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psych drugs
psychopharmacology
| Question | Answer |
|---|---|
| How many nerve cells in the brain | 100 billion neurons |
| conducting electrical impulse from one end of the neuron to another is called | neurotransmission |
| Electrical signals within neurons are converted into ______ signals at synapses. | chemical |
| Molecules released at synapses are called | neurotransmitters |
| What do neurotransmitters do? | they elicit electrical signals on the other side of the synapse |
| when a neurotransmitter reaches a receptor it either _____ or _____ the postsynaptic neuron | inhibits or excites |
| It is the interaction between _______ and _______ that is a major target of psychotropic drugs. | transmitter; receptor |
| What happens after a transmitter attaches to a receptor | it exerts its influence on the postsynaptic cell, separtates from the receptor and is destroyed. |
| Some transmitters are destroyed by specific enzymes, list one | acetylcholine is destroyed by acetylcholinesterase at the postsynaptic cell |
| List three types of monoamine transmitters | norepinephrine, dopamine, serotonin |
| How are the monoamine transmitters destroyed | monoamine oxidase (MAO) |
| monoamine transmitters are taken back into presynaptic cell. This process is called _______ | reuptake |
| When monoamine transmitters (norephinephrine, serotonin, dopamine) are taken back into presynaptic cell (reuptake) what happens? | either reused or destroyed by intracellular enzymes (monoamine oxidase). |
| A chemical messenger between neurons by which one neuron triggers another is called | neurotransmitter |
| List the four major groups of neurotransmitters in the brain. | 1. monoamines 2. amino acids 3. peptides 4. cholinergics (acetylcholine) |
| List the neurotransmitters that are implicated in a variety of neuropsychiatric disorders. | 1. norephinephrine 2. dopamin 3. serotonin 4. acetylcholine |
| What do amino acid neurotransmitters do? | balance brain activity |
| list two types of amino acid neurotransmitters | 1. GABA (gamma aminobutyric acid) 2. glutamate |
| What do peptide neurotransmitters do? | modulate or adjust general brain function |
| List a peptide neurotransmitter | hypothalamic CRH (corticotrophic releasing hormone) |
| List dopamine's receptors | D1, D2, D3, D4, D5 |
| clinical relevance of increased dopamine include? | schizophrenia, mania |
| clinical relevance of decreased dopamine include? | Parkinson's disease, Depression |
| What are the functions of dopamine? | Excitatory: 1. fine muscle movement 2. integration of emotion & thoughts 3. decision making 4. stimulates hypthalamus to release hormones sex, thyroid, adrenal |
| List norepinephrine (NE) receptors | alpha 1, alpha 2, beta 1, beta 2 |
| clinical relevance of increased norepinephrine include | mania, anxiety schizophrenia |
| clinical relevance of decreased norepinephrine include | depression |
| Functions of norephinephrine include? | Excitatory: 1. mood 2. attention and arousal 3. stimulates sympathetic branch of ANS for "fight or flight" in response to stress |
| Serotonin receptors include | 5-HT, 5-HT2, 5-HT3, 5-HT4 |
| clinical relevance of increased serotonin include: | anxiety (high levels) |
| clinical relevance of decreased serotonin include: | depression |
| Functions of serotonin include: | Excitatory: 1. mood 2. sleep regulation 3. hunger 4. pain perception 5. aggression 6. hormonal activity |
| Histamine is what type of neurotransmitter? | Monoamine |
| What are the receptors for Histamine? | H1, H2 |
| Clinical relevance of increased histamine include: | hyperactivity, compulsivity, suicidal depression |
| Clinical relevance of decreased histamine include: | sedation, weight gain, hypotension |
| List an Amino Acid neurotransmitter. | GABA |
| What are the receptors for GABA | GABAa, GABAb |
| Clinical relevance of increased GABA include | Reduction of anxiety |
| Clincial relevance of decreased GABA include | mania, anxiety, schizophrenia |
| Functions of GABA include: | Inhibitory: 1. reduces anxiety, excitation and aggression 2. may play a role in pain perception 3. anticonvulsant and muscle-relaxing properties |
| List two amino acid neurotransmitters | GABA and Glutamate |
| Which amino acid neurotransmitter is inhibitory | GABA |
| Which amino acid neurotransmitter is excitatory? | glutamate |
| What are glutamate's receptors | NMDA, AMPA |
| Clinical relevance of increased (glutamate's)NMDA include: | prolonged activation kills neurons |
| Clinical relevance of decreased glutamate's NMDA include | psychosis |
| What is the function of glutamate's AMPA? | excitatory: AMPA plays a role in learning and memory |
| List a cholinergic neurotransmitter | acetylcholine (ACh) |
| List acetylcholine's receptors | Nicotinic and muscarinic (M1, M2, M3) |
| Clinical relevance of increased acetylcholine is | depression |
| Clinical relevance of decreased acetylcholine is? | alzheimer's disease, Huntington's chorea, Parkinson's disease |
| What are the functions of acetylcholine? | 1. plays a role in learning 2. memory 3. regulates mood: mania, sexual agression 4. affects sexual and aggressive behavior 5. stimulates parasympathetic nervous system |
| List three types of Peptides (Neuromodulators) | 1. Substance P 2. Somatostatin (SRIF) 3. Neurotensin (NT) |
| What is the clinical relevance of Substance P | 1. involved in regulation of mood and anxiety 2. role in pain management |
| What are the functions of Substance P | centrally active SP antagonist has antidepressant and antianxiety effects in depression 2. promotes & reinforces memory 3. enhances sensitivity to pain receptors to activate |
| Altered levels of somatostatin are associated with ________ _______. | cognitive disease |
| Clinical Relevance of decreased somatostatin (SRIF) include: | 1. alzheimer disease 2. decreased levels of somatostatin found in spinal fluid of depressed patients |
| Clinical relevance of increased somatostatin include: | Huntington's chorea |
| Clinical relevance of Neurotensin (NT) | decreased levels found in patients with schizophrenia |
| Most psychotropic drugs produce effects through alteration of synaptic concentrations of (list 7 neurotransmitters) | 1. dopamine 2. norepinephrine 3. serotonin 4. histamine 5. GABA 6. glutamate 7. acetylcholine |
| List the different ways psychotropic meds. affect neurotransmitters. | 1. agonist 2. antagonist 3.interfere with reuptake 4.enhancement of neurotransmitter release 5 inhibit enzymes |
| List some things that dopamine does? | 1. stimulates the heart 2. increases blood flow to the liver, spleen, kidney's and other visceral organs 3. controls muscle movements 4. controls motor coordination |
| Low levels of dopamine are associated with: | 1. tremors 2. muscle rigidity 3. low blood pressure |
| Drugs that block dopamine receptors like haloperidol have _________ effects | antipsychotic |
| Drugs that stimulate dopamine activity (amphetamines) induce _______ symptoms. | psychotic |
| Antipsychotic drugs block or ______ which receptors in the basal ganglia? | antagonists; D2 (dopamine receptor) |
| When a drug blocks D2 receptor, two types of movement disturbances occur. what are they? | 1. extrapyramidal symptoms (EPS) and 2. tardive dyskinesia |
| EPS can develop when | early in treatment with meds that block D2 receptors |
| Tardive dyskinesia can occur when | later in treatment with meds that block D2 receptors |
| EPS occur most frequently in what types of drugs | standard or conventional antipsychotics (with the exception of Risperdal in high doses) |
| Risperdal is what type of antipsychotic | atypical |
| What adverse affects can occur with Risperdal? | EPS (in high doses) and dysphoria (uncomfortable feeling) |
| Evidence for altered dopamine system also occurs in what conditions? | 1. depression 2. bipolar 3. substance abuse 4. attention deficit disorder |
| Dopamine is balanced by what neurotransmitter? | acetylcholine |
| Neurons that release acetylcholine are said to be _______. | cholinergic |
| cholinergic neurons are said to be involved in ______ function, especially ________. | cognitive; memory |
| ________ is deficient in alzheimers disease. | acetylcholine |
| What drugs are given to Alzheimer patients and why? | Aricept, Razadyne and Exelon because these drugs are acetylcholinesterase inhibitors (so more acetylcholine stays active) |
| Acetylcholine receptors respond to what molecules | acetylcholine and nicontine |
| Why might smoking or help people with cognitive decline? | nicotine is a cholinergic receptor agonist which is said to help with cognitive function |
| Nicotine spray is said to help patients with increased ______ and ________ abilities. | attention; computational |
| Neurons that release norepinephrine are called? | noradrenergic |
| What two neurotransmitters play a major role in regulating mood. | norepinephrine and serotonin |
| Deficiency in Norephinephrine and serotonin is thought to be the cause of ______. | depression |
| excessive amounts of norephinephrine and serotonin are thought to be the cause of ______. | mania |
| Many conventional antipsychotics act as antagonists at the alpha 1 receptors for NE (norephinephrine). Why is this problematic | 1. blockage of these receptors can bring about vasodilation & drop in blood pressure (OH) 2. alpha 1 also found in vas deferens which can lead to failure to ejaculate |
| serotonin, found in the brain and spinal cord is said to regulate | 1. attention 2. behavior and 3. body temperature |
| Drugs that block the enzyme that metabolizes monoamines are called | monoamine oxidase inhibitors |
| When might a Monoamine oxidase inhibitor (MAOI)be given? | for intractable depression (more common drug for depression are SSRI and SNRI's) |
| When some antidepressants are combined with other drugs or supplements that increase serotonin what can occur? | serotonin syndrome |
| What are some examples of supplements or over-the counter drugs that may increase serotonin? | St. John's Wort and cough and cold medications that contain dextromethorphan |
| is a potentialyl life-threatening drug reaction that causes the body to have too much serotonin, a chemical produced by nerve cells. | serotonin syndrome |
| What are the symptoms of serotonin syndrome? | 1. Agitation/restlessness 2.Diarrhea 3.Fast heart beat 4.Hallucinations 5.Increased body temperature 6.Loss of coordination 7.Nausea & Vomiting 8. Overactive reflexes 9. Rapid changes in blood pressure |
| What is the treatment for serotonin syndrome? | treatment may include: 1. Benzodiazepines such as Valium/ or Ativan to decrease agitation, seizure-like movements, & muscle stiffness 2.Periactin, a drug that blocks serotonin production 3.Fluids by IV 4. Withdrawal of medicines that caused the syndrome |
| Many conventional antipsychotic agents, as well as a variety of other psychiatric durgs, block the H1 receptors for ________. | Histamine |
| What are the effects of blocked H1 receptors? | 1. sedation 2. weight gain |
| why is blocking H1 receptors such a concern | because on effect is weight gain which can disrupt glucose and lipid metabolism and insulin resistance |
| the major inhibitory neurotransmitter is | GABA |
| GABA modulates neuronal ________ | excitability |
| most antianxiety drugs act by increasing the effectiveness of which neurotransmitter? | GABA (by increasing receptor responsiveness) |
| Glutamate is an excitablity neurotransmitter that activates ______ receptors | NMDA |
| Reduction in NMDA receptor activity causes psychotic symptoms as seen with the street drug _______ | PCP |
| Reduction in glutamate causes ______ _______ but overstimulation can cause ________ death | psychotic symptoms; neuronal |
| Overstimulation of NMDA receptors is said to be _____ to neurons. | toxic |
| Why would someone need to take a NMDA antagonist? | (Namenada) memantine is a NMDA antagonist given to people with alzheimer's disease and it is said to treat neurotoxicity and limit further deterioration. |
| Standard psychotic drugs (conventional) were once called ________. | neuroleptics (because they caused significant neurological effects) |
| neuroleptics were also called what | DRAs - Dopamine receptor antagonists |
| D2 blockade achieves therapeutic effect of decreasing _____ symptoms in schizophrenics | positive symptoms. |
| What was the problem with conventional antipsychotic meds that blocked D2. | they caused adverse effects such as: EPS such as dystonia, akathisia, tardive dyskinesia and drug induced parkinsonism, also may lead to rare life threatening NMS (neuroleptic malignant syndrome) |
| Dystonia is a neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. | dystonia |
| characterized by unpleasant sensations of "inner" restlessness that manifests itself with an inability to sit still or remain motionless | akathisia |
| an incurable, potentially fatal variety of dyskinesia (involuntary, repetitive movements) manifesting as a side effect of long-term or high-dose use of dopamine antagonists, usually antipsychotics. | tardive dyskinesia |
| muscle rigidity, fever, autonomic instability[1] and cognitive changes such as delirium, and is associated with elevated creatine phosphokinase caused by adverse reaction to antipsychotic meds | NMS - neuroleptic malignant syndrome |
| What are anticholinergic side effects? | 1. blurred vision 2. dry mouth 3. constipation 4. urinary hesitance 5. tachycardia |
| what are the effects of blocking H1 receptors | 1. sedation 2. substantial weight gain 3. orthostasis |
| What are the effects of blocking 5-HT2 (serotonine) | 1. antipsychotic effects 2. weight gain 3. hypotension 4. ejaculatory disfunction |
| What are the effects of blocking GABA receptors | lowers seizure threshold |
| What happens when you block alpha 2 receptors | sexual dysfunction & priapism |
| What are affects of blocking Alpha 1 receptors | 1. OH 2. dizziness 3. antipsychotic effect 4. reflux tachycardia 5. failure to ejaculate |
| What are effects of blocking D2 receptors | 1. antipsychotic effect 2. EPS 3. Increased prolactin (gynecomastia and galactorrhea) 4. amenorrhea (women) |
| Conventional antipsychotic drugs are divided into what two categories | high potency and low potency |
| Which conventional antipsychotic drug is low potency | chlorpromazine (Thorazine) - this drug used less frequently than high potency conventional antipsychotic drug |
| Which conventional antipsychotic drug is high potency? | haloperidol (Haldol)- This drug is high potency and can be easily combined with lorazepam to keep the sedative effect. |
| The combination of haloperidol and ______ is very effective in controlling aggression in violent patients. | lorazepam |
| atypical antipsychotic drugs are know as | serotonin-dopamine antagonists (they have higher ratio of 5-HT2 blockage than D2 blockage) |
| What are some advantages to using atypical antipsychotic drugs over conventional? | 1.have fewer motor side effects 2. target negative as well as positive symptoms of schizophrenia 3. may improve cognitive function |
| true or false Each episode of schizophrenia may be considered neurotoxic | true |
| Describe how clozapine (Clozaril), the first of the atypicals, works. | its a weak blocker of D2 receptors and a strong blocker of serotonin 5-HT2 receptors. |
| What type of patient is prescribed clozapine (Clozaril) | indicated for severely ill schizophrenic individuals who have failed to respond to standard therapy. |
| What are the problems with taking clozapine (Clozaril) | 1. may suppress bone marrow (agranulocytosis)- this risk is highest in 1st few months of treatment |
| _____ is a derivative of clozapine, has a higher affinity for 5-HT2 serotonin receptors than D2 receptors. | Olanzapine (Zyprexa) |
| What are some side effects of clozapine and olanzapine (Zyprexa)? | 1. cause significant weight gain 2. interfere with glucose metabolism and may lead to insulin resistance. |
| What medication used to regulate glucose can be prescribed for people taking antipsychotic meds that cause weight gain and glucose metabolism trouble | metformin |
| Olanzapine (Zyprexa) is usually given at bedtime. Why | because it blocks H1 receptors which causes sedation. |
| Risperidone (Risperdal) acts on what receptors | blocks D2 and very high affinity for 5-HT2 receptors |
| What are side effects of Risperidone? | EPS if over 4 mg/day, orthostatic hypotension and sedation |
| ______ was the first atypical antipsychotic available as a long-acting injectable. | Risperidone |
| Without medication, what percent of clients with schizophrenia will relapse within 1 year. | 70-80% |
| Medication compliance is very poor due to what two things | 1. side effects (with traditional antipsychotics) 2. weight gain (with atypical antipsychotics) |
| List 3 facts about traditional/conventional antipsychotics | 1. usually takes effect 3-6 weeks after start date 2. treats positive symptoms of schiz. 3. dopamine receptor antagonist - binds to (D2) in basal ganglia which ends up causing movement disturbance |
| low potency neuroleptic that is and older medication that is not used very often | Thorazine - chlorpromazine |
| What are the common side effects of chlorpromazine (Thorazine) | 1. decreases seizure threshold 2. increased sedation 3. can cause EPS, but fewer than high potency neuroleptics 4. amenorrhea 5. increased prolactin |
| give an example of a high potency neuroleptic | haloperidol (Haldol) |
| List facts about Haloperidol | 1. oral or injectable 2. used w/assaultive elderly clients due to less sedating SE and less OH 3. decreased seizure threshold 4. low anticholinergic side effects 5. high incidence of EPS |
| what are anticholinergic side effects | 1. dry mouth 2. blurred vision 3. constipation 4. agitation |
| List 4 types of EPS | 1. acute dystonia 2. akathisia 3. pseudoparkinsonism 4. tardive dyskinesia |
| muscle stiffness, muscle spasms in neck, eyes, cramps of the head and neck | acute dystonia |
| restlessness with pacing, fidgeting or rocking | akathisia |
| loss of facial movement, mask like faces, shuffling gait, monotonous speech, pill rolling, drooling | pseudoparkinsonism |
| protruding and rolling tongue, smacking, licking, spastic facial distortions, choreic movements, athetoid movements | tardive dyskinesia |
| what are choreic movements? | An involuntary spasmodic twitching or jerking in muscle groups not associated with the production of definite purposeful movements. |
| What are athetoid movements | movements that are slow complex and serpentine like |
| What do you use to assess for EPS | AIM scale (Abnormal Involuntary Movement Scale) |
| list side effects of antipsychotic medications | 1. EPS 2. photosensitivity 3. endocrine changes (breast enlargement galactorrhea, or loss of libido) 4. increased weight 5. NMS |
| What are the characteristics of NMS? Neuroleptic Malignant Syndrome (rare and potentially fatal) | 1. severe muscle rigidity 2. oculogyric crisis 3.dysphagia 4.cogwheeling 5. hyperpyrexia/hypertention 6. tachycardia 7. diaphoresis 8. incontinence 9. can occur in 1st week med started but usually later 10. rapidly progresses over 2-3 days after starting |
| What do you do if patient shows signs of NMS? | transfer to medical floor, treat symptoms, give benadryl or Parlodel |
Created by:
kellyaem
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