Psychosocial Integrity Flashcards
neurotransmitters
chemical messengers that carry impulses between nerve fibers across a synaptic junction
catecholamines
several neurotransmitters that function outside the CNS as neurohormones. Includes epi, NE, and DA
psychotherapeutics
drugs that tx psychological disorders
synapse
a tiny gap/junction between two adjacent nerve cells
glutamate
principle excitatory neurotransmitter; r/t memory function
glycine
an inhibitory neurotransmitter; r/t motor fx, vision, and hearing
acetylcholine
excitatory neurotransmitter; in CNS and PNS
dopamine
special neurotransmitter, both excitatory and inhibitory
epinephrine
excitatory neurotransmitter
gamma-aminobutyric acid
principle inhibitory neurotransmitter; opposes glutamate
norepinephrine
excitatory neurotransmitter
serotonin
inhibitory neurotransmitter
overview of the nervous system
- coordinates/controls all activities of the body
- receives internal and external stimuli
- processes information to determine appropriate response
- transmits information over varied motor pathways to effector organs
neuron
- synapse: electrochemical signaling
- nodes of ranvier: propagate electrical signaling
support cells of the nervous system
glial cells, outnumber neurons 10:1
astrocytes
form BBB, rapid transport of nutrients
oligodendroglia
form myelin sheath in the CNS
schwann cells
form myelin sheath in the PNS
microglia
clear cellular debris; phagocytosis
3 parts of the brain
forebrain, midbrain, hindbrain
spinal cord (31 segments)
- 8 cervical (neck/upper extremities)
- 12 thoracic (chest/abdomen)
- 5 lumbar (lower extremities)
- 5 sacral (lower extremities, bowel and bladder control)
- 1 coccygeal
forebrain
basal ganglia, cerebral hemispheres/lobes, diencephalon
basal ganglia
substantia nigra (produces dopamine)
cerebral hemispheres and lobes
- frontal: inhibition and decision making
- temporal: emotion, long-term memory, speech/language formation
- parietal: sensory integration, language/linguistic understanding
- occipital: visual, visuospatial perception, visual regulation
diencephalon
- epithalamus
- thalamus
- hypothalamus
- subthalamus
limbic system
- group of structures that integrate emotion and high function (decision making, meaning and semantic memory)
- essential structures: amygdala, hypothalamus, hippocampus
midbrain
- corpora quadrigemina
- tegmentum
- basis pedunculi
hindbrain
- pons (autonomic functions)
- cerebellum (gross coordination)
- medulla oblongata (bridge to PNS)
CNS - reticular activation system
- coordinates cognitive tasks and ‘filters’ stimuli to prioritize response
- plays essential role in attention and alertness
- acts as nexus for efferent motor pathways
- conscious and preconscious activity
CNS - meninges
- 3 layers, membrane, protects the contents of the brain and spinal cord
-> dura mater, arachnoid mater, pia mater
Blood-brain barrier
- BBB
- neither neurotransmitters nor catecholamines cross the BBB
- many drugs do not cross; WBC transit restricted/reduced
CNS protective structures
- cranium; bony enclosure (8 bones)
- meninges
- cerebrospinal fluid (CSF) and ventricles
- vertebral column (33 vertebrae -> 7C, 12T, 5L, 5S, 4 coccygeal)
spinal cord
- portion of CNS in the vertebrae
- vertebral column
- motor and sensory pathways
descending (efferent) pathways
- 4 motor pathways
- anterior location
ascending (afferent) tracts
- 3 sensory pathways
- posterior location
2 main divisions of the PNS
somatic and autonomic
somatic system
involved in conscious, neuromotor function
autonomic system
- regulates unconscious, continuous innervation of cardiac and smooth muscle
- activates glandular tissues; neuroendocrine system
- sympathetic and parasympathetic subdivisions
synaptic function
- transmits nervous impulses from one neuron to another
- chemical transmission between nerve cells involve multiple steps
- electrochemical impulses transmit impulses down neuronal axon
where is synthesis of the neurotransmitter
presynaptic nerve
where are neurotransmitters stored
secretory vesicles
where is the regulated release of neurotransmitters in the synaptic space
between the pre- and post- synaptic neurons
why must specific receptors for the neurotransmitter on the postsynaptic membrane be present
so that the neurotransmitter can mimic the effects of nerve stimulation
glutamate
- key excitatory neurotransmitter, ‘gas pedal’
- abundant in the CNS, especially in the brain - it plays an essential role in glial health
- assists in regulation of memory areas
- glutamate dysregulation is implicated in several neurological and psychiatric diseases
glycine
- inhibitory neurotransmitter
- simplest neurotransmitter, very small molecule
- helps regulate efferent and afferent tracts
- also a non-essential amino acid, glycine plays an important role in sleep regulation
Acetylcholine
- wide variety of neurochemical processes
- regulatory of activation in the PNS at the neuromuscular junction
- essential regulator of parasympathetic ANS activation
- muscarinic receptors are stimulated by acetylcholine
- in the CNS, plays a critical role in memory, formation, learning, cognition, and recall
epinephrine
- stimulant neurotransmitter
- sympathomimetic catecholamine; stimulates alpha and beta adrenergic receptors
- relatively small role in the CNS: alertness, excitement, focus, and panic responses
norepinephrine
- essential stimulating neurotransmitter
- important to neurological arousal, attention, cognition, and stress reactions
- peripherally acts as catecholamine - part of the sympathetic nervous system activation; like Epi
dopamine
- very complex neurotransmitter; both excitatory and inhibitory properties dependent on setting
- plays an integral role in reward center; also in limbic system risk/rear vs reward
- modulates motor coordination and afferent motor signaling
- has peripheral sympathetic effects -> vasostimulant
serotonin
- complex neurotransmitter; involved primarily in activation/modulation of emotion and memory in CNS
- increased levels in synapses in CNS correlated to elevated mood, increased mood stability -> primary target for psychotherapeutic drugs treating conditions with depression/anxiety
- low levels associated with emotional lability, depressive attributes, sleep dysregulation, irritability, and anhedonia
- serotonin plays a wide variety of roles outside the CNS; normal coagulation, cardiac contractility, vascular tone, endocrine signaling, and metabolism
gamma-aminobutyric acid
- primary inhibitory neurotransmitter, ‘brake pedal’
- stress reduction, sleep enhancing effects
- suppresses the RAS, slows synaptic firing
- when activated, GABA receptors have muscle relaxant, amnestic, and antiseizure properties
addiction
a state of physical and psychological dependence on a substance in which an affected individual will engage in deleterious behavior to avoid cessation of a substance use
physical dependence
a physiological state in which the body is accustomed to the presence of a substance, where abstinence from the substance produces a characteristic withdrawal symptom
psychological dependence
a mental state characterized by compulsion to take in a particular substance. may be influenced by social norms; often described as ‘craving’ or ‘obsession’
psychotropic drugs
any drug or substance that affects a persons mental state, typically denoting recreational or non-therapeutic use
substance use disorder
use of a substance in a way that is inconsistent with medical or social norms, or in a manor that is harmful to the individual
withdrawal
an unpleasant, and occasionally dangerous, physical reaction associated with cessation of use of a drug
antidepressant
any drug that works to elevate mood, relieve negative emotional affect, or remove the inability to feel pressure
antipsychotic
any drug used to treat psychotic features (psychosis), such as hallucinations, delusions, paranoia, and disordered thinking
anxiolytic
any drug used to reduce features of anxiety
hypnotic or sedative
any drug or substance that is sleep-inducing or which is taken for its calming effects
mood stabilizer
any drug that is used to treat disorders associated with intense and/or sustained shifts in mood
stimulant
any drug that raises levels of physiological or nervous system activity; usually CNS or cardiopulmonary activity
adaptation of the CNS to prolonged exposure to drugs
- increased therapeutic effects (some drugs take weeks to work due to adaptive physiological changes of the CNS)
- decreased side effects (with chronic use, diminished intensity of side effects can occur)
- multiple agents may need to be tried individually or in combination
tolerance and physical dependence
can occur with any drug, therapeutic or psychotropic
Monoamine oxidase inhibitor drugs (MAOI)
- antidepressants, may also be used for chronic anxiety-type conditions
- first antidepressants, 1950s
- monoamine hypothesis speculated that depleted concentrations of 5-HT, NE, and DA caused depression
- turns off enzyme that breaks down neurotransmitters (MAO) -> NE, Tyr, DA, 5-HT
- boosts the availability of neurotransmitters at the synapse -> allows for neurotransmitters to continue their influence for longer
Selegiline - MAOI
- first generation antidepressant
- selectively inhibits MAO-B, specifically in CNS
- PO or transdermal
- effect: resolve/reduce depressive and/or anxiety symptoms
- side effects: anticholinergic effects (dry mouth, dizziness, sleepiness)
- adverse reactions: hypertensive crisis, serotonin syndrome
- may take >2 weeks to show benefit, allow 3-5 weeks for ‘washout’ after dc
hypertensive crisis
extreme high BP >180/120, especially when combined with sympathomimetic drugs or aged/fermented foods (cheeses, cured meats, beer)
serotonin syndrome
dangerous altered mental state and autonomic dysregulation caused by high serotonin levels when combined with migraine medications, SSRIs, and ST Johns Wort
tricyclic antidepressants (TCAs)
- blocks synaptic reuptake of 5-HT and NE in the CNS
- prolongs the influence of 5-HT, NE; upregulates neuronal signaling
- depressive symptoms, neuropathic pain syndromes, and sleep dysregulation
- do NOT combine with MAOI (serotonin syndrome)
- overdose is notoriously fatal as there is NO antidote
amitriptyline
- TCA
- first generation antidepressant
- oldest and most widely used TCA
- can be used to promote sleep, reduce neuropathic pain
- NOT safe for pregnant clients
- route: PO
- effect: improvement of depressive symptoms, anxiety, pain, or insomnia
- side effects: strong anticholinergic effects (dry mouth, drowsiness, increased HR)
- adverse effects: rare, serotonin syndrome, hyper pyretic syndrome
- long half-life (up to 50 hours), allow two weeks for washout after dc
- do NOT combine with anticholinergics, MAOIs, seizure drugs, or sympathomimetic drugs
benzodiazepine drugs
- facilitate GABA binding to GABAminergic receptors, amplifies GABA
- potent anxiolytic, hypnogogic, and sedative effects, sometimes amnestic
- often used as needed, effect on first dose, some risk of dependence
- risk for significant CNS depression and/or dangerous respiratory depression
- antidote: FLUMAZENIL
anxiolytic and sedative/hypnotic drugs
- widely prescribed for at home and hospital use
- benzodiazepines
- nonbenzodiazepines
nonbenzodiazepines
- reduces anxious symptoms without acting on GABA or GABAminergic receptors
- may be a serotonin or dopamine agonist, exact mechanism unknown
- can’t be used as needed, must be scheduled dosing for full effect
- no risk of abuse, minimal dependence
- lacks sedative, CNS depressant, and respiratory suppressing effects
Alprazolam, clonazepam, diazepam, lorazepam, chlordiazepoxide
- Benzodiazepines
- schedule 4 drugs, risk for dependence/abuse
- routes: PO, diazepam and lorazepam can be taken IM or IV
- effect: rapid relief of anxiety-type symptoms, significant reduction of neuroirritability, suppresses the reticular activating system (can be used to tx acute seizure activity and alcohol withdrawal)
- side effects: dizziness, drowsiness, confusion, muscle weakness
- adverse effects: potentially fatal CNS depression and/or respiratory depression, hepatotoxicity, amnesia
- do NOT combine with alcohol, increases the risk of CNS/respiratory depression
- avoid combo with oral contraceptives, antiseizure drugs, CNS depressants, SSRIs
buspirone
- nonbenzodiazepine
- no risk of abuse, trivial risk of dependence
- does not produce sedation, must be taken on a schedule for effect
- Route: PO
- effect: reduction in anxiety symptoms
- may take ~7 days for full therapeutic effect
- do not take in combination with MAOIs, high risk for hypertensive crisis
selective serotonin reuptake inhibitors (SSRIs)
- 1970s, fluoxetine was the first in the late 80s
- inhibit presynaptic reuptake of serotonin
- prolong the effects of serotonin
- negligibly also prolongs NE and DA
fluoxetine
- SSRI
- second generation antidepressant
- indicated for relief of depressive symptoms. Also used for OCD or panic disorders
- route: PO
- effect: reduction in depressive symptoms, improvement of features of other mental/physical disorders (mood, panic, eating disorder)
- side effects: dizziness, drowsiness, insomnia, GI upset, sexual dysfunction, HA
- do not abruptly dc, can be unpleasant withdrawal symptoms
- do not combine with MAOIs (serotonin syndrome), space by a minimum of 14 days
citalopram
- SSRI
- second generation antidepressant
- indicated for the relief of depressive symptoms. used for OCD as well
- route: PO
- effect: reduction in depressive symptoms, improvement of features of other mental/physical disorders
- escitalopram is chemically similar to citalopram, different molecular structure
- do not abruptly stop; significant, unpleasant withdrawal effects
- do not combine with MAOIs (serotonin syndrome)
selective norepinephrine reuptake inhibitors (SNRIs)
- late 80s, first drug (venlafaxine) approved in 93
- inhibit presynaptic reuptake of serotonin and norepinephrine
- prolong the effects of 5-HT and NE
- slightly prolongs DA
venlafaxine
- SNRI
- first one
- depressive or anxiety symptoms (also used for socially related and panic type symptoms. may be beneficial for migraine and neuropathic pain)
- SE: anticholinergic effects, HA, sexual dysfunction, N/V, and anorexia (especially when first starting)
- rarely causes serotonin syndrome, severe HTN
desvenlafaxine
- SNRI
- chemically, it is the active form of venlafaxine
- venlafaxine (prodrug) requires hepatic metabolism to activate
- same indications, SEs, and therapeutic profile as venlafaxine
buproprion
- inhibits NE and DA reuptake, prolongs synaptic activity, novel MOA
- mild antidepressant effects, SAD and smoking cessation
- route: PO
- SE: HA, weight loss, insomnia, anticholinergic effects
trazodone
- suppresses synaptic release of 5-HT, NE, DA, and Ach
- indicated for management of significant depression
- route: PO
- SE: drowsiness, dizziness, N/V/C, anticholinergic effects
antipsychotic agents
- psychosis is a feature of several psychiatric conditions
- antipsychotics diminish dopamine transmission
- abnormal dopamine transmission results in an aberrant limbic integration, inappropriate assignment of salience
- reducing dopamine activity correspondingly reduces perception of hallucination and delusional thinking
- best paired with behavioral and cognitive therapy interventions
hallucinations
seeing, hearing, feeling something that is not there
delusions
believing something that is not real
confused and disturbed thoughts
influenced by hallucinations/delusions
haloperidol
- typical antipsychotic
- strongly antagonizes DA receptors, also anticholinergic
- route: PO, IM, or IV
- SE: anticholinergic effects, sedation, weight gain, EPS
- not recommended for older adults
- can cause cardiac arrythmias, NMS, tardive dyskinesia
ziprasidone
- atypical antipsychotic
- strongly antagonizes DA receptors, 5-HT, and alpha 1 receptors
- route: PO or IM
- SE: anticholinergic effects, hypotension, sedation, N/V/D, HA, and EPS
- not recommended in older patients (over 65)
- can cause cardiac arrythmias, NMS, tardive dyskinesia
clozapine
- antipsychotic
- atypical
- antagonist to both DA and 5-HT receptors
- route: PO
- SE: drowsiness, dizziness, drooling, N/V/C, irritability
- black box warning: dangerous low WBC count, seizure
risperidone
- atypical antipsychotic
- antagonist to more 5-HT receptors than DA receptors
- route: PO or IM
- SE: drowsiness, dizziness, drooling, N/V/D, SSRI type side effects
- black box warning: dangerous low WBC count, seizure
mood stabilizers
- reduces swings in mood; prevent manic and depressive period symptoms
- taken on a schedule to prevent mood/affect lability, not PRN
- exact mechanism of mood stabilizers are not clear
lithium carbonate
- mood stabilizer
- route: PO
- used since the 19th century, first formally used as a med in the 40s
- SE: N/V/D, muscle weakness, slurred speech, hyperreflexia
- regular monitoring of serum Li+ levels required
- consistent fluid intake of 2+ L/day
- high risk of toxicity: tremor/seizure, confusion, blurred vision, coma
- do NOT restrict sodium intake, leads to increased risk of toxicity
lamotrigine
- mood stabilizer
- primarily anticonvulsant/classic antiseizure
- electrical conduction of CNS neurons
- does not change neurotransmitter levels
- reduces the ability of glutamate to act on the brain
- increases the effects of GABA on the brain
- route: PO
- SE: HA, sedation, drowsiness, N/V/D, aggression, dizziness
psychotropic drugs
- broad category. Change mood, thought processes, inhibition, behavior, or perception
- many can be used therapeutically
- several have strong abuse potentials, can be used as social/recreational drugs, or are illicit substances
- stimulants, depressants, psychedelics, dissociative drugs
caffeine
- psychotropic drug
- natural in many alkaloid plants
- reduces synaptic adenosine -> increases activity of Ach. Results in increased excitation in CNS, blunts fatigue, increases executive function
- in food/drink
- mild diuretic effect -> increases blood flow to the nephron
- withdrawal in tolerant/dependent patients -> irritability, fatigue, headache
alcohol
- psychotropic drug
- intoxication has profound CNS depressant effect (disinhibition, relaxation, somnolence, euphoria)
- hepatotoxic, neurotoxic
cannabinoids (marijuana)
- psychotropic drug
- complex mechanism of actions, cannabinoid receptors in CNS
- over 100 distinct compounds in cannabis (THC, CBD)
- relaxation, euphoria, disinhibition. GABAminergic activity may partially explain HIS, some anticholinergic/adrenergic effects noted
- inhaled or ingested
heavily fat bound, may extend distribution/effect - federally illegal, legality depends on state/local jurisdiction
cocain
- psychotropic, stimulant
- prevents synaptic reuptake of DA, epi, 5-HT (increases synaptic responsivity)
- interferes with sodium channel activity in nerve cells
- strong adrenergic agonist (increases BP, HR, SVR)
- federally illegal, some dilute solutions used medically
opioids
- psychotropic
- derivatives of opium
- heroin is potent, produced from morphine. Illicit/street drug
- prescription drug abuse (hydrocodone, oxycodone), increasingly prevalent
- Mu opioid receptor activity can produce euphoria, sedation, relaxation
- overdose is major concern, national health crisis (significant respiratory depression, cardiovascular collapse)
- antidote: NALOXONE (nasal, SC, IM, or IV)
amphetamines
- psychotropic stimulant
- most common, methamphetamine (meth, crystal)
- strongly prevents synaptic reuptake of DA, epi, 5-HT
- behaves like an ultra potent MAOI, increases catecholamines in PNS
- net effect: profound stimulation of CNS/PNS, upregulation of sympathetic tone
- some versions are Rx, federally illegal as an unregulated/street drug
psychedelic agents
- psychotropic
- lysergic acid (LSD), Psilocybin (magic mushrooms), Lophophora (peyote, mescaline)
- exact mechanism of action is unknown, dopaminergic activity is upregulated
- vivid hallucinations, synesthetic activity
- federally illegal in most preparations
dissociative agents
- psychotropic
- ketamine, phencyclidine (PCP), dextromethorphan (DXM)
- interrupts associative pathways in the reticular activating center
- prevents sensory information from PNS from being perceived
- can also prevent efferent signaling from CNS to muscles, usually more apparent in overdose
- PCP federally illegal; street/non-medical use of other drugs is also illegal
