Lecture 2 Flashcards by Sydney Coopland

A subspecialty of pharmacology that concentrates on:
1. the impact of drugs on the brain
2. the impact of diseases on the central nervous system
3. the behavioural consequences of psychiatric medicine

Psychopharmacology

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Nervous systemis composed of:

Central nervous system
Peripheral Nervous System

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Contains the brain and spinal cord

Central Nervous System

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Contains:
Autonomic Nervous System
Somatic Nervous System

Peripheral Nervous System

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Contains:
Parasympathetic System
Sympathetic System

Autonomic Nervous System

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With the increased need to reduce the stigma of mental illness across the globe, many individuals are using the term “chemical imbalance of the brain” to describe mental illness.

According to David Anderson, what is the ramification of this oversimplification?

Doesn’t address the complexity of mental illness

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The target of psychiatric medications is primarily the ____

CNS

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The basic unit of the nervous system is the _______

Neuron

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also called sensory neurons, are the nerve fibers responsible for bringing sensory information from the outside world into the brain. Sensory information may involve special senses, such as vision, hearing, smell, or taste, as well as the sense of touch, pain, and temperature.

Afferent neurons

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As the name suggests, _________ are the ones in between -they connect spinal motor and sensory neurons. As well as transferring signals between sensory and motor neurons, can also communicate with each other, forming circuits of various complexity.

interneurons

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also called motor neurons, are the nerve fibers responsible for carrying signals from the brain to the peripheral nervous system in order to initiate an action. In other words, they are the neurons that tell your body to perform an action, such as removing your hand from a hot pan.

Efferent neurons

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Composed of:
Afferent Neurons
Interneurons
Efferent Neurons

Peripheral Nervous System (PNS)

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Effects on the _____ contribute to the pharmacological profile of psychiatric drugs
Regulates autonomic or unconscious responses to stimuli

Autonomic Nervous System (ANS)

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Is the nerve cell or the neuron
Transmit messages from other neurons and communicate with one another
______ can affect this transmission.

Drugs

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have 4 basic parts:
Soma (Cell Body)
Dendrites
Axon
Axon Terminals

Neurons

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cell body

Soma

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large and small branches of the neuron

Dendrites

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long slender tube

Axon

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are found at the end of axons, they contain small sacs or vesicles that hold neurotransmitters

Axon Terminals

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Neural communication facilitated:

Electrically
Chemically

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occurs within the neuron (nerve impulse)

Electrically

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occurs between the neurons

Chemically

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Nerves send messages through

action potentials

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how electric signals are transmitted from one neuron to the next

Action Potential

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Electrical action potentials are transmitted across the synapse by __________.

neurotransmitters

causes this electrical charge

Sodium Potassium Pump

Stimulation of the nerve causes

Depolarization

needs to occur prior to the nerve being able to be depolarized again

Repolarization

At the end of the ____ there is a halt in electrical communication

axon

Chemical communication is required between 2 neurons or between a neuron and a

gland/muscle

are the chemical messengers that are released into the synaptic cleft (between neurons)

Neurotransmitters

is the same as the synaptic gap

Synaptic cleft

Have receptors Receptors are proteins that are embedded in the cell membrane and have binding sites for endogenous substances and drugs. ____________ needs to return to a resting state so that it can be activated again

Post-Synaptic Effector Cell

found within the body

Endogenous

The neuron transmitting the electrical impulse away from the synapse is called post-synaptic neuron, if the post-synaptic cell is not neuronal it is sometimes referred to as an _______. Synapses can be classified by the type of cellular structures serving as the pre- and post-synaptic components

effector cell

Is what the drug does to the body or how the drug behaves in the body

Pharmacodynamics

Most drugs exert their effect by chemically binding with receptors at the cellular level This is the ______ theory of action

Receptor Theory of Action

_________ produce reactions one of three ways: 1. Enzyme Alteration 2. Open or Close Ion Channels 3. Neurohormone Alteration

Drugs

“Feel good” pathways Movement, coordination, judgement, release of prolactin ↑Mania, anxiety, schizophrenia, addiction ↓ Parkinson’s disease, depression, ADHD

Dopamine (D2)

Fight or flight Mood, cognition, perception, motion, cardiovascular function, sleep, arousal ↑Mania, anxiety, schizophrenia ↓Depression

Norepinephrine (NE)

“Excitatory” neurotransmitter Sleep, arousal, libido, appetite, mood, aggression, pain, coordination ↑Anxiety ↓ Depression, anxiety

Serotonin (5-HT)

Wakefulness, pain, inflammation ↑Sleep disorders, anxiety, Alzheimer's disease, psychosis ↓Depression

Histamine

Synaptic communication Parasympathetic system Sleep, arousal, pain, movement, memory ↑Depression ↓Alzheimer’s disease, Huntington’s disease, Parkinson’s disease

Acetylcholine (ACh) (Cholinergic)

Inhibitory Slow down body activity, reduces activity in neurons ↑Toxic levels - encephalopathy ↓Huntington’s disease, anxiety disorders, schizophrenia, and forms of epilepsy

Gamma-amino-butyric acid (GABA) (Amino Acid)

Communicate sensory information ↑Huntington’s disease, forms of epilepsy, anxiety, depression ↓ Schizophrenia

Glutamate (Amino Acid)

makes it’s own antidepressants, anxiolytics and hallucinogens

Brain

Therefore pharmaceuticals often ______ the brain’s natural neurotransmitters

mimic

Drugs act on a specific receptor site The drugs chemical composition is similar to the neurotransmitter for that receptor

Psychopharmacologic Action

When attached to a receptor, the ____ can have one of two actions: 1. agonist 2. antagonist

drug

is the degree of strength in the bond between a drug and the receptor

Affinity

the ability of a drug to be specific to a certain receptor

Selectivity

ability of the drug to produce a biological response once attached to the receptor

Intrinsic Activity

Use of multiple medications

Polypharmacy

Leads to: Greater complications Diminished mental status Increase in the risk-to-benefit ratio

Polypharmacy

*Maybe slowed Decreased function of ventricles, intestines and the blood flow to intestines

ABSORPTION

*Decreased distribution of water soluble drugs *Increased distribution of lipid soluble drugs Increase in body fat due to aging

DISTRIBUTION

*Hepatic metabolism may be reduced Decreased hepatic blood flow and liver mass

METABOLISM

*Renal elimination is reduced Decreased glomerular filtration rate

EXCRETION

affinity to water (water soluble)

Hydrophilic drugs

affinity to lipids (lipid soluble) – most meds stored in adipose tissue (as most meds are lipid soluble) Need to be lipid soluble to pass the B-Brain barrier

Lipophilic drugs

Take a thorough list of medications taken by the client (including OTC, herbal and prescription) Assess clients’ ability for excretion (kidney function) Assess clients ability for metabolism (liver function) Assess therapeutic drug levels Educate the client about potential drug interactions Educate client about generic and trade names to prevent overmedication Assess the clients adherence to medication Provide client with medication administration aids

Prevention of Adverse Effects

Water soluble drugs are more diluted and therefore drug dosage requirements may increase. Increased plasma volume and body water. Increased cardiac output and increased blood flow to uterus, kidneys, skin and breasts.

ABSORPTION in Pregnant People

Fat soluble drugs more widely distributed and stay in the body longer. Decreased capacity of drug binding Increased weight and body fat Decreased serum albumin

DISTRIBUTION in Pregnant People

Increased ________ and clearance of many drugs Increased hormones (e.g. estrogen and progesterone) induce drug metabolizing hormones in the liver

METABOLISM in Pregnant People

Increased _______ of drugs by the kidneys Decreased when women is supine Increased renal blood glow and glomerular filtration Renal blood flow may decrease when the woman assumes a supine position

EXCRETION in Pregnant People

Numerous medications also cause a _______ risk by crossing the placenta and are also secreted in breast milk

teratogenic

______is sensitive to drug effects because: Size Few plasma proteins that can bind drug molecules Weak capacity for metabolizing and excreting drugs

Fetus

Molecular size, weight, and lipid solubility determine which substances (chemicals, drugs and antibodies) are readily _____ into the fetal circulation from the maternal circulation

absorbed

Difference in body composition Immature systems Genetic make up

Pharmacodynamic differences are caused by

Throughout ______ the effectiveness of drugs are also influenced by Total body water Fat stores Protein amounts

childhood

Oral medications most likely will need to have dosage adjustments IM medications should be avoided Topical drugs have a higher rate of absorption Age of the child, gastric emptying, and intestinal motility Unpredictable absorption Skin permeability

ABSORPTION in Pediatrics

Serum levels of highly protein-bound drugs may be higher in infants and toxicity may occur Adverse effects of drugs that affect the CNS occur in neonates Percentage of body water Degree of protein binding Development of blood brain barrier

DISTRIBUTION in Pediatrics

Drugs will either metabolize too quickly or too slowly Immaturity level of liver in children and infants causes a difference in the metabolism of drugs

METABOLISM in Pediatrics

Drugs may stay in the system longer Slower renal clearance Reduced glomerular filtration rate

EXCRETION in Pediatrics

Who said these things? Brain is a bag of chemicals - some imbalances in flavour profile Create treatments that target the problem without causing side effects Medications now address the entire brain - not a specific spot (not specific enough area that medication effects)

David Anderson

Post-Synaptic Effector Cell can be activated again by

- Reuptake - Enzyme