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Pharm > Psychosocial Integrity > Flashcards

Psychosocial Integrity Flashcards

1
Q

neurotransmitters

A

chemical messengers that carry impulses between nerve fibers across a synaptic junction

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2
Q

catecholamines

A

several neurotransmitters that function outside the CNS as neurohormones. Includes epi, NE, and DA

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3
Q

psychotherapeutics

A

drugs that tx psychological disorders

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4
Q

synapse

A

a tiny gap/junction between two adjacent nerve cells

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5
Q

glutamate

A

principle excitatory neurotransmitter; r/t memory function

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6
Q

glycine

A

an inhibitory neurotransmitter; r/t motor fx, vision, and hearing

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7
Q

acetylcholine

A

excitatory neurotransmitter; in CNS and PNS

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8
Q

dopamine

A

special neurotransmitter, both excitatory and inhibitory

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9
Q

epinephrine

A

excitatory neurotransmitter

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10
Q

gamma-aminobutyric acid

A

principle inhibitory neurotransmitter; opposes glutamate

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11
Q

norepinephrine

A

excitatory neurotransmitter

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12
Q

serotonin

A

inhibitory neurotransmitter

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13
Q

overview of the nervous system

A
  • 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
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14
Q

neuron

A
  • synapse: electrochemical signaling
  • nodes of ranvier: propagate electrical signaling
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15
Q

support cells of the nervous system

A

glial cells, outnumber neurons 10:1

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16
Q

astrocytes

A

form BBB, rapid transport of nutrients

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17
Q

oligodendroglia

A

form myelin sheath in the CNS

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18
Q

schwann cells

A

form myelin sheath in the PNS

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19
Q

microglia

A

clear cellular debris; phagocytosis

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20
Q

3 parts of the brain

A

forebrain, midbrain, hindbrain

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21
Q

spinal cord (31 segments)

A
  • 8 cervical (neck/upper extremities)
  • 12 thoracic (chest/abdomen)
  • 5 lumbar (lower extremities)
  • 5 sacral (lower extremities, bowel and bladder control)
  • 1 coccygeal
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22
Q

forebrain

A

basal ganglia, cerebral hemispheres/lobes, diencephalon

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23
Q

basal ganglia

A

substantia nigra (produces dopamine)

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24
Q

cerebral hemispheres and lobes

A
  • 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
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25
Q

diencephalon

A
  • epithalamus
  • thalamus
  • hypothalamus
  • subthalamus
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26
Q

limbic system

A
  • group of structures that integrate emotion and high function (decision making, meaning and semantic memory)
  • essential structures: amygdala, hypothalamus, hippocampus
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27
Q

midbrain

A
  • corpora quadrigemina
  • tegmentum
  • basis pedunculi
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28
Q

hindbrain

A
  • pons (autonomic functions)
  • cerebellum (gross coordination)
  • medulla oblongata (bridge to PNS)
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29
Q

CNS - reticular activation system

A
  • 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
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30
Q

CNS - meninges

A
  • 3 layers, membrane, protects the contents of the brain and spinal cord
    -> dura mater, arachnoid mater, pia mater
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31
Q

Blood-brain barrier

A
  • BBB
  • neither neurotransmitters nor catecholamines cross the BBB
  • many drugs do not cross; WBC transit restricted/reduced
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32
Q

CNS protective structures

A
  • cranium; bony enclosure (8 bones)
  • meninges
  • cerebrospinal fluid (CSF) and ventricles
  • vertebral column (33 vertebrae -> 7C, 12T, 5L, 5S, 4 coccygeal)
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33
Q

spinal cord

A
  • portion of CNS in the vertebrae
  • vertebral column
  • motor and sensory pathways
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34
Q

descending (efferent) pathways

A
  • 4 motor pathways
  • anterior location
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35
Q

ascending (afferent) tracts

A
  • 3 sensory pathways
  • posterior location
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36
Q

2 main divisions of the PNS

A

somatic and autonomic

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37
Q

somatic system

A

involved in conscious, neuromotor function

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38
Q

autonomic system

A
  • regulates unconscious, continuous innervation of cardiac and smooth muscle
  • activates glandular tissues; neuroendocrine system
  • sympathetic and parasympathetic subdivisions
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39
Q

synaptic function

A
  • transmits nervous impulses from one neuron to another
  • chemical transmission between nerve cells involve multiple steps
  • electrochemical impulses transmit impulses down neuronal axon
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40
Q

where is synthesis of the neurotransmitter

A

presynaptic nerve

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41
Q

where are neurotransmitters stored

A

secretory vesicles

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42
Q

where is the regulated release of neurotransmitters in the synaptic space

A

between the pre- and post- synaptic neurons

43
Q

why must specific receptors for the neurotransmitter on the postsynaptic membrane be present

A

so that the neurotransmitter can mimic the effects of nerve stimulation

44
Q

glutamate

A
  • 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
45
Q

glycine

A
  • 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
46
Q

Acetylcholine

A
  • 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
47
Q

epinephrine

A
  • stimulant neurotransmitter
  • sympathomimetic catecholamine; stimulates alpha and beta adrenergic receptors
  • relatively small role in the CNS: alertness, excitement, focus, and panic responses
48
Q

norepinephrine

A
  • 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
49
Q

dopamine

A
  • 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
50
Q

serotonin

A
  • 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
51
Q

gamma-aminobutyric acid

A
  • 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
52
Q

addiction

A

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

53
Q

physical dependence

A

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

54
Q

psychological dependence

A

a mental state characterized by compulsion to take in a particular substance. may be influenced by social norms; often described as ‘craving’ or ‘obsession’

55
Q

psychotropic drugs

A

any drug or substance that affects a persons mental state, typically denoting recreational or non-therapeutic use

56
Q

substance use disorder

A

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

57
Q

withdrawal

A

an unpleasant, and occasionally dangerous, physical reaction associated with cessation of use of a drug

58
Q

antidepressant

A

any drug that works to elevate mood, relieve negative emotional affect, or remove the inability to feel pressure

59
Q

antipsychotic

A

any drug used to treat psychotic features (psychosis), such as hallucinations, delusions, paranoia, and disordered thinking

60
Q

anxiolytic

A

any drug used to reduce features of anxiety

61
Q

hypnotic or sedative

A

any drug or substance that is sleep-inducing or which is taken for its calming effects

62
Q

mood stabilizer

A

any drug that is used to treat disorders associated with intense and/or sustained shifts in mood

63
Q

stimulant

A

any drug that raises levels of physiological or nervous system activity; usually CNS or cardiopulmonary activity

64
Q

adaptation of the CNS to prolonged exposure to drugs

A
  • 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
65
Q

tolerance and physical dependence

A

can occur with any drug, therapeutic or psychotropic

66
Q

Monoamine oxidase inhibitor drugs (MAOI)

A
  • 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
67
Q

Selegiline - MAOI

A
  • 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
68
Q

hypertensive crisis

A

extreme high BP >180/120, especially when combined with sympathomimetic drugs or aged/fermented foods (cheeses, cured meats, beer)

69
Q

serotonin syndrome

A

dangerous altered mental state and autonomic dysregulation caused by high serotonin levels when combined with migraine medications, SSRIs, and ST Johns Wort

70
Q

tricyclic antidepressants (TCAs)

A
  • 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
71
Q

amitriptyline

A
  • 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
72
Q

benzodiazepine drugs

A
  • 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
73
Q

anxiolytic and sedative/hypnotic drugs

A
  • widely prescribed for at home and hospital use
  • benzodiazepines
  • nonbenzodiazepines
74
Q

nonbenzodiazepines

A
  • 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
75
Q

Alprazolam, clonazepam, diazepam, lorazepam, chlordiazepoxide

A
  • 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
76
Q

buspirone

A
  • 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
77
Q

selective serotonin reuptake inhibitors (SSRIs)

A
  • 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
78
Q

fluoxetine

A
  • 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
79
Q

citalopram

A
  • 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)
80
Q

selective norepinephrine reuptake inhibitors (SNRIs)

A
  • 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
81
Q

venlafaxine

A
  • 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
82
Q

desvenlafaxine

A
  • SNRI
  • chemically, it is the active form of venlafaxine
  • venlafaxine (prodrug) requires hepatic metabolism to activate
  • same indications, SEs, and therapeutic profile as venlafaxine
83
Q

buproprion

A
  • 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
84
Q

trazodone

A
  • 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
85
Q

antipsychotic agents

A
  • 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
86
Q

hallucinations

A

seeing, hearing, feeling something that is not there

87
Q

delusions

A

believing something that is not real

88
Q

confused and disturbed thoughts

A

influenced by hallucinations/delusions

89
Q

haloperidol

A
  • 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
90
Q

ziprasidone

A
  • 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
91
Q

clozapine

A
  • 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
92
Q

risperidone

A
  • 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
93
Q

mood stabilizers

A
  • 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
94
Q

lithium carbonate

A
  • 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
95
Q

lamotrigine

A
  • 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
96
Q

psychotropic drugs

A
  • 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
97
Q

caffeine

A
  • 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
98
Q

alcohol

A
  • psychotropic drug
  • intoxication has profound CNS depressant effect (disinhibition, relaxation, somnolence, euphoria)
  • hepatotoxic, neurotoxic
99
Q

cannabinoids (marijuana)

A
  • 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
100
Q

cocain

A
  • 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
101
Q

opioids

A
  • 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)
102
Q

amphetamines

A
  • 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
103
Q

psychedelic agents

A
  • 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
104
Q

dissociative agents

A
  • 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

Pharm (4 decks)

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