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EPPP Physio pharma 2
Physio pharma Eppp part 2
| Term | Definition |
|---|---|
| Synaptic transmission | The transmission of information between neurons is referred to as ? and is usually chemical. It begins when an action potential reaches the axon terminal |
| Homologous area adaptation | response 2 early damage -particular area of the brain. Fxns of that area shift to the corresponding area in the opp hemisphere. drawback; pre-existing fxns of the corresponding area may be negatively affected. |
| Cross modal reassignment | Ex: neurons in the visual cortex of a child who was born blind do not receive and process visual input. these neurons may receive ,process somatosensory input which, visual input, allows the child to create cognitive representations of physl world. |
| Compensatory masquerade | For instance, when people lose their spatial sense (sense of direction) as the result of a brain injury, they may rely on memorizing landmarks to get from one place to another. |
| Map expansion | involves recruiting neurons from the borders of that region. This type of neuroplasticity often occurs when people are learning and practicing a new skill such as playing a musical instrument. |
| Dopamine links | low level in the substantia nigra has been linked to Parkinson’s disease, an excessive level in the caudate nucleus linked to Tourette’s disorder. Dopamine hypothesis, schizophrenia is due to high levels of dopamine or hyperactivity of dopamine receptors. |
| mesolimbic dopaminergic pathway | begins in ventral tegmental area and ends in the ventral striatum (nucleus accumbens). It’s an essential part of the brain’s “reward circuit”. |
| Mesocortical pathway | begins in the ventral tegmental area and ends in the prefrontal cortex. It’s involved in emotion, motivation, and executive cognitive fxns. |
| Acetylcholine | both excitatory and inhibitory and is involved in movement, arousal, attention, and memory. Movement: causes muscles to contract. |
| Ach links | levels of ? in the entorhinal cortex and hippocampus have been linked to the early memory loss associated w Alzheimer’s disease. |
| Glutamate | is an excitatory neurotransmitter and contributes to movement, emotions, learning, and memory. Excessive ? can cause cell damage and death |
| Glutamate links | believed to contribute to a number of conditions including stroke, seizure disorders, and several neurodegenerative diseases including Huntington’s disease and Alzheimer’s disease. |
| Norepinephrine | is an excitatory neurotransmitter and is involved in arousal, attention, learning, memory, stress, and mood. |
| norepinephrine Links | According to the catecholamine hypothesis, some forms of depression are caused by a deficiency. while mania is due to excessive. |
| Serotonin | an inhibitory effect and plays a role in many functions including arousal, sleep, sexual activity, mood, appetite, and pain. |
| Serotonin links | Low levels of serotonin linked to depression, increased risk for suicide, bulimia nervosa, OCD, migraine headaches. Higher blood levels found in individuals w autism and chronic schizophrenia w/enlarged cerebral ventricle. |
| GABA-mmmASleep areas? | primary inhibitory neurotransmitter and is involved in memory, mood, arousal, sleep, and motor control. |
| GABA links | Low levels linked to insomnia, seizures, and anxiety, and benzodiazepines reduce anxiety and induce sleep by amplifying the effects of GABA. Degeneration of GABA and ACh cells in the basal ganglia contributes to the motor symptoms of Huntington’s. |
| Partial agonist versus inverse agonist | Partial agonists produce effects that are similar to (but weaker than) the effects of a neurotransmitter. Inverse agonists produce effects opposite of the effects of a neurotransmitter or agonist. |
| Antagonist types | direct antagonist binds to and blocks receptors. Preventing a neurotransmitter from attaching to the receptors. An indirect antagonist prevents the production or release of a neurotransmitter by presynaptic cell. |
| Drug facts in America | 1 in 6 adults had filled one or more prescriptions for psychiatric drugs in 2013 l. Largest number prescriptions for antidepressants (12%), anxiolytics, sedatives, and hypnotics (8.3%) and antipsychotics (1.6 percent). |
| First Generation Antipsychotic utility | Treat schizophrenia and other disorders w psychotic symptoms and are more effective for treating pos symptoms than negative symptoms. Exert their therapeutic effects primarily by blocking dopamine (especially D2) receptors. |
| FGA | Traditional and conventional antipsychotics and include chlorpromazine (Thorazine), haloperidol (Haldol), thioridazine (Mellaril), and fluphenazine (Prolixin). |
| FGA side effects -Anticholinergic | side effects are most likely w low potency FGAs (chlorpromazine and thioridazine) and include dry mouth, blurred vision, urinary retention, constipation, and tachycardia. |
| FGA-Side effects-Extrapyramidal side effects | most likely with high-potency FGAs (haloperidol and fluphenazine) and include parkinsonism (resting tremor, muscle rigidity, slowed movement), dystonia (uncontrollable muscle contractions), akathisia (sense of inner restlessness), Tardive dysk. |
| Tardive dyskinesia | potentially life threatening, long-term drug use, more common: women/older adults. invol/ rhythmic movements of the tongue, face, jaw and, over time body. irreversible 4some. treated by gradually withdrawing, administer a benzo, or switch2nd gen antipsy |
| Neuroleptic malignant syndrome (NMS) | rare life-threatening side effect. Its symptoms include muscle rigidity, a high fever, autonomic dysfunction (unstable blood pressure, tachycardia, excess sweating), altered mental state |
| Second Gen antipsychotics | clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and aripiprazole (Abilify). Like the FGAs, can treat schizophrenia and other disorders w/ psychotic sym, some are FDA-approved as an adjunctive treatment for mdd |
| SGA function | These drugs alleviate positive symptoms primarily by blocking dopamine (especially D3 and D4) receptors and alleviate negative and cognitive symptoms primarily by blocking serotonin receptors |
| SGA risks | less likely than the FGAs to cause extrapyramidal side effects; can cause anticholinergic effects, neuroleptic malignant syndrome, and metabolic syndrome (substantial weight gain, high blood pressure, insulin resistance). |
| Agranulocytosis + SGA | clozapine and, to a lesser extent, other SGAs can cause agranulocytosis, which is a potentially life-threatening condition that involves a dangerously low white blood cell count and requires regular white blood cell monitoring. |
| SSRI drugs | include fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), and citalopram (Celexa). The SSRIs are the most frequently prescribed antidepressants and are generally considered to be the first-line |
| SSRI treats | treatment for major depress and persistent depressive disorder. Some are also used to treat other disorders including premenstrual dysphoric disorder, OCD, panic disorder, generalized anxiety disorder, PTSD, bulimia nervosa, and premature ejaculation. |
| SSRI therapeutic mechanism | exert their therapeutic effects primarily by blocking the presynaptic reuptake of serotonin, thereby increasing its availability in synaptic cleft. Because they increase the availability of serotonin. classified as serotonin agonists or indirect agonists |
| SSRI's Advantages | ? are comparable 2 TCAs in terms of efficacy /have several advantages: The SSRIs have fewer side effects, safer in overdose (less cardiotoxic), safer for older adults. |
| SSRI Side effects | mild anticholinergic effects, gastro probs, insomnia, anxiety, sexual dysfunction, |
| SSRI Problems to be aware of | abrupt cessation of an ? can cause discontinuation syndrome: headaches, dizziness, mood lability, impaired concentration, sleep disturb, flu-like symp. combining with an MAOI, lithium, or other serotonergic drug can cause serotonin syndrome, |
| TCA's and SNRI's can be switched from SSRis | as they have lower rates of tachyphylaxis- Poop out/antidepressant tolerance. |
| SSRI Onset | have a delayed onset: Initial therapeutic effects occur by about 2 to 4 weeks, with full effects not being achieved until 6 to 8 weeks |
| SNRI are like SSRI's except | effects on norepinephrine, they can elevate blood pressure and may be contraindicated for patients with hypertension or heart problems. *can cause discontinuation syndrome when abruptly stopped, serotonin syndrome when combined w/ other 5ht drugs. * |
| NDRIs | ? include bupropion (Wellbutrin, Zyban), used to treat MDD and assist w/ smoking cessation and therapeutic mechanism is inhibiting the reuptake of norepinephrine and dopamine at synapses |
| Advantages of bupropion (NDRI) | few anticholinergic effects, does not cause sexual dysfunction, is not cardiotoxic. *increase levels of norepinephrine and dopamine have an energizing effect, useful for patients who have low energy/ motivation but not for ppl w insomnia/ very anxious. |
| The TCAs | tertiary amines include amitriptyline (Elavil), imipramine (Tofranil), clomipramine (Anafranil), and doxepin (Sinequan) mechanism is inhibiting the reuptake of both serotonin and norepinephrine, with some having a stronger effect on serotonin. |
| TCA second amine | Secondary amines include nortriptyline (Pamelor) and desipramine (Norpramin) and are more potent at inhibiting the reuptake of norepinephrine than serotonin |
| TCAs treatment use | are used to treat major depressive disorder, panic disorder, obsessive-compulsive disorder (especially clomipramine), and neuropathic pain (especially nortriptyline and amitriptyline). |
| The side effects of the TCAs | cardiovascular effects (hypertension, tachycardia, ortho hypotension), anticholinergic effects, sedation, weight gain, sexual dysfunction. The secondary amines have fewer side effects (less likely to cause sedation and anticholinergic effects). |
| Warning with prescribing TCA's | Because the ? are cardiotoxic and lethal in overdose, they must be prescribed with caution for patients who have heart disease or are suicidal. |
| MAOI options and use tx | include phenelzine (Nardil), isocarboxazid (Marplan), and tranylcypromine (Parnate). useful for patients with treatment-resistant dep or atypical depression, which involves reversed vegetative symp-hypersomnia, increased appetite, a reactive dysphoria |
| MAOI Mechanism | The enzyme monoamine oxidase deactivates norepinephrine, serotonin, and dopamine, and they increase the levels of these neurotransmitters by inhibiting the activity of this enzyme. |
| MAOI warning | may also produce a hypertensive crisis when taken in conjunction with certain drugs (e.g., amphetamines, antihistamines) or food containing tyramine (e.g., aged cheese and meat, soy products, beer |
| MAOI Side effects | Side effects include anticholinergic effects, orthostatic hypotension, sedation, and sexual dysfunction. Don't eat ripe bananas-Tyramine |
| The benzodiazepines | include diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan). These drugs increase GABA activity and are used to treat anxiety, insomnia, seizures, and alcohol withdrawal. |
| Benzo side effects | side effects are drowsiness and sedation; others include weakness, unsteadiness, impaired memory/concentration, anticholinergic effects, sexual dysfu. in older adults, disorientation and confusion. These drugs canb paradoxical effect =excitability/anxiety |
| Benzo general warning | chronic use can result in tolerance, dependence, and withdrawal sympt, may cause rebound anxiety and depression, anorexia, delirium, and seizures. Discontinuation following long-term use requires gradual tapering 2 prevent sym reemergence withdrawal symp. |
| Benzo danger warning | combining with alcohol can have a synergistic depressant effect that can be lethal, and combining it with certain high blood pressure medications (e.g., central agonists, alpha blockers) can cause a dangerous drop in blood pressure. |
| Barbituates | thiopental (Pentothal), amobarbital (Amytal), and secobarbital (Seconal). enhance GABA activity, used as a general anesthetic and treatment for anxiety, insomnia, and seizures. |
| Barbituates | Side effects drowsiness, dizziness, confusion, ataxia, cognitive impairment, and paradox excitement. Chronic use= tolerance, dependence, withdrawal sym, sudden withdrawal can cause seizures, delirium, death. Like benzos, taking w/ alcohol can be lethal. |
| Azapriones | include buspirone (BuSpar), used to treat generalized anxiety disorder/other anxiety disorders. Side effects include dizziness, dry mouth, sweating, nausea, and headache. An advantage = it does not cause sedation, dependence, or tolerance. |
| Opioids-Narcotic analgesics | mimic the body’s natural analgesics (endorphins and enkephalins) and include the natural opioids (opium, morphine, heroin, codeine) and synthetic and semi-synthetic opioids (methadone, oxycodone, hydrocodone, fentanyl). |
| Opioids-Narcotic analgesics use | Narcotic-analgesics are used as a pre-surgery anesthetic and to treat pain, and methadone is used for heroin detoxification.Methadone doesn’t produce the pleasurable effects of heroin, but it does reduce the craving for heroin and withdrawal symptoms. |
| Opioids-Narcotic analgesics side effects/warnings | Side effects =dry mouth, nausea, pupil constriction, postural hypotension, drowsiness, dizziness, constipation, respiratory depres, overdose can cause convulsions, coma, and death. Chronic use leads to dependence, tolerance, and withdrawal symptoms. |
| Opioid narc withdrawal | Initial withdrawal symptoms are similar to the flu (e.g., runny nose, watery eyes, nausea, muscle aches, fever, and yawning); these are followed by insomnia, abdominal cramps, vomiting, diarrhea, rapid heartbeat, and elevated blood pressure. |
| drug overdose | is the leading cause of accidental deaths in the United States, with opioids being the most frequent cause of these deaths |
| Beta Blockers mechanism/use | inhibit the activity of the sympathetic nervous system and are used to treat hypertension, cardiac arrhythmias, migraine headache, and essential tremor. |
| Beta Blockers in Mental Health | These drugs include propranolol (Inderal) which is also used to treat anxiety, with research suggesting that it’s more effective for alleviating the somatic symptoms of anxiety than its psychological symptoms (e.g., apprehension, worry, dread). |
| The side effects of propranolol | include hypotension, decreased sex drive, insomnia, nausea and vomiting, dry eyes, dizziness, and depression. Abrupt discontinuation is contraindicated because it can cause rebound hypertension, tremors, headaches, confusion, and cardiac arrhythmia. |
| Lithium toxicity | can cause seizures, coma, and death.first-line drug for acute mania and classic bipolar disorder (euphoric mania without rapid cycling). Levels must b checked |
| Anticonvulsant drugs | used to treat acute mania and bipolar disorder with mixed episodes and include carbamazepine (Tegretol) and valproic acid (Depakene). |
| Lithium side effects | Common side effects include nausea, vomiting, diarrhea, a *metallic taste, *increased thirst, weight gain, hand tremor, fatigue, and impaired memory and concentration |
| Anticonvulsant side effects | Side effects include nausea, dizziness, sleepiness, lethargy, ataxia, tremor, *visual disturbances, and impaired concentration. |
| Anticonvulsant monitoring warning | Blood levels must be monitored to avoid liver failure when taking valproic acid or carbamazepine and to avoid agranulocytosis (low white blood cell count) and aplastic anemia when taking carbamazepine. |
| Alzheimer’s treatment | The cholinesterase inhibitors delay the breakdown of acetylcholine and include tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). All four have been approved for mild and moderate Alzheimer’s disease |
| Moderate to severe Alzheimer’s treatment | donepezil approved for severe Alzheimer’s disease.NMDA receptor antagonist memantine (Namenda) has been approved for moderate to severe Alzheimer’s disease and is believed to exert its effects by regulating the activity of glutamate. |
| Psychostimulants | Psychostimulants are the first-line pharmacological treatment for ADHD and include methylphenidate (Ritalin, Concerta), pemoline (Cylert), and amphetamine-dextroamphetamine (Adderall). |
| ADHD meds for kids | Common side effects are insomnia, nervousness, decreased appetite, weight loss, and abdominal pain. These drugs can also suppress growth in children, but this can be reversed with “drug holidays” |
| ADHD medication abuse research | there’s evidence that these drugs increase attention and positive mood but do not improve reading comprehension and fluency and may have negative effects on working memory and academic performance |
| Atomoxetine | is a norepinephrine reuptake inhibitor and is the most commonly prescribed nonstimulant drug for ADHD. It has been found to improve the core symptoms of ADHD and to be more effective than stimulants for patients with certain comorbidities |
| Alcohol use disorder drug treatment | Disulfiram causes nausea ,vomiting, shortness of breath, tachycardia, a throbbing headache, dizziness, unpleasant symptoms when taken in w/alcohol. Naltrexone reduces the pleasurable effects /craving for alcohol, while acamprosate just reduces craving. |
| Tobacco drug treatment | Bupropion also been found to prevent relapse following smoking cessation by reducing nicotine craving and withdrawal symptoms. Varenicline reduces nicotine craving, and there’s evidence that it also reduces the rewarding effects of smoking |
| THC | exerts its psychoactive effects by stimulating the release of dopamine in the ventral striatum (nucleus accumbens), which is an essential component of the brain’s mesolimbic dopaminergic reward pathway |
| THC use | Dronabinal oral solution (Syndros) contains THC - approved by the U.S. FDA for treatment of anorexia ,weight loss for patients wAIDS ,chemotherapy-induced nausea and vomiting for patients with cancer who have not responded to other antiemetic treatments. |
| Drug half life | The half-life of a drug is the time needed for the blood level of the drug to decrease to 50% of its peak level. It’s used to determine the time interval between doses: For drugs with a short half-life, the interval between doses is short, and vice versa. |
| Half life and age | anxiolytics, antipsychotics, antidepressants, and many other drugs have a longer half-life for older (versus younger) adults due to age-related changes in the metabolism and elimination of these drugs. |
| Start low/slow half life rule | Because of the increased half-life of many drugs for older adults and their greater sensitivity to the effects of these drugs, the rule of thumb when prescribing them for these individuals is to “start low and go slow” |
| Cross tolerance | occurs when tolerance to 1 drug produces tolerance to other drugs in same class. Ex-alcohol is a cns depressant, and tolerance to alcohol produces tolerance to benzodiazepines and barbiturates, which are also central nervous system depressants. |
| Therapeutic index details | A drug with a low LD50 is more lethal than a drug with a high LD50. ED50 (effective dose 50) is a measure of the drug’s effectiveness and indicates the minimum drug dose that produced the therapeutic (desired) effect in 50% of the test sample |
| Calculate therapeutic dose | human studies, the most common way to calculate TI is to divide TD50 by ED50 (TD50/ED50): TD50 (toxic dose 50) indicates the minimum drug dose that had a toxic (harmful) effect in 50% of the test sample and ED50 is the same as it is for animal studies |
| Narrow therapeutic window (not safe) | When a drug’s ED50 is the same as or higher than its LD50 or TD50, TI equals 1.0 or less, and the drug is said to have a narrow therapeutic window. Drugs with a narrow therapeutic window are not very safe and require close monitoring |
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