Psychopharmacology Flashcards
1
Q
what s/s are common to neurologic/psychiatric disorder?
A
delusions
hallucinations
mania
depression
anxiety
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
3
Q
in what conditions are delusions common?
A
delirium, AD, vascular dementia, schizophrenia, and PD (drug-induced)
4
Q
are delusions in PD bc of the disease itself or the drugs used to treat it?
A
drug-induced
5
Q
what are hallucinations?
A
sensory perceptions experiences w/o corresponding sensory stimuli
can be visual, auditory, or olfactory
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
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
8
Q
what conditions have mania as a common symptom?
A
bipolar disorder or drug induced mania
9
Q
what drugs can cause mania?
A
steroids, stimulants, and antidepressants
10
Q
what is depression?
A
hopelessness and sense of worthlessness w/aberrant thoughts and behavior
11
Q
dementia is a common symptom of what conditions?
A
dementia, PD, MS, epilepsy
12
Q
what is anxiety?
A
tension or uneasiness that accompanies anticipating danger
tense skeletal muscles
on alert all the time
13
Q
anxiety is the result of overactive____ symptoms
A
autonomic
14
Q
what are sedative-hypnotic and anxiolytic drugs used to treat?
A
drugs for generalized anxiety disorder, panic disorder, OCD PTSD
15
Q
t/f: sedative-hypnotic drugs called benzodiazepines affect all GABA-R subunits
A
true
16
Q
what drugs are very effective for short term panic, anxiety, and sleep?
A
benzos
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
18
Q
benzos can also be used to break ___ and manage side effects from ___
A
catatonia, antipsychotics
19
Q
what is catatonia?
A
abnormal movement/static posture often seen w/schizophrenia
20
Q
t/f: benzos in lower doses have a calming effect
A
true
21
Q
higher doses of benzos can be used for what?
A
sedation, hypnosis, sleep, and general anesthetics
22
Q
what is the mechanism of action for benzos?
A
they bind to GABA and open chloride channels, inhibiting neuronal activity
23
Q
is GABA excitatory or inhibitory?
A
inhibitory
24
Q
what are some names of benzos?
A
Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)
Clonazepam (Klonopin)
25
what are barbiturates?
very potent and addictive sedative-hypnotic drugs that have specificity for midbrain RF neurons and limbic structures
26
barbiturates potentiate what effects?
GABA
may potentiate glycinergic effect
27
barbiturates decrease the influence of what?
glutamate (excitatory)
28
barbiturates upregulate ____ effects and downregulate ____ effects
inhibitory, excitatory
29
t/f: barbiturates are safer than benzos
false, they are very fatal with overdose
30
barbiturates end in...
-barbital
31
what are the names of some barbiturates?
Amobarbital (Amytal)
Pentobarbital (Nembutal)
Phenobarbital (Luminal)
32
what are non-benzo sedative-hypnotics?
less sedative drugs that affect GABAa receptors in the brain
33
t/f: non-benzo sedative-hypnotics have less risk of producing side effects when discontinued
true
34
what are the names of some non-benzo sedative-hypnotics?
Zolpidem (Ambien)-very common
Zaleplon (Sonata)
Eszopiclone (Lunestra)
Ramelteon (Rozerem)
35
how do beta blockers help with anxiety?
they reduce sympathetic influence and help with fast beating heart
36
what are the 2 antianxiety drugs?
benzos
azapirones
37
what is the therapeutic classification of azapirones?
anxiolytic, antidepressant, antipsychotic
38
what are azapirones used to treat?
panic disorders, OCD, PTSD, general anxiety, depression, etc
39
azapirones are a common add on to what drugs?
SSRIs and SNRIs
40
t/f: azapirones can reduce the psychomotor symptoms of PD meds
true
41
azapirones increase the effects of ___
serotonin
42
what antianxiety med is a partial serotonin agonist?
azapirones
43
t/f: azapirones are safer for anxiety than benzos
true, esp long term
44
what is the only prescribed azaprione on the market in the US?
Buspirone (Buspar)
45
azapirones have ___ efficacy, but ____ risk of tolerance and dependence
moderate, lower
46
do benzos or azapirones have less sedation and psychomotor side effects?
azapirones
47
what are the side effects of sedative-hypnotic and anxiolytic drugs?
GI discomfort
dry mouth, sore throat
muscular incoordination and balance loss
residual ("hangover") effect
anterograde amnesia
small TI
nocturnal behaviors
48
what is the residual ("hangover") effect?
still feeling the sedative effects after discontinuation
49
what is anterograde amnesia?
cannot form new memories
short term memory loss
50
what is the TI of benzos and barbiturates?
about 10:1
51
abrupt cessation of sedative-hypnotics or anxiolytics can cause what side effects?
rebound anxiety
seizures
52
t/f: sedative-hypnotics and anxiolytics can exacerbate existing problems like balance issues in older populations or worsened dementia in AD
true :(
53
what are the PT implications of sedative-hypnotics and anxiolytics?
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
54
what are some nonpharmacolgoical interventions for anxiety and sleep?
mindfulness, mediation, sleep hygiene, relaxation techniques, reduced blue light b4 bed, increased physical exercise, yoga
55
what are drugs used to treat affective disorders?
antidepressants
56
what are the theories of depression?
monoamine deficiency hypothesis
neurogenesis hypothesis
57
what is the monoamine deficiency hypothesis?
the thought that depression results from lack of some monoamine like serotonin, NE, and/or dopamine
58
what is the role of serotonin?
mood, sleep, appetite, attention, learning, libido, pain, temp regulation
59
what is the role of NE?
concentration, arousal, learning, and memory
60
what is the role of dopamine?
movement, working memory, attention, reward-motivated behavior
61
what is the neurogenesis hypothesis?
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
what are the types of antidepressants?
MAOIs
TCAs
SSRIs
SNRIs
63
what are monoamine oxidase inhibitors (MAOIs)?
antidepressants that work by inhibiting the enzyme that is located at amine synapses
64
there are drug and food interactions w/___ (a type of monoamine)
tyramine
65
what foods contain tyramine?
soy products, wine, cheese, citrus/tropical fruits, aged/pickled foods
66
how do MAOIs work?
they increase BP?
67
what are the names of MAOIs?
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Emsam)
Tranylcypromine (Parnate)
68
what are tricyclic antidepressants (TCAs)?
antidepressants that block reuptake of amine NTs
69
t/f: TCAs are not used as much any more
true
70
t/f: TCAs have many drug interaction
true
71
t/f: TCAs are highly lethal when overdosed
true
72
what are the names of some TCAs?
Amitriptyline (Elavil, Endep)
Doxepin (Silenor)
73
TCAs are commonly used to treat what kind of pain in small doses?
neuropathic pain
74
what are SSRIs?
selective serotonin reuptake inhibitors
75
what is the 1st line of defense for depression?
SSRIs
76
t/f: SSRIs are generally well tolerated
true
77
what are the names of some SSRIs?
Fluoxetine (Prozac)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Citalopram (Celexa)
Paroxetine (Paxil)
78
what are SNRIs?
serotonin NE reuptake inhibitors
79
are SSRIs or SNRIs newer, with increased efficacy and overall tolerability to TCAs?
SNRIs
80
you should take SNRIs for more than _ months once effective
9
81
stopping SNRIs sooner than 9 months can increase the chance of what?
recurrent depression
82
what are the names of some SNRIs?
Duloxetine (Cymbalta)
Venlafaxine (Effexor)
83
what are the side effects of antidepressants?
GI disturbances (nausea and diarrhea)
dry mouth
irritability
sedation/insomnia
HTN (MAOIs)
sexual dysfunction, bruxism (teeth grinding), headaches (SSRIs)
hyponatremia
serotonin syndrome
84
what is hyponatremia?
low sodium that may cause electrolyte imbalances and heart symptoms
85
t/f: serotonin syndrome is an emergency
true
86
what causes serotonin syndrome?
combining SSRIs/SNRIs with st John's wart
87
what are the s/s of serotonin syndrome?
diarrhea, aggitation, sweating, shivering, seizures, confusion, arryhthmias, unconsciousness, etc
88
abrupt discontinuation of antidepressants can result is what symptoms?
flu like symptoms (fever, nausea, balance issues, sensory disturbances)
89
abrupt cessation of meds after taking them for _ weeks is likely to cause side effects
6
90
t/f: the longer you are on an antidepressant, the more likely you are to experience symptoms from abrupt cessation
true
91
mild s/s of abrupt cessation of antidepressants usually last ___ weeks and disappear quickly when _____
1-2, put back on the meds
92
what antidepressants are generally the safer options?
SSRIs and SNRIs
93
t/f: antidepressants and psychological therapies have similar success rates
true
94
about 60% of people respond to antidepressants within __ months, but about 80% of pts stop taking them within ___months
2, 1
95
what are antidepressants taken for chronic pain?
Amitriptyline (Elavil, Endep)
Amoxapine (Asendin)
Doxepin (Sinequan)
Duloxetine (Cymbalta)
Fluoxetine (Prozac)
96
what are drugs that often treat bipolar disorder?
mood stabilizers
97
what are mood stabilizers used to treat?
borderline personality disorder, bipolar disorder, and treatment resistant depression
98
what are some mood stabilizers?
lithium
antiseizure meds
antipsychotic meds
electro shock therapy
99
what is a classic agent for mood stabilizers?
lithium
100
t/f: lithium has lots of side effects
true
101
how does lithium work?
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
what is the gold standard in bipolar treatment?
lithium
103
lithium is effective in ___ pts
1/3
104
when is lithium indicated?
bipolar and suicidality
105
what is a large risk factor of lithium?
lithium toxicity
106
what is a crucial requirement when on lithium to prevent toxicity?
frequent serum level monitoring every 3 months
checked 4-7 days after starting then adjust dosage
107
what are the CNS effects of lithium toxicity?
less serious: tremor, fatigue, weakness, dizziness, blurred vision, slurred speech
more serious: ataxia, nystagmus, confusion, seizures, coma
108
what are the GI effects of lithium toxicity?
less serious: nausea, loss of appetite, dry mouth, abdominal pain
more serious: vomiting, diarrhea
109
what are the CV effects of lithium toxicity?
less serious: ECG changes
more serious: syncope, bradycardia, AV block, arrhythmia
110
what are the renal effects of lithium toxicity?
polyuria (frequent urination)
polydipsia (thrist)
renal insufficeincy
permanent renal damage
renal toxicity
111
what are the PT implications of mood stabilizers?
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
what are first generation antipsychotics?
traditional/"typical"
directly affect D2 receptors w/in the limbic system (dopaminergic)
mainly used for positive symptoms
113
what are positive symptoms?
catatonia, delusions, hallucinations
114
what are the side effects of typicals?
motor symptoms
115
what are the first generation antipsychotics?
Chlorpromazine (Thorazine, Largactil)
Fluphenazine (Permitil)
Modecate (Modilen, Prolixin)
Haloperidol (Haldol, Peridol)
Thioridazine (Mellaril, Melleril)
Trifluoperazine (Stelazine)
116
what are second generation antipsychotics?
"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
what are negative symptoms?
flat affect (lack of emotional responses and expression/motivation), apathy, inability to experience pleasure
118
are first or second generation antipsychotics stronger?
first generation
119
do first or second generation antipsychotics have higher compliance among pts?
second generation
120
are you more or less likely to see motor symptoms with second generation antipsychotics?
less
121
what are the second generation antipsychotic drugs?
Clozapine (Clozaril, Fazaclo, Versacloz)
Iloperidone (Fanapt)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
Aripraprazole (Abilify)
122
what is the differing mechanism of action of Aripiprazole (Abilify)?
blocks one of the serotonin receptors selectively
partially activates dopaminergic receptors
also used in bipolar
123
what are the side effects of antipsychotics?
sedation
anticholinergic effects
extramyramidal symptoms (involuntary movement)
OH
metabolic effects
HTN
increased risk of stroke and CV events in older pts
124
what are anticholinergic effects?
constipation, urinary retention, dry mouth
125
what are extrapyramidal symptoms?
muscles spasms
tardive dyskinesia
Parkinsonism
dyskinesia and dystonia
akathesia
dysphagia
126
what is often the most debilitating symptom of antipsychotics?
tardive dyskinesia
127
what tracts are effected by extrapyramidal symptoms?
medial tracts
128
what is tardive dyskinesia?
irregular jerky movements like rapid eye blinking or lip smacking
129
when may deep brain stimulation be used?
with tardive dyskinesia
130
what are the parkinsonism side effects of antipsychotics?
drug induced rigidity, tremor, postural instability
131
what is akathesia?
movement disorder that makes it very hard to stay still
internal desire to be in constant motion
132
what are the metabolic effects of antipsychotics?
glucose dysregulation (hyperglycemia), dyslipidemia (increased cholesterol levels in the blood)
133
is HTN a side effect of first of second generation antipsychotics?
both
134
what are the PT implications for antipsychotics?
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
what can we tell to pts experiencing OH?
take your time with position changes, wear compression socks
136
when a pt gets injected meds, what should we be aware of?
that exercising/using heat on the area may increase circulation and drug distribution
