Psych medication
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| cerebrum | responsible for mental activities, sense of being, perception of external world, emotional status, memory, control of skeletal muscles, language and communication
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| frontal lobe | 4 subdivisions. the motor strip, motor area, broca's area, prefrontal cortex
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| 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
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| parietal lobe | contain primary sensory area for touch, pressure, pain, and temp, also involved in attention, spatial orientation, and language development.
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| decision making | both frontal and parietal lobes are important for good decision making
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| occipital lobe | primarily responsible for visual reception, help recognize shapes and colors.
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| temporal lobe | primarily concerned w/ sensory experiences, also in memory processing and emotion. includes hippocampus
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| hippocampus | in medial temporal lobe, interacts w/ prefrontal areas in memory and learning.
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| hippocampus fails to adequately develop | schizophrenia
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| atrophies of hippocampus | occurs from recurrent unipolar or bipolar disorder, severe stress disorder, PTSD, also damages by toxicity of alcohol addiction or alzheimers dementia
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| amygdala | in temporal lobe, plays major role in memory and in processing fear and anxiety.
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| limbic system | "emotional brain", include amygdala, hippocampus, hypothalamus, and thalamus. include 4 f's, fighting, fleeing, feeding, and f'ing
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| 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.
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| hypothalamus | maintains homeostasis. regulates temp, bp, perspiration, sex drive, hunger, thirst, sleep cycles. direct secretions of hormones.
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| brainstem | controls vital life functions. made up of midbrain, pons, and medulla. RAS, cycles of wake and sleep.
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| cerebellum | primarily involved in balance and smooth muscle movement
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| neuroimaging | measure structure, function, and brain chemistry. use CT, MRI, fMRI, PET, SPECT
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| CT scan | series of x-rays to view brain structure
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| MRI | use strong magnetic field and radio waves distinguishing gray and white matter better than CT
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| fMRI | shows brain function w/out contrast injections or invasive tests.
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| PET, SPECt | radioactive material to asses regional brain glucose metabolism and to secure images of brain function
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| 4 major groups of neurotransmitters | monoamines, amino acids, peptides, and cholinergics
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| monoamines | dopamine, norepinepherine, serotonin, histamine
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| amino acids | GABA, glutamine
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| cholinergics | acetylcholine (ACh)
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| peptides | substance P, somatostatin, neurotensin
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| dopamine functions | fine motor movement, integration of emotions and thoughts, decision making, stimulate hypothalamus to release hormones (sex,thyroid,adrenal)
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| dopamine increase/decrease | increase-schizophrenia, mania
decrease-parkinsons, depression
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| norepinepherine functions | mood, attention and arousal, stimulate flight or fight response
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| norepinepherine increase/decrease | I-mania, anxiety, schizophrenia
D-depression
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| serotonin functions | mood, sleep reg, hunger, pain perception, aggression, hormonal activity
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| serotonin increase/decrease | I-anxiety
D-depression
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| histamine functions | alertness, inflammatory response, stimulate gastric secretions
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| histamine increase/decrease | I-hyperactivity, compulsivity, suicidal depression
D-sedation, wt gain, hypotension
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| GABA function | reduces anxiety, excitation, aggression, pain perception, anticonvulsant, and muscle relaxing properties
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| GABA incease/decrease | I-reduction of anxiety
D-mania, anxiety, schizophrenia
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| glutamine functions | AMPA plays a role in learning and memory
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| glutamine NMDA increase/decrease | I-toxic to neurons
D-psychosis
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| acetylcholine function | learning, memory, regulates mood (mania, sexual aggression), affects sexual and aggressive behavior, stimulate parasympathetic nervous system
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| acetylcholine inscrease/decrease | I-depression
D-alzheimers, huntingtons, parkinsons
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| substance P functions | regulation of mood and anxiety, role in pain management,
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| somatostatin functions | altered levels associated with cognitive disease
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| somatostatin increase/decrease | I-huntingtons chorea
D-alzheimers, depression
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| neurotensin function | endogenous antipsychotic-like properties
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| neurotensin inscrease/decrease | I-huntingtons chorea
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| how psychotropics work | produce effects through alteration of synaptic concentration of neurotransmitters. either antagonist or agonist effect
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| antipsychotic drugs | standard (thorazine, prolixin, stelazine, navane, hadol)and atypical (clozapine, risperdal, geodon, abilify, seroquel)
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| standard antipsychotics | tranq or neuroleptics,used to tx aggressive behavior&thought disorders, dopamine receptor antagonist(DRA), 1st generation only relieve positive symptoms
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| 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 $$$)
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| 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
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| common SE of antipsychotics | sedation, blurred vision, constipation, urinary retention, photosensitivity, extrapyramidal symptoms, neuroleptic malignant syndrome(NMS), tardive dyskinsia
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| extrapyramidal side effects | dystonia, akinesia, akathisia, tardive dyskinesia, pseudoparkinsonism
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| dystonia | muscle stiffness, involuntary muscle movement of face, arms, and legs, cogwheeling, eye rolling(oculogyric crisis)
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| akinesia | muscle weakness
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| akathisia | continuous restlessness and fidgeting, pacing, agitation
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| tardive dyskinesia | long term disorder resulting in involuntary, repetitive body movements
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| neuroleptic malignant syndrome | life threatening complications involving autonomic, motor, and behavioral symptoms
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| cause of extrapyramidal symptoms | dopamine plays a major role in basal ganglia to regulate movement and dopamine is blocked with antipsychotics causing SE
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| 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
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| mood stabilizers | for manics- bipolar, schizo. lithium carbonate and anticonvulsants used to treat
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| 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
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| lithium SE | dry mouth, Gi upset, tremors, pulse irregularities, polyuria, wt gain
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| 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
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| anticonvulsants | klonopin, tegretol, depakote, neurontin,topomax,trileptal, lamictal. unsure how it works in mania to stabilize moods
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| antidepressants | increase norepinepherine and serotonin, used in mood disorders in which depression is a symptom. takes 3-4wks to work,
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| antidepressant SE | anticholinergic, sedation, orthostatic hypotension, hypertensive crisis w/ MAO's
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| types of antidepressants | SSRI, MAO, MAOI's, SNRI, atypical antidepressants, TCA's
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| SSRI | prozac,celexa,zoloft,paxil,laxepro. block serotonin transport into presynaptic neurons, increase conc. of synaptic serotonin
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| SSRI SE | H/A, insomnia, sexual dysfunction, anxiety, Gi disturbance
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| SNRI | serotonin norepinepherine reuptake inhibitor
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| atypical antidepressants | wellbutrin,remeron,effexor,cymbalta, serzone,desyrel.
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| 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.
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| TCA caution | increased rate of death w/ overdose (liver failure, brain death), compliance decrease r/t wt gain
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| monoamine oxidase (MAO) | an enzyme that destroys monoamines
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| action of monoamine oxidase inhibitor (MAOIs) | drugs that prevent the destruction of monoamines by inhibiting the action of MAO.
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| MAOI medications | marplan, nardil, parnate, emsam(patch)
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| 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
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| HTN crisis | caused by ingestion of foods w/ tyramine or concurrent use of tricyclics
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| 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
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| Antianxiety meds | benzodiazepines, antihistamines, antidepressants(short term), miscellaneous, minor tranquilizers, beta blockers
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| benzodiazepines | high risk for dependence, include xanax, ativan, librium, valium, klonopin, serax
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| 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
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| 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
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| 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.
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| 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
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| 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
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