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psych drugs

psychopharmacology

QuestionAnswer
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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