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week 1 Flashcards

1
Q

psychotic

A

out of touch from reality

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2
Q

hallucination

A

experience something without an external stimulus

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3
Q

delusions

A

false unshakeable idea or belief is out keeping with the patients educational , cultural and social background; it is held with extraordinary conviction and subjective certainty

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4
Q

different types of delusions

A

grandiose

hypochondriacal

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5
Q

pharmacodynamics

A

what the drug does to your body

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6
Q

bioavailability

A

expressed as F
affected by many factors
fraction of the administered does of the drug that reaches the systemic circulation
enzyme enhancers/inhibitors affect F

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7
Q

apparent vol of drug distribution

A

total amount of the drug in the body/ drug blood plasma conc.
the amount of the drug would need to be uniformly distributed to produce observed blood conc

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8
Q

half life

A

timre required for serum plasma conc to decrease by half

determined by clearance and vol of distribution

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9
Q

elimination half life

A

time for conc to fall by half

-time to eliminate the drug

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10
Q

linear pharmoco

A

double the dose double the conc

50% of the drug will be eliminated in a given time frame

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11
Q

non linear oharmaco

A

concentration that results is not proportional to dose

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12
Q

how to avoid morphone over dose going from oral to subcut

A

when converting oral to parenteral morphine we prescribe 1/3 of the oral dose
there is a difference in bioavailability

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13
Q

loading does

A

A loading dose is an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose.
volume of distribution needs to be considered here

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14
Q

phenytoin has what feature

A

non linear pharmacokinetics

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15
Q

loading dose depends on…

A

the concentration you wish to achieve and the volume of distribution

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16
Q

IV loading dose? how to calculate

A

target conc (mg/L)x volume of distribution (L/kg) = target c x (mg/kg)

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17
Q

pharmacodynamics

A

what the drug does t0 you

e.g.efficacy

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18
Q

different drug receptors

A 
enzyme linked (multiple actions)
ion channel linked (speedy)
g protein linked (amplifier)
nuclear (gene) linked (long lasting)
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19
Q

Affinity

A

measure of the propensity of a drug to bind wiht receptor , the attractiveness of drug and receptor

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20
Q

efficacy?

A

ability of a bound drug to change the receptor in a way

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21
Q

core features in ADHD

A 
excessive activity 
impulsivity
inattention 
inattention 
impact on family and child
worse in the afternoon
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22
Q

pervasive

A

evident in more than one in enviroment , look for 3 environments

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23
Q

comrobid associations with adhd

A 
sleep disorders 
behavioural difficulties 
specific learning disabilities 
developmental coordination disorders
social communication difficulties 
anxiety symptoms 
tic disorders
mood difficulties
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24
Q

diagnosis for adhd

A

assessments

  • direct observation in more than one setting
  • psychoeducation assessment - schools, school staff
  • structured questionnaires , full developmental history
  • identifying co-morbid mental health problems
  • multi diciplinary team used
25
what neurotransmitter is responsible for alertness , concentration, and energy
Noradrenaline
26
what emotions is serotinin responsible for
obsessions and compulsions memory
27
what emptions is dopamine responsible for?
pleasure reward , motivation
28
ADHD characteristics
``` Attention deficit (selected attention and sustained attention ) motor hyperactivity / psychomotor agitation Impulsivity- inappropriate /defective filtering of info ```
29
Dopamine neurotransmission relative to ADHD
enhances signal | improves attention - focus , on task behaviour , on task recognition
30
NA neurotransmission relative to ADHD
Dampens noise executive operations increases inhibition
31
A defective inhibitory response in a compromised prefrontal cortex leads to
insufficient info processing - symptoms of inattention , hyper activity and impulsivity . neurons in the prefrontal cortex are out of tune and unable to distinguish between important signals and background noise
32
what is hypo-arousal
need to improve the signal to noise detection ratio - to relieve adhd symptoms - increase the drive of the arousal network to improve efficiency of info processing . Hypoarousal is associated with low tonic firing of dopamine and noradrenaline neurons.
33
Stimulants enhance ...
arousal neurotransmitters - amplify tonic firing rates.
34
hyper arousal
Too much ‘arousal’ i.e excess norad/dop stimulates some receptors and causes the signal to noise detection to deteriorate (poor attention and impulsivity) Hyper-arousal is associated with increased phasic firing of dop / norad neurons Need to desensitize postsynaptic norad / dop receptors & down regulate neuronal activity to return norad/dop neurons to normal phasic firing
35
first line treatment of ADHD
Psychostimulants - methylphenidate and dexamphetamine
36
2nd line for ADHD
When stimulants ineffective/ not tolerated/ co morbidity - atomoxetine
37
3rd line ADHD
augment therapy
38
example of a dopaminergic drug
modafinal
39
co morbidities of ADHD
``` Tics -11% CD - 14% mood -4% anxiety -40% ODD - 40% Oppositional defiant disorder (ODD) - 40% ```
40
psychostimulants
Since tonic firing rates are low – need drugs which boost norad / dop signalling Effective in majority of cases (75%) Improve attention span,  hyperactivity & impulsivity ,  aggression Rapid onset of action (within an hour)
41
Dexamfetamine
facilitates release of dopamine from presynaptic cytoplasmic storage vesicles in synapse & blocks dopamine transporter protein (inhibits reuptake) – NET RESULT IS INCREASE IN DOPAMINE
42
Methylphenidate
acts primarily on the dopamine transporter & has little effect on synaptic release – INCREASE IN DOPAMINE
43
prep for dexamfetamine
dexedrine 5 mg Rapid onset of action, lasts 13 hours Can be dissolved in water (ease of administration)
44
prep for methylphenidate
MPH immediate releasing tabs 3-4 x a day modified release and sustained release - duration of 8-12 hours rapid action of onset usually give long acting in the morning with IR tablet slate in afternoon before 5
45
Psychostimulant side effects
Potential for growth retardation (clinically insignificant effect on height, weight) Anorexia (give with meals, dose  or omission) BP and HR irregularities (monitor after every dose increase) Insomnia / sleep difficulties (good sleep hygiene or melatonin) Other: sadness, irritability, abdominal pain & headaches
46
what kind of monitoring is required for ADHD
 monitoring of physical health parameters Baseline HP & BP. Repeat at every dose adjustment & every 6 months Pre- treatment height & weight on growth chart & every 6 months Complete history documenting concomitant medicines, past, present medical & psychiatric disorders, family history of sudden cardiac death & unexplained death  in contra indications including history of depression, anorexia, suicidal tendencies, psychosis, pre-existing cardio vascular disorders
47
legal status of ritilin
has 28 days validity 30 days supply and more can be requested must be signed on collection to prove identity
48
Prescription requirements
the form and strength total quantity to be supplied in words and figures the dose to be administered must be signed and dated by prescriber
49
Atomoxetine
``` noradrenaline reuptake inhibitor enhances NA transmission in the PFC area once daily or twice a day. monitoring on BP pulse weight , LFTs , mood No recorded abuse effective for co morbidity SIX weeks for onset . NA is released into the synapse , NA reversibly attaches to receptors , atomoxetine blocks the reabsorption of NA from the synapse . ```
50
side effects of atomoxetine
Nausea / vomiting Excessive tiredness Insomnia Abdominal pain, appetite suppression, weight loss Constipation Headaches Mood swings / Rage Hepatic impairment (monitor LFTs, recognise symptoms) Increased heart rate / blood pressure Suicidal ideation (raised awareness amongst parents/carers)
51
example of alpha adrenergic
clonidine and guanfacine
52
mechanism of alpha adrenergic
Central & peripheral adrenergic agonists - inhibit norad at the synapse . clinical effect takes 4-6 weeks . Children metabolise faster so require frequent dosing (clonidine may be Rx TDS)
53
alpha adrenergic side effects
SE’s: Sedation, dizziness, hypotension (monitor BP &HR) Precaution with psychostims- case reports of sudden death . Caution- Guanfacine is a CYP 3A4 substrate
54
Antidepressants- not used in CAMHS
Enhance amount of monoamines at the synapse. Rarely used in children (mostly adults) Nortriptyline, Imipramine most common. SE’s: anticholinergic, cardiac, seizures
55
modafinil
not used in CAMHS -Weak psychostimulant - weak affinity for dopamine uptake carrier sites ; may work by decreased GABA and increased release of glutamate also contolling the degreee of hypothalmic control
56
susceptibility ADHD genes
DRD4 Receptor 7-Repeat Alleles associated with overactivity & impulsivity SLC6A3/DAT1 – Dopamine Transporter gene DRD5 - Dopamine receptor gene SLC6A4/5HTT – Serotonin Transporter gene associated with emotional volatility HTR1B - Serotonin receptor gene associated with emotional volatility
57
brain anatomy in people with ADHD
smaller brain volume – frontal & parietal cortex smaller basal ganglia right dorso-lateral prefrontal lobe reduced smaller cerebellar vermis
58
assessments for ADHD
Direct Observations in ≥ 1 setting Psychoeducational Assessment Structured Questionnaires Identifying co-morbid (mental) health problem Developmental history Develop a formulation
59
additional test when assessing for ADHD
hearing and vision screening checks (low threshold) If appropriate to previous health problems, e.g. cardiac or epilepsy screening for neurological signs & physical anomalies   Baseline height & weight (record on growth chart) Baseline blood pressure & heart sounds

people and illness (5 decks)

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