Psychopharmacology Flashcards
what s/s are common to neurologic/psychiatric disorder?
delusions
hallucinations
mania
depression
anxiety
what are delusions?
false beliefs despite evidence to the contrary
ie: thinking someone is stealing your money or that the TV is talking to you
in what conditions are delusions common?
delirium, AD, vascular dementia, schizophrenia, and PD (drug-induced)
are delusions in PD bc of the disease itself or the drugs used to treat it?
drug-induced
what are hallucinations?
sensory perceptions experiences w/o corresponding sensory stimuli
can be visual, auditory, or olfactory
when there is a decreased sensitivity in the temperoparietal junctions, what can result?
auditory hallucinations
ppl perceive their inner voice as someone talking to them
what is mania?
excessive excitement, euphoria, delusions, and overactivity
false sense of grandiosity about themselves
ie. thinking you can fly or fight a tiger
what conditions have mania as a common symptom?
bipolar disorder or drug induced mania
what drugs can cause mania?
steroids, stimulants, and antidepressants
what is depression?
hopelessness and sense of worthlessness w/aberrant thoughts and behavior
dementia is a common symptom of what conditions?
dementia, PD, MS, epilepsy
what is anxiety?
tension or uneasiness that accompanies anticipating danger
tense skeletal muscles
on alert all the time
anxiety is the result of overactive____ symptoms
autonomic
what are sedative-hypnotic and anxiolytic drugs used to treat?
drugs for generalized anxiety disorder, panic disorder, OCD PTSD
t/f: sedative-hypnotic drugs called benzodiazepines affect all GABA-R subunits
true
what drugs are very effective for short term panic, anxiety, and sleep?
benzos
what are the sedative-hypnotic and anxiolytic drugs?
benzodiazepines
barbiturates
non-benzo sedative-hypnotics
opioid analgesics
antidepressants
anticonvulsants
antihistamines
beta-adrenergic anatagonists (beta blockers)
Azapirones
benzos can also be used to break ___ and manage side effects from ___
catatonia, antipsychotics
what is catatonia?
abnormal movement/static posture often seen w/schizophrenia
t/f: benzos in lower doses have a calming effect
true
higher doses of benzos can be used for what?
sedation, hypnosis, sleep, and general anesthetics
what is the mechanism of action for benzos?
they bind to GABA and open chloride channels, inhibiting neuronal activity
is GABA excitatory or inhibitory?
inhibitory
what are some names of benzos?
Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)
Clonazepam (Klonopin)
what are barbiturates?
very potent and addictive sedative-hypnotic drugs that have specificity for midbrain RF neurons and limbic structures
barbiturates potentiate what effects?
GABA
may potentiate glycinergic effect
barbiturates decrease the influence of what?
glutamate (excitatory)
barbiturates upregulate ____ effects and downregulate ____ effects
inhibitory, excitatory
t/f: barbiturates are safer than benzos
false, they are very fatal with overdose
barbiturates end in…
-barbital
what are the names of some barbiturates?
Amobarbital (Amytal)
Pentobarbital (Nembutal)
Phenobarbital (Luminal)
what are non-benzo sedative-hypnotics?
less sedative drugs that affect GABAa receptors in the brain
t/f: non-benzo sedative-hypnotics have less risk of producing side effects when discontinued
true
what are the names of some non-benzo sedative-hypnotics?
Zolpidem (Ambien)-very common
Zaleplon (Sonata)
Eszopiclone (Lunestra)
Ramelteon (Rozerem)
how do beta blockers help with anxiety?
they reduce sympathetic influence and help with fast beating heart
what are the 2 antianxiety drugs?
benzos
azapirones
what is the therapeutic classification of azapirones?
anxiolytic, antidepressant, antipsychotic
what are azapirones used to treat?
panic disorders, OCD, PTSD, general anxiety, depression, etc
azapirones are a common add on to what drugs?
SSRIs and SNRIs
t/f: azapirones can reduce the psychomotor symptoms of PD meds
true
azapirones increase the effects of ___
serotonin
what antianxiety med is a partial serotonin agonist?
azapirones
t/f: azapirones are safer for anxiety than benzos
true, esp long term
what is the only prescribed azaprione on the market in the US?
Buspirone (Buspar)
azapirones have ___ efficacy, but ____ risk of tolerance and dependence
moderate, lower
do benzos or azapirones have less sedation and psychomotor side effects?
azapirones
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
what is the residual (“hangover”) effect?
still feeling the sedative effects after discontinuation
what is anterograde amnesia?
cannot form new memories
short term memory loss
what is the TI of benzos and barbiturates?
about 10:1
abrupt cessation of sedative-hypnotics or anxiolytics can cause what side effects?
rebound anxiety
seizures
t/f: sedative-hypnotics and anxiolytics can exacerbate existing problems like balance issues in older populations or worsened dementia in AD
true :(
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
what are some nonpharmacolgoical interventions for anxiety and sleep?
mindfulness, mediation, sleep hygiene, relaxation techniques, reduced blue light b4 bed, increased physical exercise, yoga
what are drugs used to treat affective disorders?
antidepressants
what are the theories of depression?
monoamine deficiency hypothesis
neurogenesis hypothesis
what is the monoamine deficiency hypothesis?
the thought that depression results from lack of some monoamine like serotonin, NE, and/or dopamine
what is the role of serotonin?
mood, sleep, appetite, attention, learning, libido, pain, temp regulation
what is the role of NE?
concentration, arousal, learning, and memory
what is the role of dopamine?
movement, working memory, attention, reward-motivated behavior
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
what are the types of antidepressants?
MAOIs
TCAs
SSRIs
SNRIs
what are monoamine oxidase inhibitors (MAOIs)?
antidepressants that work by inhibiting the enzyme that is located at amine synapses
there are drug and food interactions w/___ (a type of monoamine)
tyramine
what foods contain tyramine?
soy products, wine, cheese, citrus/tropical fruits, aged/pickled foods
how do MAOIs work?
they increase BP?
what are the names of MAOIs?
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Emsam)
Tranylcypromine (Parnate)
what are tricyclic antidepressants (TCAs)?
antidepressants that block reuptake of amine NTs
t/f: TCAs are not used as much any more
true
t/f: TCAs have many drug interaction
true
t/f: TCAs are highly lethal when overdosed
true
what are the names of some TCAs?
Amitriptyline (Elavil, Endep)
Doxepin (Silenor)
TCAs are commonly used to treat what kind of pain in small doses?
neuropathic pain
what are SSRIs?
selective serotonin reuptake inhibitors
what is the 1st line of defense for depression?
SSRIs
t/f: SSRIs are generally well tolerated
true
what are the names of some SSRIs?
Fluoxetine (Prozac)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Citalopram (Celexa)
Paroxetine (Paxil)
what are SNRIs?
serotonin NE reuptake inhibitors
are SSRIs or SNRIs newer, with increased efficacy and overall tolerability to TCAs?
SNRIs
you should take SNRIs for more than _ months once effective
9
stopping SNRIs sooner than 9 months can increase the chance of what?
recurrent depression
what are the names of some SNRIs?
Duloxetine (Cymbalta)
Venlafaxine (Effexor)
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
what is hyponatremia?
low sodium that may cause electrolyte imbalances and heart symptoms
t/f: serotonin syndrome is an emergency
true
what causes serotonin syndrome?
combining SSRIs/SNRIs with st John’s wart
what are the s/s of serotonin syndrome?
diarrhea, aggitation, sweating, shivering, seizures, confusion, arryhthmias, unconsciousness, etc
abrupt discontinuation of antidepressants can result is what symptoms?
flu like symptoms (fever, nausea, balance issues, sensory disturbances)
abrupt cessation of meds after taking them for _ weeks is likely to cause side effects
6
t/f: the longer you are on an antidepressant, the more likely you are to experience symptoms from abrupt cessation
true
mild s/s of abrupt cessation of antidepressants usually last ___ weeks and disappear quickly when _____
1-2, put back on the meds
what antidepressants are generally the safer options?
SSRIs and SNRIs
t/f: antidepressants and psychological therapies have similar success rates
true
about 60% of people respond to antidepressants within __ months, but about 80% of pts stop taking them within ___months
2, 1
what are antidepressants taken for chronic pain?
Amitriptyline (Elavil, Endep)
Amoxapine (Asendin)
Doxepin (Sinequan)
Duloxetine (Cymbalta)
Fluoxetine (Prozac)
what are drugs that often treat bipolar disorder?
mood stabilizers
what are mood stabilizers used to treat?
borderline personality disorder, bipolar disorder, and treatment resistant depression
what are some mood stabilizers?
lithium
antiseizure meds
antipsychotic meds
electro shock therapy
what is a classic agent for mood stabilizers?
lithium
t/f: lithium has lots of side effects
true
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
what is the gold standard in bipolar treatment?
lithium
lithium is effective in ___ pts
1/3
when is lithium indicated?
bipolar and suicidality
what is a large risk factor of lithium?
lithium toxicity
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
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
what are the GI effects of lithium toxicity?
less serious: nausea, loss of appetite, dry mouth, abdominal pain
more serious: vomiting, diarrhea
what are the CV effects of lithium toxicity?
less serious: ECG changes
more serious: syncope, bradycardia, AV block, arrhythmia
what are the renal effects of lithium toxicity?
polyuria (frequent urination)
polydipsia (thrist)
renal insufficeincy
permanent renal damage
renal toxicity
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)
what are first generation antipsychotics?
traditional/”typical”
directly affect D2 receptors w/in the limbic system (dopaminergic)
mainly used for positive symptoms
what are positive symptoms?
catatonia, delusions, hallucinations
what are the side effects of typicals?
motor symptoms
what are the first generation antipsychotics?
Chlorpromazine (Thorazine, Largactil)
Fluphenazine (Permitil)
Modecate (Modilen, Prolixin)
Haloperidol (Haldol, Peridol)
Thioridazine (Mellaril, Melleril)
Trifluoperazine (Stelazine)
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
what are negative symptoms?
flat affect (lack of emotional responses and expression/motivation), apathy, inability to experience pleasure
are first or second generation antipsychotics stronger?
first generation
do first or second generation antipsychotics have higher compliance among pts?
second generation
are you more or less likely to see motor symptoms with second generation antipsychotics?
less
what are the second generation antipsychotic drugs?
Clozapine (Clozaril, Fazaclo, Versacloz)
Iloperidone (Fanapt)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
Aripraprazole (Abilify)
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
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
what are anticholinergic effects?
constipation, urinary retention, dry mouth
what are extrapyramidal symptoms?
muscles spasms
tardive dyskinesia
Parkinsonism
dyskinesia and dystonia
akathesia
dysphagia
what is often the most debilitating symptom of antipsychotics?
tardive dyskinesia
what tracts are effected by extrapyramidal symptoms?
medial tracts
what is tardive dyskinesia?
irregular jerky movements like rapid eye blinking or lip smacking
when may deep brain stimulation be used?
with tardive dyskinesia
what are the parkinsonism side effects of antipsychotics?
drug induced rigidity, tremor, postural instability
what is akathesia?
movement disorder that makes it very hard to stay still
internal desire to be in constant motion
what are the metabolic effects of antipsychotics?
glucose dysregulation (hyperglycemia), dyslipidemia (increased cholesterol levels in the blood)
is HTN a side effect of first of second generation antipsychotics?
both
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
what can we tell to pts experiencing OH?
take your time with position changes, wear compression socks
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
