about 80% of pts stop taking them within ___months

A

2, 1

95
Q

what are antidepressants taken for chronic pain?

A

Amitriptyline (Elavil, Endep)

Amoxapine (Asendin)

Doxepin (Sinequan)

Duloxetine (Cymbalta)

Fluoxetine (Prozac)

96
Q

what are drugs that often treat bipolar disorder?

A

mood stabilizers

97
Q

what are mood stabilizers used to treat?

A

borderline personality disorder, bipolar disorder, and treatment resistant depression

98
Q

what are some mood stabilizers?

A

lithium

antiseizure meds

antipsychotic meds

electro shock therapy

99
Q

what is a classic agent for mood stabilizers?

A

lithium

100
Q

t/f: lithium has lots of side effects

A

true

101
Q

how does lithium work?

A

it influences the neuronal activity by competing with cations

may alter the balance of NT signaling in the hypothalamus

may be neuroprotective and decrease neuroinflammation and prevent neuronal degeneration

reduces severity and frequency of manic episodes

102
Q

what is the gold standard in bipolar treatment?

A

lithium

103
Q

lithium is effective in ___ pts

A

1/3

104
Q

when is lithium indicated?

A

bipolar and suicidality

105
Q

what is a large risk factor of lithium?

A

lithium toxicity

106
Q

what is a crucial requirement when on lithium to prevent toxicity?

A

frequent serum level monitoring every 3 months

checked 4-7 days after starting then adjust dosage

107
Q

what are the CNS effects of lithium toxicity?

A

less serious: tremor, fatigue, weakness, dizziness, blurred vision, slurred speech

more serious: ataxia, nystagmus, confusion, seizures, coma

108
Q

what are the GI effects of lithium toxicity?

A

less serious: nausea, loss of appetite, dry mouth, abdominal pain

more serious: vomiting, diarrhea

109
Q

what are the CV effects of lithium toxicity?

A

less serious: ECG changes

more serious: syncope, bradycardia, AV block, arrhythmia

110
Q

what are the renal effects of lithium toxicity?

A

polyuria (frequent urination)

polydipsia (thrist)

renal insufficeincy

permanent renal damage

renal toxicity

111
Q

what are the PT implications of mood stabilizers?

A

scheduling (make sure pt is keeping up with physician)

pt education (make sure they know the timeline of when drugs start to work; teach them that antidepressants are not addictive (other than bezos and barbiturals); be aware of discontinuation symptoms

pt safety (fall risk from OH, lethargy, sedation, muscles weakness, ataxia)

exercise tolerance

monitor pt’s s/s for self harming

prevention of depression (suggest strategies like sunlight and exercise)

112
Q

what are first generation antipsychotics?

A

traditional/”typical”

directly affect D2 receptors w/in the limbic system (dopaminergic)

mainly used for positive symptoms

113
Q

what are positive symptoms?

A

catatonia, delusions, hallucinations

114
Q

what are the side effects of typicals?

A

motor symptoms

115
Q

what are the first generation antipsychotics?

A

Chlorpromazine (Thorazine, Largactil)

Fluphenazine (Permitil)

Modecate (Modilen, Prolixin)

Haloperidol (Haldol, Peridol)

Thioridazine (Mellaril, Melleril)

Trifluoperazine (Stelazine)

116
Q

what are second generation antipsychotics?

A

“atypicals”

block serotonin receptors and can also affect glutamate, GABA, etc

rx of pos and neg symptoms

lower incidence of relapse-not as strong

higher pt compliance bc they are better tolerated

less likely to see motor related side effects

117
Q

what are negative symptoms?

A

flat affect (lack of emotional responses and expression/motivation), apathy, inability to experience pleasure

118
Q

are first or second generation antipsychotics stronger?

A

first generation

119
Q

do first or second generation antipsychotics have higher compliance among pts?

A

second generation

120
Q

are you more or less likely to see motor symptoms with second generation antipsychotics?

A

less

121
Q

what are the second generation antipsychotic drugs?

A

Clozapine (Clozaril, Fazaclo, Versacloz)

Iloperidone (Fanapt)

Olanzapine (Zyprexa)

Quetiapine (Seroquel)

Risperidone (Risperdal)

Ziprasidone (Geodon)

Aripraprazole (Abilify)

122
Q

what is the differing mechanism of action of Aripiprazole (Abilify)?

A

blocks one of the serotonin receptors selectively

partially activates dopaminergic receptors

also used in bipolar

123
Q

what are the side effects of antipsychotics?

A

sedation

anticholinergic effects

extramyramidal symptoms (involuntary movement)

OH

metabolic effects

HTN

increased risk of stroke and CV events in older pts

124
Q

what are anticholinergic effects?

A

constipation, urinary retention, dry mouth

125
Q

what are extrapyramidal symptoms?

A

muscles spasms

tardive dyskinesia

Parkinsonism

dyskinesia and dystonia

akathesia

dysphagia

126
Q

what is often the most debilitating symptom of antipsychotics?

A

tardive dyskinesia

127
Q

what tracts are effected by extrapyramidal symptoms?

A

medial tracts

128
Q

what is tardive dyskinesia?

A

irregular jerky movements like rapid eye blinking or lip smacking

129
Q

when may deep brain stimulation be used?

A

with tardive dyskinesia

130
Q

what are the parkinsonism side effects of antipsychotics?

A

drug induced rigidity, tremor, postural instability

131
Q

what is akathesia?

A

movement disorder that makes it very hard to stay still

internal desire to be in constant motion

132
Q

what are the metabolic effects of antipsychotics?

A

glucose dysregulation (hyperglycemia), dyslipidemia (increased cholesterol levels in the blood)

133
Q

is HTN a side effect of first of second generation antipsychotics?

A

both

134
Q

what are the PT implications for antipsychotics?

A

normalizing pt behavior

exercise tolerance: be aware of extrapyramidal symptoms, HTN, OH, sedation

pt safety

pt education on how to handle OH

documenting med/symptoms changes

135
Q

what can we tell to pts experiencing OH?

A

take your time with position changes, wear compression socks

136
Q

when a pt gets injected meds, what should we be aware of?

A

that exercising/using heat on the area may increase circulation and drug distribution

DPT 530 (14 decks)

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