all notse Flashcards
1
Q
mitrazapine what class of drug?
A
NASSA
2
Q
side effect of this drug?
A
weight gain
3
Q
what does it prevent reuptake of?
A
5HT, NA (5N taru mitra) - varyingly inhibit
4
Q
what class of drug is clomipramine?
A
TCA
5
Q
what peptide transmitters are involved in aversive defensive systems?
A
NA/CRF
6
Q
hippocampus - approach or defensive?
A
defensive
7
Q
biosynthesis of serotonin?
A
try 5 - tryptophan -> 5 hydroxytryptophan -> serotonin
8
Q
5HT2 receptors - where are they found?
A
everywhere basically
9
Q
5HT1 ?
A
blood vessels/CNS - (a-f) alan
10
Q
receptor effect of 5HT1?
A
inhibitory
11
Q
effect of 5HT2?
A
excitory
12
Q
an agonist of 5HT2?
A
LSD
13
Q
Some biological functions of 5HT?
A
cooker - mood, apetite, sleep, anxiety, aggression, memory, learning, addiction
14
Q
what can SSRIs be used to treat?
A
panic attacks, OCD, eating disorders, premature ejaculation, PTSD, chronic pain (knee), social anxiety disorder, DEPRESSION
15
Q
how long does it take to increase synaptic 5HT?
A
hours
16
Q
how long does it take to imove mood?
A
2-3 weeks
17
Q
what does the increased concentration of extracellular 5HT stimulate?
A
5HT1a autoreceptors to inhibit firing
18
Q
when do you get return to norma firing?
A
in chronic treatment
19
Q
what sort of dose can you start an SSRI at?
A
ev therapeutic dose
20
Q
side effects?
A
anxiety, sexual dysfunction, increased risk of suicude initial with young patients, dyspepsia, vomiting, diarrhoea, constipation.
21
Q
which SSRIS inhibit CYP450?
A
fluoxetine and paroxetine
22
Q
what drugs do SSRIs therefore have an interaction with>
A
drugs metabolised via the same pathway i.e. CYP450 pathway
23
Q
sexual dysfunction in pathophysioogy?
A
can be dopamine blockade and/or 5HT2 activation
24
Q
how can this be reversed?
A
5HT2 antagonists or 5HT1a partial agonists
25
TCA - block reptake of?
5HT and NA
26
titration?
require a bit more individualised dose titration
27
at higher doses, patients might need ECGs, what could be seen on ECG?
QT prolongation
28
adverse effects?
constipation, dry mouth, blurred vision, effects on cardiac function, postural hypotension.
29
CHAD. what does cholinergic and adrenergic blockade cause failure of?
peripheral orthostatic reflex
30
3 MAOIs?
Phenelzine, isocaroxazid, tranylcypromide
31
what does mono oxidase A metabolise?
5HT, NA, tyramine
32
MAO B, what does it metabolise?
DA, tyramine, phenylethylamine
33
which drug causes sympathy mimetic effects?
tranylcypromide
34
what are MAOIs used to treat?
atypical depression
35
what does MAO do in the gut?
inactivates tyrosine
36
how do patients on MAO inhbitors get hypertensive crisis ?
tyramine (in food like cheese) cause more NA to be released. under normal circumstances it would be broken down by MAO. increased levels of NA caused constriction of blood vessels
37
foods that contain tyrosine?
cheese, yoghurt, yeast extracts, broad beans, pickled herring, alcohol
38
can also cause high serotonin. symtptoms of high serotoin?
flushed, headache, increased BP
39
treatment? up hill ruri
chlorpremazine and phentolamine (prem, ph a)
40
what is akathisia?
inner restlesness
41
tremor, dystonia, akathisia and TD can occur which which anti depressant?
paroxetine
42
which hormone plays a key role in reward and motivation
dopamine
43
what is the main inhibitory neurone in developing brain
GABA
44
GABA actions in developing brain?
excitatory
45
GABA binding causes flow of which ions into post synaptic cell?
chlorine
46
do you get hyperpolarisation/depolarisation?
hyperpolarisation (cl-)
47
which ions flow into post synaptic cell from glutamate?
ca 2 +, causing depolarisation
48
two receptors that glutamate bind to?
NMDA and AMPA
49
which is faster?
AMPA
50
which one lets calcium through?
NMDA
51
GABA binding allows flow of either cl ions in to the cell or K ions out of the cell
yeah
52
antagonist of GABAa receptor?
flumazenil
53
agonists?
benzos, anaesthetics, ethanol, propofol
54
****GABA B agonists (GEE PROTEIN)
me and my back pack going to the show (baclofen, propofol)
55
Mood stabilisers? anti convulsants?
lamotrigine, valproate, carbamazepine
56
are they more effective at reducing manic episodes or depressive episodes?
manic
57
would you rather have type 1 BP or type 2?
type 1
58
ATYPICAL MOOD STABILISERS?
olanzepine, risperidone, quetiapine, ariprazole
59
other mood stabilisers?
lithium carbonate and nimodipine
60
what does lamotrigine do? Drug action)
blocks sodium channels
61
what overall effect does this have?
reduces cell firing
62
what also inhibit uptake of?___________
serotonin (MM)
63
Lithium. what does it do to BCL2? to 5HT auto receptors? inositol? GSK3?
increases apoptotic factor for BCL2, inhibition of 5HT autorecetors, depletion of inositol, inhibition GSK 3
64
what do you get in lithium overdose?
toxicity
65
there is a risk of inadvertent toxicity
y
66
what does lithium treatment require?
blood monitoring
67
anti psychotics show affinity for which receptor?
D2
68
in which circuit?
mesolimbic
69
movement disorders due to DA blockade in which pathway>
nigrostratial
70
hyperprolactinaemia?
tubero inffandibular
71
which part of the brain (in approach system) is involved in relative reward preference and rule learning?
OFC
72
periaqueductal grey matter - in approach or defence?
defence
73
average onset depression? bipolar?
27, 21
74
male to female ration depression, bipolar?
depression f2:1m , bipolar 1:1
75
in major depression what happens to cortisol?
increased
76
how would you test for this clinically?
increased cortisol in urine, saliva
77
what would the adrenal glands look like?
enlarged
78
in depression, TRH levels? TSH levels?
TRH up, TSH (pituitary) blunted
79
6 key regions implicated in mood disorders
orbital frontal cortex, hippocampus, ventromedial and prefrontal cortex, anterior cingulate nucleus, amygdala, DorsoLateral prefrontal cortex. down low
80
dense coactivation with AIC and ACC during almost all studies of emotion
y
81
there is dense connectivity with the anterior insular cortex and what?
anterior cingulate cortex
82
DO NOT use anti depressants to treat persistant sub threshold depressive symptoms or mild depression - risk benefit ratio is poor.
y
83
when do you consider anti depressants?
past history of moderate/severe depression, initial presentation of sub threshold depressive symptoms that have been present for a long period i.e. 2 years. also for sub threshold or mild depression that persists after other interventions
84
what is the typical treatment started for moderate or severe depression (top of page (yellow and red)
combination of anti depressant and high intensity pharmacological intervention
85
rules from isolated incidents that apply in all cases?
pat dog bite - overgeneralising
86
dichotomous thinking?
all or nothing or black and white thinking
87
what is the term for focusing on one negative detail and this colours entire experience?
selective abstraction
88
Personalisation?
relate external events to self without cause
89
Minimisation/magnification
over estimating/underestimating magnitude of undesirable events
90
drawing a conclusion in context of no evidence or contrary evidence
arbitrary evidence
91
what is emotional reasoning?
i feel bad/guilty, therefore i am bad/have something to feel guilty about
92
anorexia - BMI?
less than 17.5
93
how do people with anorexia lose weight?
strict dieting/vomiting/excessive exercise/medication
94
amenorrhoea
y
95
starvation effects on the brain?
loss of grey and white matter, increased compulsive behaviour, decreased social skills, poor concentration and new learning stunted, enhanced response to hedonic and neurostat signals
96
Investigations in anorexia?
haeatology/biochemistry/ecg/dxa
97
people with anorexia can be more at risk of?
heart disease
98
what heart problem can be picked up on egg?
long qt syndrome
99
what is the name of the scheme to manage patients with anorexia?
MARSIPAN
100
high risk AN?
13-14.9
101
v high risk?
less than 13
102
moderate
15-16
103
age of onset ?
9-24 years
104
moratlity rate?
20 percent - up to half are suicides
105
aetiology? biological
puberty, weght loss, starvation effects
106
physiological? (3)
brain atrophy, reduced attention and memory, hypothalamus dysfunction
107
physiological? (4)
low self esteem, childhood sexual abuse, perfectionist, adolescence, black and white thikning
108
renal complications of anorexia?
nocturia, acute or chronic renal failure, increased thirst (polydipsia)
109
physical signs?
lanugo hair, dry skin, bruising, hair loss, muscle wasting,
110
blood pressure and heart rate?
LOW and SLOW - bradycardia, low blood pressure
111
Metabolic complications? blood sugar, temp, hydration status, LFTs? electrolytes?
hypoglycaemic, hypothermia, dehydrated, raised LFTs, low K, PO4, Mg, Ca
112
Haematological?
anaemic (low b12, iron and foalate), low WBC, thrombocytopenia (low platelet)
113
cortisol, TOG, thyroxin?
increased cortisol, decreased test, oest, gonadotrophin), decreased thyroxin
114
co morbidities of AN? dance floor ***
DODS, diabetes, depression, OCD and Substance misuse
115
what happens to the muscles and bones in anorexia?
muscle cramps, tetany, spasm, ospeoperosis and possible fractures
116
Risk assessment - bad signs
BMI less than 13 with weight loss of over 1kg per week, prolonged QT, heart rate less than 40, SBP less than 80, core temp less than 34, unable to rise from squat position without using arms or legs, cognitive impairment
117
refeeding syndrome is caused by?
Depletion of MPP. magnesium, phosphate and potassium.. already inadequate stores are used up as body starts to repair itself.
118
GI side effects?
swollen salivary glands, dental caries, delayed gastric emptying, bloating and constipation
119
Bullemia - 4 criteria? jamie 3 and attempts
persistant pre occupation with eating, irreversible craving for food, binges then attempt to counter the effects of binges.
120
4 ways they attempt to counter?
NO EXERCISE!!! (model) starvation, laxatives, vomiting, drug misuse
121
hydration status? K?
dehydration and hypokalaemia
122
signs in the eyes?
subconjunctival haemorrhage
123
what are the callouses on knuckles called?
russells sign
124
hypertrophy of what?
parotid gland
125
teeth?
dental caries (acid)
126
what proportion make good recovery with tx?
50 percent
127
evidence based treatment?
CBT, SSRI (send step brother to table)
128
Binge eating disorder - more males or females?
females
129
compensatory behaviour?
no
130
what is important about the food?
taste and quality
131
which gene codes for glutamine?
CAG
132
what happens if there are more CAG repeats in the genome?
bigger glutamine chains are present in the huntington protein. protein is misshapen.
133
what do misshapen huntington proteins do to the brain?
gradually damage the brain. neuronal loss leads to huntingtons disease
134
is there a genetic test?
yes, very easy
135
what is life exp of alzheimers after diagnosis?
7 years
136
what is one of the first areas in the brain to be affected in al?
nucleus basalis of meynert?
137
early onset familial disease accounts for what percentage?
2 percent
138
tend to have 3 affected individuals in family under the age of 60
y
139
sensation of a lump in throat indicative of?
anxiety problem
140
numbness/tingling sensation
same
141
cognitive problems in anxiety?
mind going blank, self distant, racing thoughts
142
which part of the brain acts as an emotional filter for brain assessing whether sensory material via the thalamus requires a stress or fear response?
amygdala
143
where is cortisol released from?
adrenal
144
GAD - how long do you have to have it? control? impact?
6 months, can't control, significant impact
145
what is the course of the condition like?
fluctuating
146
what is dissipation? (genetic)
know you're going to get a disease faster than your parents
147
age of onset?
20-40
148
free floating anxiety, what are the 4 main symptoms?
nervousness, trembling, muscular tensions, sweaty/lightheaded
149
f:m ratio?
2 females to 1 male
150
balanced translocation - what test?
fish (normally do ACGH, but that only picks up imbalances)
151
what is GAD associated with (bedroom)
feeling restless, keyed up or on edge, difficulty concentrating, mind going blank, muscle tension, sleep disturbance
152
GAD is associated with disability, medically unexplained physical symptoms, over utilisation of health care responses
y
153
what antidepressant can be used in GAD?
venlafaxine
154
what class of drug is this ?
SNRI
155
Panic disorder - are they restricted to any particular place or set of circumstances?
no, they are unpredictable
156
symtoms? including onset
sudden onset palipations, chest pain, choking sensation, diziness, feelings of unreality
157
secondary fear of?
dying, losing control, going mad
158
can be with/without what condition?
agoraphobia
159
what can panic disorder NOT be due to?
a drug or effect of a drug. also not correct if it is better accounted for by another medical condition
160
what percentage have agoraphobia?
50-67%
161
waxing and weaning (moon) what does it mean?
usually moving towards full or past full blown
162
at 10 year follow up, statistics?
1/3 well, 1/3 moderate improvement, 1/3 worse
163
what other conditions can it be co morbid with? (sack bin)
other anxiety disorders, depression, alcohol , drug (DAD)
164
what can trigger it in susceptible individuals ?
lactate infusions (weight in bike shelter) - by product of muscular activity
165
what else?
rebreathing air (by increasing carbon dioxide)
166
what would you see on a PET scan? increased metabolism where?
parahippocampal gyrus
167
three types of phobia?
agorophobia, specific phobia, social phobia
168
fear of being in siutations where escape might be unavoidable?
agoraphobia
169
what are the symtptoms of agoraphobia while on public transport/shopping centre/leaving home?
panic attack
170
what does this often involve to avoid anxiety?
other people doing things for them or online (i.e. internet shopping)
171
specific phobia cued by?
specific object or situation
172
do they have insight?
yes, recognise the fear as excessive/unreasonable
173
what is social phobia?
persistent fear of social or performance situations in which someone is exposed to scrutiny by others
174
what does the individual fear?
they will act in a way that is embarrassing or humiliating
175
common symptoms
blushing or shaking, fear of vomiting, urgency, fear of urination and defacation
176
increase in bilateral activation of?
amygdala
177
what happens in terms of cerebral blood flow?
increases bilaterally
178
what RIMA anti depressant can you use?
meclobomide
179
what drug class is this?
RIMA
180
defence has a _________ origin?
midbrain
181
when do you get tonic immobility? (freezing)
inescapable threat
182
what sort of situation would it happen in?
sexual assault case
183
symptoms?
decreased vocalisation, intermittent EC, rigidity and paralysis, muscle tremors in extremities, unresponsiveness to pain
184
what is the orientating response?
immediate response to change in environment
185
with increasing proximity to a predator, brain activation shifts from _________ to the ___________. (football pitch)
prefrontal cortex to the midbrain (defensive)
186
which specific 2 areas in the midbrain?
PAG, SC (superior colliculi)
187
acute stress leads to increase in what?
catecholamines and cortisol
188
what is the purpose of cortisol release in stress?
to shut down the stress response
189
what sites does it exert negative feedback on?
pituitary, hypothalamus, hippocampus, amygdala
190
cortisol levels in PTSD?
low
191
acute stress increases cortisol levels, but the RISE in cortisol levels are lowest in PTSD
y
192
what psychiatric problems are co morbid?
depression, drug and alcohol misuse
193
risk of suicide in PTSD?
6 x higher (c note, suicide note)
194
DSM IV criteria?
```
traumatic event. INTRUSIVE symtoms (1) or more
avoidance symtoms 3 or more
hyper arousal (2 or more)
```
195
duration has to be?
4 weeks (red arrow to head)
196
they also have to have distress and impairment in social/occupational functioning)
y
197
avoidance and emotional symptoms?
avoid thinking about it, avoid reminders about event i.e. places, amnesia for important aspect of trauma, loss of interest in activities, detachment, emotional numbing
198
hyerarousal?
sleep disturbance, irritability/anger, concentration difficulties, hyper vigilance, exaggerated startle response
199
intrusive symptoms?
nightmares, flashbacks, physiological reactions, recurrent distressing recollection
200
where are defence and orientating responses generated
midbrain
201
what do high levels of cortisol damage?
the hippocampus
202
brocas area in PTSD, what happens?
reduced blood flow
203
how are memories described?
fragmented
204
which part of the brain has a role in memory and the stress response?
hippocampus
205
which part is involved in the role of fear during trauma and recollection?
amygdala
206
"it feels like yesterday" i had that last broca
reduces bloodflow
207
the emotional memory in PTSD is in which side of the brain?
RHS
208
impairment of emotional event memory related to which part of brain? green box around it?
amygdala
209
therapy treatment used ? C notE
CBT and EMDR should be used
210
4 drugs that can be used?
first 2 - mitrazipine and paroxetine. 2nd take trip to pond. amytriptyline and phenelzine
