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Psychopharmacology
| Term | Definition |
|---|---|
| Pharmacology | Study of actions of drugs and their effects on living organisms. |
| Psychopharmacology | Drug-Induced changes in mood, thinking, and behavior. Usually in Nervous System most cases the CNS. |
| Drug Action | specific molecular changes produced by a drug when it binds to specific site or receptor. |
| Drug Effects | Widespread alterations in physiological or psychological functions. (observing or seeing) |
| Therapeutic Effects | The drug-receptor interaction produces the desired effect or change |
| Placebo | pharmacologically inert compound with potential therapeutic and side effects. |
| Active Placebo | give something that has some sort of effect so participants don’t realize they are in placebo group. |
| Pharmacokinetics | What the body does to the drug. |
| Pharmacodynamics | What the drug does to the body. |
| Enteral Administration | Absorbed in the GI tract. Oral or Rectal |
| Parenteral Administration | Avoids GI tract. Intravenous, Intramuscular, Subcutaneous, Inhalation, Topical, Intranasal, Transdermal, Epidural |
| Advantages and disadvantages of oral administration | Safe, self administered, economical. Disadvantages: slow an highly variable absorption, subject to first-pass metabolism |
| Advantages and disadvantages of intravenous administration | Advantage: most rapid, most accurate blood concentration Disadvantages: overdose danger, cannot be readily reversed, needles |
| Advantages and disadvantages of Intramuscular administration | Advantage: slow and even absorption Disadvantage: localized irritation at injection site, needles |
| Advantages and disadvantages of subcutaneous admin | Advantage: slow and prolonged absorption Disadvantage: variable absorption depending n blood flow |
| Advantages and disadvantages of Inhalation | Advantage: large absorption surface, very rapid onset, no needles Disadvantage: irritation of passage, small particles may damage lungs |
| Advantages and disadvantages of Topical admin | Advantage: localized action and effects disadvantage: may be absorbed into general circulation |
| Advantages and disadvantages of transdermal admin | Advantage: controlled and prolonged absorption Disadvantage: local irritation, only for lipid-solvable drugs |
| Advantages and disadvantages of epidural admin | Advantage: bypasses BBB, very rapid effects on CNS Disadvantage: not reversible, need anesthesiologist, possible nerve damage |
| Advantages and disadvantages of intranasal admin | Advantage: easy use, local or systematic effects, very rapid, no first-pass metabolism, bypasses BBB Disadvantage: Not all drugs can be atomized, potential irritation of nasal passages |
| Blood Brain Barrier is maintained by | astrocytes |
| Highly ionizing drugs do not cross | BBB |
| Lipid soluble molecules cross the ________ barrier easily | Placental |
| Drug Depots | inactive binding sites, nonselective |
| First-order kinetics | exponential elimination of free drug in the blood. The 1st pass a certain percentage gets metabolizes and leaves and then it speeds up until it is eliminated, or more is taken |
| Half life determine the time needed to reach | steady state plasma level |
| Enzyme induction increases biotransformation | 2-3 fold |
| enzyme production and make drugs | more or less effective |
| enzyme inhibition | drugs may inhibit a particular enzyme that metabolized other drugs increasing likelihood of toxicity |
| Drug competition | drugs that share a metabolic system. one will bind and the other will be free floating |
| Cocaine, nicotine caffeine are | stimulants |
| alcohol and benzos are | depressants |
| pain relievers, opioids are | analgesics |
| mood stabilizers and anti-depressants are | psychotherapeutics |
| Ligand | any molecule that binds to a receptor with some selectivity |
| Receptor Agonists | lock and key binding that produces a cellular response |
| Receptor antagonist | lock and key binding that blocks site and does not produce an effect |
| ligands are ______ and can | temporary, detach and reattach |
| Potency | absolute dose needed to produce an effect |
| dendrites | tree-like projections the receive info from other cells over the synapse |
| Soma | cell body filled with cutyoplasm. Contains the nucleus and other organelles |
| soma is responsible for the ______ care of the neuron | metabolic |
| axon | tubular extension that conducts the electrical signal from the soma to the axon terminals. |
| terminal buttons | end of neuron close to subsequent neurons and contain chambers full of neurotransmitters |
| axoplasmic transport allows | transport proteins to carry material to and from the terminal buttons |
| anterograde transport vs retrograde transport | anterograde is to the terminal and retrograde is from the terminal |
| schwann cells release | growth factors |
| oligodendrocytes do not release | growth factors or promote growth |
| microglia support brain | immune-function and inflammation reaction in brain |
| resting membrane potention | -70mV |
| Action potential charge | -70mV to -50 mV |
| Action potentials are all | or nothing |
| Local potentials happen at the ____ level and are ________ | dendritic/soma graded |
| Local potentials charge rapidly from | -50mV to 40mV |
| anesthetics block | voltage-gated sodium channels |
| Neuron Doctrine | the nervous system is composed of individual cells that are not physically connected |
| Reticulum Theory | consists of a series of vast continuous networks, all elements are interconnected |
| Glutamate and GABA are | amino acids |
| Dopamine, serotonin, and norepinephrine are | monoamines |
| _________is a precursor to ATP and is what is predominately blocked by caffeine | Adenosine |
| Corticotrophin-releasing factor (CRF) plays a role in | depression, anxiety, and drug addiction |
| Neurotransmitters are created by | enzymatic reactions anywhere in the cell |
| Neuropeptides are manufactured in the | cell body |
| Exocytosis | fusion of the vesicle membrane with the terminal at the point of active zones. |
| Vesicle recycling prevents | build-up and depletion of vesicles |
| Lipid and gaseous transmitters cross membranes | very easily |
| Autoreceptors | receptors on the presynaptic cell that read the transmitter it releases |
| Terminal Autoreceptors | Acts as a natural thermostat to inhibit the release of transmitter when the substance reaches certain levels |
| Somatodendritic Autoreceptors slows down | the rate of firing |
| Receptors | proteins along the membrane that “read” neurotransmitters |
| Many receptor subtypes exist for a single neurotransmitter and the goal of pharmacology is to make drugs | as specific as possible |
| 2 categories of receptors | Ionotropic and metabotropic |
| Ionotropic recepters are rapid and | play an important role in fast neurotransmission processes |
| Ionotropic recepters have a ____ or _____ for ion transfer and one or more binding sites | pore or channel |
| ACh allows in Na+ which | depolarizes the cell |
| GABA allows in Cl- which | hyperpolarizes the cell |
| Metabotropic receptors are slower but | more long-lasting |
| Metabotropic receptors have a _____ protein subunit | single |
| Metabotropic receptors work by activating | proteins inside of the cell (G-Proteins) |
| Allosteric sites | sites on the receptor that are not recognized by a typical agonist or antagonist. |
| Secondary binding sites provide an | alternate way to create drugs for chemicals that don’t easily cross the blood-brain barrier or cause too dangerous of side effects. |
| Vasopressin acts on | kidneys to increase water retention |
| Oxytocin stimulates | uterine contractions and triggers milk letdown |
| _________ hormones work on metabotropic receptors and 2nd messengers | Peptide |
| Bipolar I you can see ______, _____, or _______ | manic, depressed, or mixed |
| Encephalitis can mimic | manic episodes |
| Psychostimulants, levothyroxine, some antihypeprtenisve medication can cause | manic episodes |
| ________ antidepressants and ______ can induce mania in some people | tricyclic, SSRIs |
| SSRI abrupt withdrawal can induce | manic induction |
| Types of drugs used for BP | mood stabilizers, antidepressants, antipsychotics |
| For bp treatment you should start with ___ and then introduce ________ | mood stabilizers then antidepressants |
| If a bipolar patient presents with mania symptoms or a manic episode with classic mania treat with | lithium or valproate |
| If a bipolar patient presents with mania symptoms or a manic episode with extreme agitation or psychosis treat w/ | atypical anti-psychotic drug |
| If a bipolar patient presents with mania symptoms or a manic episode with mixed mania treat w/ | valproate |
| If a bipolar patient presents with depressive symptoms or a major depression episode treat w/ | mood stabilizers such as lithium, valproate, or lamotrigine |
| Appropriate treatment for BP can reduce the | number, frequency, severity, and length of mood episodes |
| Epidemiologic data indicate that _____% of patients diagnosed with Bipolar Disorders commit suicide | 15 to 20% |
| Bipolar patients need _________ and _________ interventions to help them learn to cope successfully with a chronic, lifelong illness | education and psychotherapeutic |
| For the majority of patients with bipolar disorder, ______ ________ is the most effective medication | lithium carbonate |
| Lithium Carbonate is useful for reducing | the frequency and severity of recurrent bipolar episodes |
| Electrolyte hypothesis for lithium | Lithium may exert its therapeutic effect by modifying membrane excitability via an ionic mechanism. |
| Biogenic Amine Hypothesis for lithium | Lithium’s actions may be related to its ability to modulate serotonin and/or norepinephrine function |
| Second Messenger System Hypothesis for lithium | Lithium alters the transduction of the neurotransmitter-initiated signal by modifying the function of second messengers. Lithium may reduce the post-synaptic actions of 5-HT and NE on second messenger systems |
| Lithium is a member of the _______ _______ family | alkali metal |
| Lithium is absorbed in the | stomach and intestines |
| Lithium reaches steady state levels in | 6 to 10 days |
| Lithium metabolism | Li+ is not metabolism;izied, it is processed and cleared by the kidneys |
| Lithiums half-life | one day and increase w/ relation to age and renal dysfunction |
| Due to lithiums narrow therapeutic-toxic ration | blood monitoring is required because it is lethal |
| Lithium dosage is adjusted according to | age, renal function, lithium level and clinical response |
| Lithium side effects include | gastrointestinal, CNS, dermatologic , cardiac, and endocrine symptoms |
| Polydipsia | increase thirst/desire for water |
| Polyuria | increased urination |
| weight gain is associated with lithium due to | water retention |
| Overdose symptoms of lithium | flu-like symptoms, muscle twitching, confusion, arrhythmia, CNS effects |
| _____ will increase lithium levels by retaining lithium and eliminating water | diuretics |
| rapid-cycling patients are resistant to the therapeutic effects of what drug | lithium |
| lamictal | lamotrigine |
| Lamictal is good for | depression, mixed biolar, and rapid cycling |
| Lamictal can cause a rare but severe rash | stevens-johnson syndrome |
| Lamictal has ___ side effects than lithium | fewer |
| Side effects of lamictal include | headaches, rash, dizziness |
| Lamictal is an | anticonvulsant |
| lamictal interactions w/ Ethanol | psychomotor impairment, lower seizure threshold, CNS depression |
| Valrelease | Valproic acid |
| Depakote side effects | PCOS and pancreatitis |
| ______ is used to augment lithium for "beak through" manic episodes | depakote |
| Valproic mechanism of action is | unclear seems to involve inhibition of metabolism of GABA, second messenger systems |
| Divalproex Sodium advantages | strong acute efficacy data, good chemical for BP longterm tx, broad activity spectrum, less toxic |
| Disadvantages of divalproex sodium | nausea, weight gain, drowsiness, abdominal pain, GI issues |
| Tegretol is | carbamazepine |
| Tegretol has negative interactions with | Prozac, Luvox, and lithium |
| Carbamazepine requires mandatory | blood count monitoring and periodic liver function tests |
| Tegretol is used for | rapid cycling BD |
| Carbamazepine mechanism of action is | unclear but related to tricyclic antidepressants |
| Carbamazepine's extent and time course of efficacy in reducing manic symptoms is | identical to lithium |
| Neurontin is | gabapentin |
| Neurontin is helpful for | manic states, but may have antidepressant properties |
| Neurontin needs to be taken up to | 4x a day |
| Topiramate is | topamax |
| Topiramate seems to help | regulate mood in those with manic depression |
| Topiramate does not seem to interact negatively with | MAOIs, lithium, Lamictal, or Neurontin |
| Signs of Toxicity or Overdose with Anticonvulsants | CNS, gastrointestinal, and cardiac symptoms |
| Classic antipsychotics are used for | very short-term control of excessive psychotic behaviors |
| Now, atypical antipsychotics used as ______ for episodes of mania or bipolar disorder | monotherapy |
| clozapine | clozaril |
| olanzapine | zyprexa |
| quetiapine | seroquel |
| resperidone | risperdal |
| ziprasidone | Geodon |
| aripiprazole | abilify |
| With all mood stabilizers _______ is a big issue | compliance |
| Components for psychoeducational protocols for BD | Education about BD, Relapse prevention, Medication compliance, Communication skills training |
| Medical disorder types that can cause depression | endocrine, infections, metabolic, thematic, and neurological disorders |
| What is the Most common medical disorders to result in depressive illness | hypothyroidism |
| Drugs that can cause depression | alcohol, anxiolytic drugs (benzos), antiparkinsonism drugs, and hormones |
| 5-HT or 5-hydroxytriptamine is | serotonin |
| Monoamine transporters are neurotransmitter transporters that transfer | monoamine neurotransmitters in or out of cells |
| The monoamine (MA) hypothesis | Depression results from a decrease in monoamines (norepinephrine, serotonin, dopamine) at critical synapses |
| Evidence that the MA or Biogenic Amine Hypothesis is too simple | Affective disorders are too complex, there s a disconnect between pharmacology and therapeutic benefit, lack of correlation between drug potency and effective therapeutic does, and no evidence for amine depletion in depressed individuals. |
| What is the delayed effect problem? | It takes 2-3hours for drugs to exert effects on synapse but take 3-5 weeks for drugs to exert their antidepressant effect |
| SSRI have more of a _____ approach | selective |
| Isozymes are multiple forms of | an enzyme that differ from one another in one or more properties |
| MAO-A is responsible for | red wine and cheese effect |
| The 1st MAOIs were found trying to treat | tuberculosis |
| MAOIs act to block the ______ of monoamines by MAO | metabolism |
| A single dose of MAOIs increase | norepinephrine, epinephrine, dopamine, and serotonin |
| Pharmacokinetcs of MAOIs | oral administration, rapid absorption in GI tract, liver metabolism |
| half life of MAOIs | 2 to 3 hours |
| Nardil is | pheneizine |
| parnate is | tranylcypromine |
| Marplan is | isocarboxazid |
| Deprenyl is | selegiline |
| EMSAM | selgiline transdermal system |
| Side effects of MAOIS | hypertensive crisis, hypotension, weight gain, urinay hesitation, constipation, seizures, insomnia, |
| tricyclics are what generation | 2nd |
| Tricyclics were created as a tx for | psychosis |
| Tricyclics antidepressant action is attributed to | inhibition of neuronal uptake mechanisms |
| In higher doses TCAs block | sodium and calcium pumps |
| Tricyclics are allosteric modulators of | monoamine reuptake transporters |
| TCAs Bind near receptor sights and prevent monoamines | from working how they normally would |
| Tertiary amine tricyclics = | sedating |
| Secondary amine tricyclics = | stimulating |
| tetracyclics are | mixed |
| side effects of TCAs | strong anticholinergic effects, blurred vision, dry mouth, rapid heart rate, sedation, hypotension, etc |
| Tricyclics can only be prescribed | a week at a time or less |
| fluoxetine | prozac |
| sertraline | Zoloft |
| paroxetine | Paxil |
| fluvoxamine | Luvox |
| Citalopram | celexa |
| escitalopram | lexapro |
| Serotonin syndrom symptoms | cognitive (hallucinations, agitation, confusion), autonomic (shivering, sweating, nausea), and somatic (twitch or tremor) |
| SSRI Black Box warning | Rare increase in suicidal ideation & behavior, especially for adolescents & children |
| Common side effects of SSRIs | sexual dysfunction, dry mouth, GI issues, insomnia, anxiety, sweating |
| If a patient fails first SSRI trial; ______ % chanced next rx will work | 30-50% |
| Prozac half life is | 2-3 days |
| bupropion | Wellbutrin |
| Venlafaxine | Effexor |
| Mirtazapine | Remeron |
| duloxetine | Cymbalta |
| desvenlafaxine | Pristiq |
Created by:
taeverly
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