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Psych medication

cerebrum responsible for mental activities, sense of being, perception of external world, emotional status, memory, control of skeletal muscles, language and communication
frontal lobe 4 subdivisions. the motor strip, motor area, broca's area, prefrontal cortex
prefrontal cortex (PFC) connected to all other brain regions to execute goal-directed activity. when impaired by disorder there is decrease in executive function, attention, impulse control, socialization, regulations of drives, and emotions
parietal lobe contain primary sensory area for touch, pressure, pain, and temp, also involved in attention, spatial orientation, and language development.
decision making both frontal and parietal lobes are important for good decision making
occipital lobe primarily responsible for visual reception, help recognize shapes and colors.
temporal lobe primarily concerned w/ sensory experiences, also in memory processing and emotion. includes hippocampus
hippocampus in medial temporal lobe, interacts w/ prefrontal areas in memory and learning.
hippocampus fails to adequately develop schizophrenia
atrophies of hippocampus occurs from recurrent unipolar or bipolar disorder, severe stress disorder, PTSD, also damages by toxicity of alcohol addiction or alzheimers dementia
amygdala in temporal lobe, plays major role in memory and in processing fear and anxiety.
limbic system "emotional brain", include amygdala, hippocampus, hypothalamus, and thalamus. include 4 f's, fighting, fleeing, feeding, and f'ing
thalamus major sensory relay station to the cortex, abnormalities and changes in gray matter bridge connecting the two thalamic lobes are thought to be patho of schizophrenia.
hypothalamus maintains homeostasis. regulates temp, bp, perspiration, sex drive, hunger, thirst, sleep cycles. direct secretions of hormones.
brainstem controls vital life functions. made up of midbrain, pons, and medulla. RAS, cycles of wake and sleep.
cerebellum primarily involved in balance and smooth muscle movement
neuroimaging measure structure, function, and brain chemistry. use CT, MRI, fMRI, PET, SPECT
CT scan series of x-rays to view brain structure
MRI use strong magnetic field and radio waves distinguishing gray and white matter better than CT
fMRI shows brain function w/out contrast injections or invasive tests.
PET, SPECt radioactive material to asses regional brain glucose metabolism and to secure images of brain function
4 major groups of neurotransmitters monoamines, amino acids, peptides, and cholinergics
monoamines dopamine, norepinepherine, serotonin, histamine
amino acids GABA, glutamine
cholinergics acetylcholine (ACh)
peptides substance P, somatostatin, neurotensin
dopamine functions fine motor movement, integration of emotions and thoughts, decision making, stimulate hypothalamus to release hormones (sex,thyroid,adrenal)
dopamine increase/decrease increase-schizophrenia, mania decrease-parkinsons, depression
norepinepherine functions mood, attention and arousal, stimulate flight or fight response
norepinepherine increase/decrease I-mania, anxiety, schizophrenia D-depression
serotonin functions mood, sleep reg, hunger, pain perception, aggression, hormonal activity
serotonin increase/decrease I-anxiety D-depression
histamine functions alertness, inflammatory response, stimulate gastric secretions
histamine increase/decrease I-hyperactivity, compulsivity, suicidal depression D-sedation, wt gain, hypotension
GABA function reduces anxiety, excitation, aggression, pain perception, anticonvulsant, and muscle relaxing properties
GABA incease/decrease I-reduction of anxiety D-mania, anxiety, schizophrenia
glutamine functions AMPA plays a role in learning and memory
glutamine NMDA increase/decrease I-toxic to neurons D-psychosis
acetylcholine function learning, memory, regulates mood (mania, sexual aggression), affects sexual and aggressive behavior, stimulate parasympathetic nervous system
acetylcholine inscrease/decrease I-depression D-alzheimers, huntingtons, parkinsons
substance P functions regulation of mood and anxiety, role in pain management,
somatostatin functions altered levels associated with cognitive disease
somatostatin increase/decrease I-huntingtons chorea D-alzheimers, depression
neurotensin function endogenous antipsychotic-like properties
neurotensin inscrease/decrease I-huntingtons chorea
how psychotropics work produce effects through alteration of synaptic concentration of neurotransmitters. either antagonist or agonist effect
antipsychotic drugs standard (thorazine, prolixin, stelazine, navane, hadol)and atypical (clozapine, risperdal, geodon, abilify, seroquel)
standard antipsychotics tranq or neuroleptics,used to tx aggressive behavior&thought disorders, dopamine receptor antagonist(DRA), 1st generation only relieve positive symptoms
atypical antipsychotic serotonin-dopamine antagonists (SDAs), different receptor-binding profile=less motor SE & target neg and pos symptoms of schizo. may improve cognitive function (good, less SE, but $$$)
clozapine(clozaril) weaker block of D2=less extrapyramidal SE, for severely ill schizo. not used first due to poss. suppression of bone marrow (agranulocytosis), WBC orderd weekly
common SE of antipsychotics sedation, blurred vision, constipation, urinary retention, photosensitivity, extrapyramidal symptoms, neuroleptic malignant syndrome(NMS), tardive dyskinsia
extrapyramidal side effects dystonia, akinesia, akathisia, tardive dyskinesia, pseudoparkinsonism
dystonia muscle stiffness, involuntary muscle movement of face, arms, and legs, cogwheeling, eye rolling(oculogyric crisis)
akinesia muscle weakness
akathisia continuous restlessness and fidgeting, pacing, agitation
tardive dyskinesia long term disorder resulting in involuntary, repetitive body movements
neuroleptic malignant syndrome life threatening complications involving autonomic, motor, and behavioral symptoms
cause of extrapyramidal symptoms dopamine plays a major role in basal ganglia to regulate movement and dopamine is blocked with antipsychotics causing SE
antipsychotic long acting preparations haldol, prolixin, resperidal, good for people who cheek and compliance problems, increase compliance because IM q2-4wks. thick suspension(Ztrack) 18-20g to wdraw 1.5-2in needle-hard to push
mood stabilizers for manics- bipolar, schizo. lithium carbonate and anticonvulsants used to treat
lithium carbonate LiCO3,eskalith,lithobid. prevention and tx of manic episodes, decrease levels of serotonin and norepinepherine, narrow window, monitor blood lithium on regular basis
lithium SE dry mouth, Gi upset, tremors, pulse irregularities, polyuria, wt gain
lithium toxicity 0.6-1.2mEq/L(keep @ 1), above 1.5toxic, levels drawn 1-2X/wk until stable then monthly, draw 12h q last dose, levels can be WNL but may be toxic, mantain nl na and fluid intake, lithium I as sodium D
anticonvulsants klonopin, tegretol, depakote, neurontin,topomax,trileptal, lamictal. unsure how it works in mania to stabilize moods
antidepressants increase norepinepherine and serotonin, used in mood disorders in which depression is a symptom. takes 3-4wks to work,
antidepressant SE anticholinergic, sedation, orthostatic hypotension, hypertensive crisis w/ MAO's
types of antidepressants SSRI, MAO, MAOI's, SNRI, atypical antidepressants, TCA's
SSRI prozac,celexa,zoloft,paxil,laxepro. block serotonin transport into presynaptic neurons, increase conc. of synaptic serotonin
SSRI SE H/A, insomnia, sexual dysfunction, anxiety, Gi disturbance
SNRI serotonin norepinepherine reuptake inhibitor
atypical antidepressants wellbutrin,remeron,effexor,cymbalta, serzone,desyrel.
Tricyclic Antidepressants (TCAs) elavil,ascendin,sinequan,pamelor.tx dysthemia(more than 6months), elevates mood & eases symptoms assoc. w/ severe depression, may also be used for chronic pain.
TCA caution increased rate of death w/ overdose (liver failure, brain death), compliance decrease r/t wt gain
monoamine oxidase (MAO) an enzyme that destroys monoamines
action of monoamine oxidase inhibitor (MAOIs) drugs that prevent the destruction of monoamines by inhibiting the action of MAO.
MAOI medications marplan, nardil, parnate, emsam(patch)
MAOI caution does not mix with many drugs, fatal adverse reactions esp. w/ narcotics, 2 week window, causes high increase of BP(die of cerebral hemorrhage), htn crisis
HTN crisis caused by ingestion of foods w/ tyramine or concurrent use of tricyclics
foods high in tyramine (cannot eat with MAOIs) aged cheese, CNS stimulants, decongestants, red beans, smoked fish and meats, antiparkinsons meds, raisins, figs, pickled foods, fava beans, yeast extract, beer
Antianxiety meds benzodiazepines, antihistamines, antidepressants(short term), miscellaneous, minor tranquilizers, beta blockers
benzodiazepines high risk for dependence, include xanax, ativan, librium, valium, klonopin, serax
benzodiazepines cautions minimal risk of overdose if used alone but can be lethal combined w/ alcohol(slows everything), if d/c abruptly cause w/draw symptoms, w/draw from large dose=seizures
minor tranquelizers not to be used for everyday stress, only to be used for severe or panic level anxiety. action=CNS depression, SE=drowsy, confusion
antihistamines (helps w/ sleeping) hydroxyzine, diphenhydramine(oral & IM),no cause of dependence or abuse, minimally toxic and safe lt use, less effective than benzos, cause drowsiness, may have after taste.
BuSpar less sedation than benzos, no dependence, take 3-4wks to work, not effective in panic disorder, does not interfere w/ CNS depressants, less OD problems
Beta-adrenergic blocker primarily cardiac med, blocks effect of ANS=relief of physical symptoms= decrease HR and panic, risk for hypotension and bradycardia, blocks where adrenaline touches body
Created by: gudknecht