Tidbits Flashcards
Which anti-psychotic MUST you get an EKG before administering?
ziprasidone
weight neutral anti-psychotics:
-mnemonic:
You can be (LAZ)y on these because you wont gain weight.
- lurasidone
- aripriprazole
- ziprasidone
thorazine
-generic name?
chlorpromazine
3 worst anti-psychotics for metabolic syndrome
-mnemonic:
your COQ wont get action if you’re fat.
- clozapine
- olanzapine
- quetiapine
In schizo pts, about how long does it take for antipsychotics to reduce positive Sxs?
1 to 2 weeks
Clozapine: what % of pts experience agranulocytosis?
1-4%
Best 2 antipsychotics for bipolar disorder:
quetiapine, olanzapine
Dopamine relationship with prolactin:
dopamine inhibits prolactin
Dopamine relationship with ACh:
dopamine inhibits ACh.
-Which is why ACh is high in parkinsons and you give anti-ACh (benadryl) with anti-psychotics (which block dopamine so then breaks taken off ACh) - helps prevent dystonia.
What is one hypothesis why SGAs cause less TD than first gens?
SGA less fat-soluble so they’re more readily released from D2 receptors and brain tissue.
Most common first gens causing EPS:
haloperidol, fluphenazine.
DMH
-in charge of what?
all outpatient mental health
DMS
-in charge of what?
inpatient/hospital/ER
What must you do before you make a psychiatric diagnosis?
rule out medical or substance induced problem
thorazine
-generic name?
chlorpromazine
NMS
-Tx options:
dantrlene, bromocriptine, diazepam
-and of course discontinue offending agent.
Difference between NMS and SS:
- reflexes
- pupils
- bowel sounds
- which has clonus?
- NMS = hyporeflexia, SS = hyper
- NMS = normal pupils, SS = dilated
- NMS = normal BS, SS = hyperactive BS
- SS has clonus
What are the major catecholamines?
-mnemonic?
Epi, NE, dopamine
-END: get to END of race, get rush of catecholamines.
Acute akathisia
-Tx options:
benzos, propranolol, anti-cholinergics.
3 drugs used in ED for acute mania:
zyprexa, haldol, risperidol
zyprexa main s/e
sedation
seroquel
-why start low and titrate high?
must beware of orthostatic hypotension
Which SGAs should be given with food?
geodon and latuda
two drugs for bipolar depression?
-which one has weight gain?
latuda and seroquel
-seroquel with weight gain.
which SGA and which benzo should not be given concurrently IM?
-why?
zyprexa and ativan
-too sedating, can cause death.
Which SGA has the strongest dopamine receptor affinity?
abilify
Which IM emeds do we give in our ED?
haldol, olanzapine, thorazine
-fluphenazine and geodon have to be cleared by pharmacy and take too long.
How long til Haldol peaks?
20 min
olanzapine
-how long til onset and peak?
onset = 15 min peak = 45 min
thorazine
-how long til onset and peak?
onset = 1 hr peak = 3 hrs
97% cases of addiction starts with substance abuse before age ___?
21
-means its a developmental disorder.
Causes of delerium:
-mnemonic:
DELIRIOUS
- drugs
- environmental factors
- labs
- infection
- respiratory status
- immobility/ictal
- organ failure
- unrecognized dementia
- shock/steroid
pharmacokinetics
-definition:
what your body does to the drug
-absorption, digestion, distribution, metabolism, excretion.
Catatonic Behavior
-definition:
Marked decrease in reactivity to the environment.
Two negative Sxs prominent in schizo:
Diminished emotional expression and avolition
Define avolition:
Decrease in motivated self-initiated purposeful activities.
-The individual may sit for long periods of time and show little interest in participating in work or social activities.
Negative Sxs of schizo:
- diminished emotional expression
- avolition
- anhedonia
- alogia
- asociality
Paranoid Ideation vs. Delusional Paranoia
Paranoid ideation is not the same thing as the delusional paranoia that can occur during psychosis. Delusional paranoia is based on false thoughts and beliefs rather than the perception of harassment.
For example, if you are experiencing delusional paranoia, you might believe that the government has bugged your house and car in order to keep tabs on you. If you are experiencing paranoid ideation, you might see two people in the hallway talking and believe they are talking about you.
Laughing in absence of appropriate stimulus
- term for this?
- seen in which disease?
- inappropriate affect
- schizo
Lack of insight into your disorder
-term for that?
anosognosia
Good phrase to use for legality:
as evidenced by
What area of the brain is used to recognize language present in written form?
-aka like wernickes but for reading rather than hearing.
angular gyrus in the parietal lobe
Definition of attention
the cognitive process that permits the person to suppress irrelevant stimuli, to notice important stimuli, and to shift from one stimulus to another.
Function of locus coeruleus in addiction
alarm centre of the brain and packed with norepinephrine, is another brain structure that plays an important role in drug addiction. When stimulated by a lack of the drug in question, the locus coeruleus drives the addict to do anything necessary to obtain a fix.
ventral tegmental area
- what part of brain?
- function?
- midbrain
- the origin of the dopaminergic cell bodies of mesocorticolimbic dopamine system and other dopamine pathways.
ventral tegmentum
-two primary efferent outputs? name circuit and destination.
- mesocorticol pathway (negative Sxs) => prefrontal cortex
- mesolimbic pathway (positive Sxs) => nucleus accumbens
How to remember that mesolimbic is VTA to nucleus accumbens and how its responsible for positive symptoms.
so the positive symptoms like paranoia and hallucinations are the ones that attribute meaning to things. This must have to do with reward circuitry. Like the example I used with the envelope that includes your results and how it has meaning to you but no meaning to anyone else. So people that put meaning on everything, such as positive symptoms of schizo, have too much dopamine in this system. This must be the system that pumps dopamine into the reward area (nucleus accumbens). Mesolimbic.
-you know this because nucleus accumbens is part of the limbic system. The limbic system is emotions and reward (and meaning).
mnemonic to remember that mesolimbic is positive symptoms.
Must be in a positive mood to do the limbo at a party.
nucleus accumbens
-function:
plays a central role in the reward circuit. Its operation is based chiefly on two essential neurotransmitters: dopamine, which promotes desire, and serotonin, whose effects include satiety and inhibition. Many animal studies have shown that all drugs increase the production of dopamine in the nucleus accumbens, while reducing that of serotonin.
-you increase dopamine in here (adderall) and you’re suddenly interested in everything (this may or may not be true).
Path for nigrostriatal pathway
substantia nigra via nigrostriatal to caudate and putamen.
Amount of D1 and D2 receptors:
- nigrostriatal termination (caudate/putamen)
- mesocorticolimbic terminations (prefrontal/nucleus accumbens)
- nigro: rich in both D1 and D2.
- mcl: mostly D1, minimal D2.
Path for tuberoinfundibular pathway
arcuate nucleus of hypoT via tuberoinfund. to pituitary
Critical brain regions mediating cognition and emotion
- prefrontal cortex, amygdala, hippocampus
- rich in what types of receptors?
D1 and 5HT2
EPS
-caused by blocking which types of receptors where?
D2 receptors in nigrostriatal pathway
Which antipsychotics have low EPS and why?
clozapine and seroquel because they have weak D2 blocking affect (more so D1 blockers).
Is the substantia nigra and the hypoT in the ventral tegmental area?
They’re right next to it/bordering it. Yes.
Norepi system in the brain
- origin?
- destination?
Arises in locus coeruleus and sends projections diffusely throughout the entire brain.
-general modulator (considering its diffuse projections)
Serotonin system in the brain
- origin?
- destination?
Arise in raphe nuclei, localized around the aquaduct in the midbrain, and project to wide range of CNS regions
-general modulator (considering its diffuse projections).
A high serotonergic tone has been associated with:
impulsivity, violence, or suicidal behavior (combo of first two).
-This is why some people get “activated” and suicidal when starting SSRIs.
3 major group of cell bodies of ACh neurons
-locations:
- nucleus basalis of Meynert (in globus pallidus)
- diagonal band of Broca and septal nucleus
- basal ganglia
Which NT plays a major role in encoding memory?
ACh
- low in alzheimers
- this is why a blockade of muscarinic receptors produces memory impairment (marijuana is anti-muscarinic).
NMDA receptor
- which drugs block it?
- what happens when you block it?
- PCP and ketamine
- produce a schizo like syndrome: withdrawal, stupor, disorganized thinking/speech, hallucinations.
- suggests an alternative to dopamine hypothesis for psychosis - the NMDA receptor hypofunction hypothesis.
Definition of anxiety
presence of fear or apprehension that is out of proportion to the situation.
