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Week 6 Flashcards

1
Q

What are the three pathological changes that may occur with neurogenic disorders?

A
  • Angulated (see pic) atrophic muscle fibers – denotes mild disease
  • Group atrophy (groups of atrophic muscle fibers – see pic) – severe disease
  • Fiber type grouping (groups of same fiber types – see pic) in chronic stage
    • Different colors denote different fiber types
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2
Q

What type of pathological change is this?

A

Angulated (see pic) atrophic muscle fibers

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3
Q

What type of pathological change is this?

A

Group atrophy

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4
Q

What type of pathological change is this?

A

Fiber type grouping (groups of same fiber types)

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5
Q

What are the 5 pathological changes with myopathic disorders? Be able to recognize each one and provide characteristics

A
  • Inflammation (lymphocytes, plasma cells) may be present (for example in inflammatory myopathy and some dystrophies) – see pic
  • Increased variability in fiber size (round atrophic fibers and hypertrophic fibers of varying diameter) – see pic (perifascicular atrophy → dermatomyositis)
  • Degeneration and regeneration (basophilia) of muscle fibers
  • Macrophage infiltrate and removal of muscle fibers (myophagocytosis)
  • Replacement of removed muscle fibers with adipose and connective tissue (see pic – Duchenne’s Muscular Dystrophy)
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6
Q

What myopathic change is this?

A
  • Inflammation (lymphocytes, plasma cells) may be present (for example in inflammatory myopathy and some dystrophies) – see pic
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7
Q

What myopathic change is this?

A

Perifasicular atrophy

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8
Q

What myopathic change is this?

A
  • Replacement of removed muscle fibers with adipose and connective tissue (see pic – Duchenne’s Muscular Dystrophy)
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9
Q

What are the clinical and pathological findings with axonal neuropathy

A
  • Axonal:
    • Common
    • Lesions - distal>proximal
    • Mild or no slowing of NCV, normal F-wave
    • Denervation change in muscle (EMG, histology) in acute and chronic forms
    • When treated, recovery is slow and often incomplete
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10
Q

What are the clinical and pathological findings with demyelinating? neuropathy

A
  • Demyelinating:
    • Uncommon
    • Lesions – proximal>distal in acute forms (e.g. AIDP)
    • Marked slowing of NCV, reduced F-wave in acute forms
    • Denervation change in muscle and onion bulbs/large nerves in chronic forms (e.g. some hereditary forms) – see pic
    • When treated, recovery is rapid and complete or with minor residual deficits in most acute forms, but not in chronic forms or acute forms with significant axonal damage.
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11
Q

What is this characteristic of?

A

Demyelinating neuropathy -

  • Denervation change in muscle and onion bulbs/large nerves in chronic forms (e.g. some hereditary forms) – see pic
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12
Q

LIST the components of a mental status exam?

A

Appearance, behavior/attitude, speech, mood/affect, thought process, thought content, perception, cognition, insight/judgement

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13
Q

What part of the mental status exam is the following:

  • Habitus, grooming, dress, hygiene, clothing, facial expression, stated age
A

Appearance

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14
Q

What goes in the behavior/attitude portion of the mental status exam?

A
  • Behavior/Attitude
    • Note whether patient is cooperative, guarding, or suspicious
    • Note patient’s eye contact, posturing (relaxed or tense), and psychomotor activity
      • Psychomotor activity: orobuccal movements (tardive dyskinesia), wavy flexibility (catatonia), tics, mannerisms
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15
Q

What goes in the speech part of a mental status exam?

A
  • Speech
    • Note quantity (talkative or mute), quality (spontaneous or latent), rate (slow or pressured), rhythm/prosody, volume/tone (loud or monotone), aphasia/dysarthria
      • Pressured speech
      • Latency
      • Clang association
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16
Q

Define the following

  • Pressured speech
  • Latency
  • Clang association
  • Prosody
A
  • Pressured speech: accelerated space
  • Latency: increased time between speech
  • Clang association: using rhyming words that mean nonsense (i.e. flippy flap)
  • Prosody: emphasis on different syllables changing meaning
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17
Q

What goes in the mood and affect part of the mental status exam?

A
  • Mood & Affect
    • Mood (subjective): patient’s self-reported emotional attitude
      • Can be neutral, euphoric, depressed, anxious, or irritable
    • Affect (objective): inferred from emotional responses that are usually triggered by some stimulus
      • Full
      • Flat
      • Blunted/constricted
      • Reactive
      • Expansive
      • Labile
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18
Q

Define each of these affects

  • Full
  • Flat
  • Blunted/constricted
  • Reactive
  • Expansive
  • Labile
A
  • Full (wide range of emotional expression)
  • Flat (no emotion at all – associated with psychotic process)
  • Blunted/constricted (low emotion, but little)
  • Reactive (normal)
  • Expansive (super happy)
  • Labile (changing emotion)
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19
Q

What words describes thought process?

A
  • Flight of ideas
  • Loosening of associations
  • Tangentiality
  • Circumstantiality
  • Thought block
  • Neologisms
  • linear/goal-directed
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20
Q

Define the following

  • Flight of ideas
  • Loosening of associations
  • Tangentiality
  • Circumstantiality
  • Thought block
  • Neologisms
  • linear/goal-directed
A
  • Flight of ideas (little association – maybe one word)
  • Loosening of associations (no association at all)
  • Tangentiality (changing subject)
  • Circumstantiality (beating around bush)
  • Thought block (thinking for a long time)
  • Neologisms (made-up words), linear/goal-directed (normal)
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21
Q

What goes in a thought content exam?

A
  • Thought Content (includes risk assessment)
    • Suicidality (w/ intent and plan is worse), homicidal ideations, perceptual abnormalities, delusions (see below)
      • Control
      • Erotomaniac
      • Grandiose
      • Somatic
      • Persecutory
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22
Q

What are these? Define each.

  • Control
  • Erotomaniac
  • Grandiose
  • Somatic
  • Persecutory
A

Delusions

  • Control (external force controlling thoughts)
  • Erotomaniac (unrecruited love)
  • Grandiose (thinking highly of oneself)
  • Somatic (body is abnormal)
  • Persecutory (someone is after you)
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23
Q

What goes in the perception part of the MSE?

A
  • Illusions
  • Hallucinations
    • Auditory/visual , tactile, olfactory
    • Hypnagogic, hypnopompic
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24
Q

Define the following:

  • Illusions
  • Hallucinations
    • Auditory/visual , tactile, olfactory (what do you get each of these with??)
    • Hypnagogic, hypnopompic
A
  • Illusions (visual misperception of an existing object – i.e rope=snake)
  • Hallucinations (visual misperception of nothing – i.e. nothing=snake)
    • Auditory/visual (thought disorders), tactile (substance use), olfactory (seizures)
    • Hypnagogic (hallucinations before sleep), hypnopompic (hallucinations at waking) – related to sleep
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25
Q

What goes in a cognition part of the MSE?

A
  • Cognition
    • Assessed via the mini-mental status exam (MMSE – out of 30) or the Montreal Cognitive Assessment (MoCA)
      • Orientation
      • Memory:
        • Very short-term:
        • Short-term:
        • Long-term:
      • General information
      • Calculation
      • Capacity to read/write
      • Visual spatial ability
      • Attention
      • Abstraction
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26
Q
  • How are the following things assessed?
    • Orientation
    • Memory:
      • Very short-term:
      • Short-term:
      • Long-term:
    • General information
    • Calculation
    • Capacity to read/write
    • Visual spatial ability
    • Attention
    • Abstraction
A
  • Cognition
    • Assessed via the mini-mental status exam (MMSE – out of 30) or the Montreal Cognitive Assessment (MoCA)
      • Orientation: assess orientation to time, person, and place
      • Memory:
        • Very short-term: repeat list of items immediately
        • Short-term: repeat list of items within 3-5 minutes
        • Long-term: recall events over last days/months/years
      • General information: assess patient’s ability to recall info from history or current events
      • Calculation: subtract from 7 starting from 100
      • Capacity to read/write: assess ability to read/write a word/sentence
      • Visual spatial ability: ability to draw a full, correct clock
      • Attention: spelling words backwards
      • Abstraction: assess patient’s ability to think abstractly (i.e. how are an orange and an apple alike?)
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27
Q

Define insight and judgement

A
  • Insight/Judgement
    • Insight (awareness of illness), judgement (capability for appropriate actions)
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28
Q

Define the following terms

  • Psychosis
  • Delusion
    • Bizarre delusions
    • Non-bizarre delusions
  • Hallucination (what conditions are these common in???)
    • Visual, auditory , olfactory, gustatory, tactile
  • Disorganized speech
  • Disorganized behavior
A
  • Psychosis: inability to distinguish reality from fantasy
  • Delusion: false belief not consistent with patient’s intelligence and cultural background
    • Bizarre delusions: delusions that are not possible in real life (i.e martians)
    • Non-bizarre delusions: belief that could be true, but is not (i.e. spying neighbor)
  • Hallucination: false sensory perceptions not associated with real external stimuli
    • Visual (medical > psychiatric), auditory (psychiatric > medical), olfactory (epilepsy/brain tumors – smell burning rubber), gustatory (epilepsy), tactile (alcohol withdrawal and stimulant use – cocaine crawlies)
  • Disorganized speech: disorganized thoughts (tangential speech to nonsensical speech)
  • Disorganized behavior: inappropriate behavior with unclear motivation (i.e. multiple coats on a warm day)
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29
Q

Define the following

  • Catatonic behavior
  • Impaired functioning
  • Negative symptoms
  • Positive symptoms
A
  • Catatonic behavior: extreme levels of motor activity (increased or decreased)
  • Impaired functioning: inability to perform normal activities (failing at school or work)
  • Negative symptoms: blunted affect, anhedonia, apathy, alogia (lack of speech), lack of interest and socialization
  • Positive symptoms: hallucinations, delusions, disordered speech, bizarre behavior
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30
Q

What is criteria A?

A
  • Criteria “A”: delusions, hallucinations, disorganized speech, disorganized behavior, negative sx (2 of these)
    • Delusions or hallucinations alone are adequate for dx
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31
Q

For Schizophrenia

  • Duration
  • Criteria?
  • Not secondary to?
  • Phases
A
  • Schizophrenia:
    • Duration: > 6 months (active sx for 1 month)
    • Criteria “A” must be followed
    • Not secondary to medical condition, substance use, mood, or schizoaffective disorder
    • Phases of schizophrenia
      • Prodrome: decline in function that precedes first psychotic episode
      • Psychotic (active): perceptual disturbances, delusions, or disordered thought
      • Residual: occurs between episodes of psychosis marked by negative sx including flat affect (hallucinations may occur)
32
Q

For Schizophrenifomr disorder

  • Duration
  • Criteria?
  • Not secondary to?
A
  • Schizophreniform disorder
    • Duration: 1 – 6 months (only difference from schizophrenia)
    • Criteria “A” must be followed
    • Not secondary to medical condition, substance use, mood, or schizoaffective disorder
33
Q

For schizoaffective disorder:

  • Duration
  • Criteria?
A
  • Schizoaffective disorder
    • Criteria:
      • Meets criteria for major depressive disorder (MDD), manic, or mixed episode and concurrently meets criteria for schizophrenia
      • Delusions or hallucinations for 2 weeks in absence of mood disorder (above disorders) sx
      • Have mood sx present for substantial portion of psychotic illness
34
Q

For brief psychotic disorder:

  • Duration
  • Criteria?
  • Not secondary to?
  • Trigger
  • Prognosis
A
  • Brief psychotic disorder
    • Duration: 1 day to 1 month
    • Criteria “A” must be followed
    • Not secondary to medical condition, substance use, mood, or schizoaffective disorder
    • Trigger: stress (bereavement, sexual assault, etc)
    • Prognosis: will return to baseline functioning usually
35
Q

For Unspecified Schizophrenia Spectrum Disorder/Psychotic Disorder

disorder

  • Criteria?
  • Duration
A
  • Unspecified Schizophrenia Spectrum Disorder/Psychotic Disorder
    • Criteria
      • Duration or symptom criteria are not met
      • Post-partum psychosis
      • Inability to determine of primary due to GMC or substance use
36
Q

For delusional disorder

  • Criteria?
  • Duration
A
  • Delusional disorder
    • Criteria
      • Non-bizarre fixed delusions for at least 1 month
      • Schizophrenia Criteria “A” not met
      • No functioning impairment
37
Q

Differentiate between psychotic sx and psychotic disorder?

A
  • Psychotic symptoms do not mean you have a psychotic disorder (i.e. delirium)
  • Psychotic disorder does not mean you have schizophrenia (i.e. delusional disorder)
38
Q

What is the epidemiology of schizophrenia?

A
  • 1% of population, equal in men (ages 18-25) and women (ages 25-46)
  • Modes increase in children born in spring and early winter
39
Q

What is the etiology of schizophrenia (genetics, structural, imaging?)

A
  • Etiology
    • Genetics
      • Some form of inheritance, commonly linked to chromosome 6 and 8 à pruning of dendrites
      • 50% penetrance in monozygotic twins
    • Structural abnormalities: reduced volume (prefrontal cortex, thalamus, hippocampus, STG), increased volume (lateral/third ventricles, and basal ganglia)
    • Brain imaging: PET/SPECT show decreased frontal lobe flow; ventriculomegaly; decreased total gray matter volume
40
Q

What are the altered dopaminergic pathways in schizophrenia? What happens when these are blocked?

A
  • Altered dopaminergic pathways (blockage)
    • Mesolimbic system: increases motor activity → positive symptoms
    • Mesocortical: decreases motor activity → negative symptoms
    • Nigrostriatal pathway: decreases motor activity → extrapyramidal symptoms
    • Tuberoinfundibular: decreases motor activity → increases prolactin → decreases libido → sexual dysfunction, galactorrhea, gynecomastia
41
Q

What is the involvement of dopaminergic pathways in schizophrenia?

A
  • Involvement in Schizophrenia and Tx
    • Mesolimbic system and mesocortical pathways are dysfunctional → Schizophrenia
    • Nigrostriatal pathway and tuberoinfundibular pathways are modulated in treatment
42
Q

General pathophys of psychotic disorders

A
  • Pathophysiology of psychotic disorders
    • Bottom line: increased dopamine → increased psychosis
      • Serotonin and glutamate can increase or decrease dopamine
        • Serotonin also directly has effects on glutamate
43
Q

Non-phamacological tx for psychosis

A
  • CBT, different types of therapy, family education, case workers, vocational training, etc
44
Q

For typical antipscyhotics (1st gen)

  • What do they typically end with?
  • Basic MOA (secondary actions too)
  • Storage
A

Typical Antipsychotics (-azine)

  • MOA: block D2 receptor and secondary M1/H1/alpha-1 blockade
  • Storage: body fats (lipid soluble) – slowed to be removed
45
Q

What typical antipsychotics have a high potency? Low potency?

A
  • Potency:
    • High (Effects: EPS): trifluoperazine, fluphenazine, haloperidol (Try 2 Fly High)
    • Low (Effect: anticholinergic/antihistamine/anti-alpha): chlorpromazine, thioridazine
46
Q

What are EPS sx of typical antipyschotics? Define based on onset and provide treatments for each!

A
  • D2 blockade: EPS, endocrine changes, sexual dysfunction
    • EPS
      • Hours to days: Dystonic reactions
        • Description: uncoordinated spastic movements of muscle groups (i.e. trunk, tongue, face)
        • Tx: benztropine
      • Days to months: Akathisia, Parkinsonism
        • Akathisia: extreme restlessness and pacing; may lead to insomnia
          • Tx: beta blockers
        • Parkinsonism: tremors of extremities
          • Tx: Oral antiparkinsonian drugs
      • Months to years: Tardive dyskinesia
        • Description: involuntary and potentially irreversible movements around oral area
        • Dx: Abnormal Involuntary Movement Scale (AIMS)
        • Tx: benztropine; change dosage of meds
47
Q

What is a syndrome that can occur with D2 blockade with typical antipscyhotics? Explain signs and sx (mnemonic). Provide treatment!

A
  • Neuroleptic malignant syndrome (life-threatening)
    • Signs/sx (Malignant FEVER): Myoglobinuria (breakdown of muscles from movement), Fever, Encephalopathy, Vitals unstable, Enzymes increased, Rigidity of muscles
    • Tx: discontinuation of antipsychotic, Dopamine agonists (bromocriptine/dantrolene)
48
Q

Provide other SE of tpyical anti-pscyhotics based on the receptors the meds block. Provide other SE

A
  • H1 blockade: sedation, drowsiness, weight gain, hypotension
  • Alpha-1 blockade: postural hypotension, reflex tachycardia, dizziness
  • M1 blockade: blurred vision, dry mouth, sinus tachycardia, constipation, urinary retention, memory dysfunction
  • Other: corneal deposits (chlorpromazine), retinal deposits (thioridazine), QT prolongation
49
Q

For atypical antipscyhotics/second-gen

  • What do the names end with?
  • MOA?
A

Atypical Antipsychotics/Second-Generation (-apine, -peridone, -idone)

  • MOA: post-synaptic blockade of D2 receptor and secondary 5HT-2A blockade
    • Equal efficacy as first-generation; less side effects
50
Q

What is a special type of atypical antispsyhcotic? What is its MOA?

A
  • **Aripiprazole: partial D2 agonist
    • Hyperdopaminergic areas (mesolimbic area) → antagonist →+ sx
    • Hypodopaminergic areas (mesocortical area) → agonist → - sx
51
Q

What are the side effects of atypical antipsychotics? General benefits? General SE?

A
  • Benefits: rare EPS, rare increase in prolactin, reduced negative sx
  • Side effects: prolonged QT
52
Q

For the following atypical antipsychotics provide SE:

  • -Apines
  • Clozapine
  • Risperidone
  • Olanzapine
  • Ziprasidone
  • Quetiapine
A
  • -Apines: Metabolic syndrome
  • Clozapine: agranulocytosis, seizures, reduced risk of suicide, must monitor CBC
  • Risperidone: increased prolactin (only second gen), less weight gain
  • Olanzapine: weight gain
  • Ziprasidone: prolongs QT interval, dizziness, somnolence
  • Quetiapine: lenticular opacities, HA, increased AST
53
Q

Epidemiology of depression?

A
  • Epidemiology: Females, ages 18-25, multiracial, medical students
54
Q

Criteria of major depressive disorder (mnemonic)

A
  • Criteria (SMIGECAPS):
    • 5/9 symptoms below, 2 weeks period,
    • Sleep changes, Mood depressed, Interest lost (anhedonia), Guilt/worthlessness, Energy decreased, Concentration diminished, Appetite change, Psychomotor agitation/retardation, Suicidal ideations
      • 1 of these must be loss of interest or depressed mood
    • Not due to substance abuse/medical condition, but have social/occupational impairment; No hx of manic or hypomanic episodes
55
Q

For major depressive disorder, list the different specifiers

A

Seasonal pattern, atypical, melancholic, peripartum, catatonic features

56
Q

Define the following MDD specifiers

Seasonal pattern, atypical, melancholic, peripartum, catatonic features

A
  • Seasonal pattern: temporal association between episodes and time of year
  • Atypical features: mood reactivity (actually laughs at joke), weight gain, hypersomnia, leaden paralysis (heavy feeling in arms/legs), rejection sensitivity
  • Melancholic features: loss of pleasure (worse in morning), anorexia
  • Psychotic features: delusions, hallucinations
  • Peripartum onset: onset during pregnancy or within 4 weeks postpartum
    • Different from postpartum blues:
      • Characterized by: depressed affect, tearfulness, fatigue, resolves 10 days postpartum
  • Catatonic features: catalepsy (posture held against gravity), wavy flexibility, stupor, agitation, mutism, negativism (opposes instructions), posturing, mannerisms, stereotypies (repetitive non-goal directed movements), grimacing, echolalia (mimics speech), echopraxia (mimics movements)
57
Q

For persistent depressive disorder (Dysthymic Disorder)

  • Criteria?
  • What is the period of no sx allowed?
  • Duration?
  • Cannot meet which criteria?
A

Persistent Depressive Disorder (Dysthymic Disorder)

  • Criteria:
    • Depressed mood most days for at least 2 years (1 year in children)
    • 2 of the following:
      • Poor appetite, insomnia/hypersomnia, low energy/fatigue, poor self-esteem, decreased concentration/difficulty making decisions, hopelessness
    • Cannot have lack of symptoms > 2 months
    • Mild depression with no discrete episodes (major depressive episode)
    • No manic/hypomanic/cyclothymic criteria met; not due to psychosis, substance use, or medical condition
    • Bottom line: 2 D’s → 2 years of depression → 2 sx → never asymptomatic > 2 months
58
Q

For premenstrual dysphoric disorder

  • Different from what?
  • Criteria?
  • Duration?
A

Premenstrual Dysphoric Disorder

  • Different from PMS (general irritability)
  • 5 symptoms (at least 1 from each category below) in final week leading up to menses → improve during/after menses
    • Affective lability, irritability/anger/conflict, depressed mood/hopelessness, anxiety/tension/on edge
      • Decreased interest, difficulty concentrating, lethargy/fatigue, appetite change, insomnia/hypersomnia, feeling overwhelmed, physical sx (pain, bloating, weight gain)
59
Q

For disruptive mood dysregulatioj

  • Age at dx?
  • Criteria?
  • Duration?
  • Not due to what?
A

Disruptive Mood Dysregulation

  • Criteria: severe recurrent temper outbursts (out of proportion) of verbal or physical aggression; > 3 times a week; persistently irritable in between outbursts
  • Diagnosed initially between age 6-18 y/o
  • No mania with elevated mood for >1 day
  • Not due to substance, medical or neurological condition
60
Q

For grief/bereavement

  • 5 stages of grief?
  • What may the patient experience?
  • Duration?
  • How is it different from depression>
A

Grief/Bereavement

  • 5 stages of grief (Kubler-Ross): denial, anger, bargaining, depression, acceptance
  • May experience hallucinations, positive emotions, emptiness
  • Duration: less than 1 year; sx less than 2 months
  • Different from depression:
    • No suicidal thoughts, sx less than 2 months, inability to have pleasure
61
Q

For Adjustment Disorder with Depressed Mood

  • Trigger?
  • Criteria
  • Sx are not that of?
  • Resolution time
A

Adjustment Disorder with Depressed Mood

  • Maladaptive/emotional behavior develops after a stressful life event (job loss etc)
  • Criteria:
    • Development of behavior/emotional sx within 3 months after event and sx produce:
      • Excessive distress OR significant impairment in function
    • Sx are not that of bereavement
    • Sx resolve within 5 months of removal of stressor
62
Q

What do biological amines have to do with depression?

Provide rate limiting steps of specific NTs. Which monoamines may be deficient?

A
  • Biogenic amines (monoamine hypothesis)
    • Deficiency of monoamines (tryptophan → serotonin, Norepi, dopamine)
      • Tryptophan converts Kynurenine during depression
      • Tyrosine hydroxylase (Norepi) and Tryptophan hydroxylase (serotonin) are the rate limiting steps in monoamine synthesis
63
Q

What neuroanatomical structures are affected in depression?

A
  • Neuroanatomical structures: PFC, amygdala, hippocampus (show volume reduction on MRI; decreased dorsolateral PFC activity)
64
Q

How does congitive theory work in depression

A
  • Cognitive theory:
    • Cognitive triad: negative view of self, world, and the future
    • Cycle: Emotion/core belief (“I am useless”) → Biased/overgeneralized Negative Thought (“No one cares”) → Negative Action (not going to work)
65
Q

How does depression and antidepressants affect sleep?

A

Depression and Sleep

  • Depression: increased REM, decreased slow-wave sleep (shortened REM latency, prolonged first REM period, increased REM density)
  • Anti-depression: reduced REM, increased slow-wave sleep (increased REM latency)
66
Q

What are the forms of depression treatment? list all.

A

Depression Treatment

  • Psychotherapy/cognitive behavioral therapy: mild depression
    • Challenge negative thoughts and negative actions
  • Antidepressants – moderate to severe
  • Electro-convulsive therapy (ECT): Highest rates of response
    • A/E: Cognitive impairment, memory problems mostly resolve
  • Transcranial magnetic stimulation (TMS): Use of magnetic field to bring about depolarization (SE: seizures)
  • Deep Brain Stimulation (DBS): Subgenual cingulate cortex; limited evidence
  • Vagal Nerve Stimulation
  • Phototherapy – seasonal pattern
67
Q
  • For SSRI
    • MOA
    • General SE:
A
  • Selective Serotonin Reuptake Inhibitors (SSRIs)
    • MOA: inhibits serotonin reuptake by serotonin transporters → increased serotonin in terminal
    • SE (fewer than TCAs): GI distress, SIADH, sexual dysfunction, suicidal thoughts (not contraindication)
68
Q

What two syndromes can you get with SSRIs? What are their etiologies and sx?

A
  • Serotonin Syndrome
    • Etiology: Due to excess serotonin secondary to SSRIs, stoppage of MAOI, combos of sertotnergic drugs (i.e. Tramadol, linezolid)
    • Signs/sx: AMS, GI sx, diaphoresis, myoclonus/hyperreflexia
  • Discontinuation Syndrome
    • Suspect after: use of short-life drug (i.e. Paroxetine)
    • Sx: dizziness, HA, N/V, anxiety, paresthesias
69
Q

What drugs are known for P450 reactions? What effect does this have?

A
  • P450 reactions: fluoxetine, fluvoxamine paroxetine (less metabolism of drugs like Tamoxifen, TCAs, etc)
70
Q

What drugs are indicated for the following

  • OCD
  • Long half life
  • QTC
  • Short half life
  • Less interactions
A
  • Indications
    • OCD: Fluvoxamine, Sertraline
    • Longest half-life: Fluoxetine (if non-compliant pt)
    • QTC prolongation: citalopram
    • Short half-life: Fluvoxamine, paroxetine
    • Less interactions: Citalopram
71
Q

For Selective Norepinephrine Reuptake Inhibitors (SNRI):

  • MOA
  • SE
  • Drug names (3)
A
  • Selective Norepinephrine Reuptake Inhibitors (SNRI)
    • MOA: inhibits serotonin and norepinephrine reuptake by serotonin transporters → increased serotonin and norepinephrine in terminal
    • SE: HTN
    • Drugs: Venlafaxine, Duloxetine (used for pain), Desvenlafaxine
72
Q

For tricylcics:

  • MOA
  • SE
    • Secondary amines vs tertiary amines
    • Toxicity
A
  • Tricyclics (TCAs)
    • MOA: inhibits 5-HT and NE reuptake in CNS
    • SE: anticholinergic effects, antihistaminergic effects (sedation), alpha blockage (hypotension)
      • Secondary amines (Nortriptyline, Desipramine, Maprotiline) have less of these side effects than Tertiary amines (Imipramine, Amitriptyline)
      • Toxicity: cardiac arrhythmias/convulsions/coma (3 Cs) secondary to Na blockade, wide QRS (administer bicarb)
73
Q

For monoamine oxidase inhibitor (MAOIs)

  • MOA (A & B)
  • Drugs (based on selectivity)
  • SE
A
  • Monoamine Oxidase Inhibitors (MAOIs)
    • MOA: Inhibits monoamine oxidase located on mitochondria → increases [NT]
      • MAO A: metabolizes Serotonin, NE, Epi
      • MAO A&B: metabolizes Dopamine, Tyramine
    • Drugs:
      • Irreversible, non-selective: Phenelzine, Tranylcypromine
      • Irreversible, MAO-B selective: Selegiline
    • SE: CNS stimulation, hypertensive crisis w/ ingestions of tyramine (a.a. in wine, cheese, and preserved meats)
74
Q

What is the MOA, SE, and use (if applicable) for the following drugs:

  • Bupropion
  • Mirtazapine
  • Trazodone
  • Nefazodone
A
  • Atypical antidepressants
    • Bupropion
      • MOA: inhibits reuptake of NE and dopamine
      • SE: seizures (people w/ eating disorders), tachycardia, insomnia
      • Uses: smoking cessation, sexual dysfunction
    • Mirtazapine
      • MOA: alpha-2 antagonist → increase release of NE and 5HT
        • Blocks 5HT2/3 and H1 receptors
      • SE: sedation, increased appetite/weight gain, dry mouth
    • Trazodone
      • MOA: blocks 5HT2, alpha1, and H1 receptors and inhibits 5HT reuptake
      • SE: sedation, priapism (traZZZobone)
      • Uses: insomnia
    • Nefazodone
      • MOA: blocks 5HT2, alpha1, and H1 receptors and inhibits 5HT reuptake
      • SE: hepatotoxicity
75
Q

What is the MOA, SE, and use (if applicable) for the following drugs:

  • Varenicline
  • Vilazodone
  • Vortioxetine
A
  • Varenicline
    • MOA: nicotinic Ach agonist
    • SE: sleep disturbance, depress mood
    • Uses: smoking cessation
  • Vilazodone
    • MOA: inhibits 5HT reuptake + 5HT1A agonist
    • SE: HA, GI issues, weight gain, anticholinergic effects
  • Vortioxetine
    • MOA: inhibits 5HT reuptake + 5HT1A agonist
    • SE: nausea, sexual dysfunction, abnormal dreams, anticholinergic effects

NBS (8 decks)

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