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Midterm Psychopharm > Midterm Outline > Flashcards

Midterm Outline Flashcards

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1
Q

Outermost layer of cerebrum

A

Cerebral cortex

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2
Q

What does the limbic lobe consist of?

A 
Surrounds upper brainstem
Includes- 
hippocampus 
Amygdala 
Hypothalamus 
Parahippocampal gyrus
Cingulate cortex
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3
Q

Plays a critical role in memory

A

Hippocampus

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4
Q

Important element of fear circuitry

A

Amygdala

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5
Q

Frontal cortex functions

A 
Planning 
Attention 
Abstract thought 
Problem solving 
Judgement 
Inhibition of impulses
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6
Q

Cerebellum function

A

Motor coordination

Cognitive and affective processes

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7
Q

Thalamus role

A

Major rely station for incoming sensory information

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8
Q

Part of the brain that plays a critical role in neuroendocrine Regulation by affecting pituitary hormone release

A

Hypothalamus / mood motivation/ sex drive/ hunger/ temperature/sleep

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9
Q

Neuromodulatory nuclei in the midbrain

A

Dopaminergic ventral tegmental area

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10
Q

Neuromodulatory nuclei in the brainstem

A

Serotonergic raphe nuclei

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11
Q

Neuromodulatory nuclei in the pons

A

Noradrenergic locus coeruleus neurons

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12
Q

Cholinergic neurons are located where?

A

Basal forebrain and brainstem

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13
Q

Neuron doctrine theory

A

Neurons act as psychically discrete functional units within the brain communicating with each other through specialized junctions

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14
Q

Cell soma function

A

Housing the nucleus with its genomic DNA

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15
Q

Support neuronal function by supplying nutrition, maintaining homeostasis, stabilization of synapses, myelinating axons

A

Glia cells- 10x more than neurons

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16
Q

Play a role in synaptic transmission

A

Glia cells

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17
Q

Smal phagocytic cells

A

Microglia

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18
Q

Astrocytes and oligodendrocytes

A

Macroglia

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19
Q

Play a critical role in glutamatergic neurotransmission (function and transport)

A

Astrocytes (macroglia)

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20
Q

Mood disorders are associated with a reduction in the number of _____ in select brain regions

A

Glia

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21
Q

Characteristics of a neurotransmitter

A

Synthesized within presynaptic neuron

Released w:depolarization from pre synaptic neuron to exert an action on post synaptic neuron

Action can be replicated by a drug

Action on synaptic cleft is terminated by a specific mechanism

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22
Q

Amino acid neurotransmitters

A

Glutamate

GABA

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23
Q

Monoamine neurotransmitters

A 
Dopamine 
Serotonin 
Norepinephrine 
Epinephrine 
Histamine
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24
Q

Small molecule neurotransmitter

A

Acetylcholine

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25
``` Opioids Hypothalamic factors Pituitary hormones Substance P/VIP Leptin ```
Peptides
26
Rapid effect neurotransmitter receptors are either
Ion channels (NMDA glutamate receptors) or coupled to ion channels
27
G protein coupled receptors work —-
Via slower second messenger systems - involve multi enzyme cascade
28
Second messenger systems convert receptor signals into a coordinated set of cellular effects by….
Altering the function of multiple target proteins
29
Second messenger pathway involving glycogen synthase kinase(gsk) may mediate therapeutic efficacy of….
Lithium salts in bipolar disorder
30
By modifying gene expression in the nucleus, _______ can produce persistent changes in neural function
Transcription factors
31
Most widely studied neuronal transcription factor
CREB (cAMP response element binding protein)
32
Upregulated and phosphorylated in neurons in response to antipsychotic meds or drugs of abuse
CREB
33
BDNF and other related neurotrophic factors exert effects by…
As a growth factor during embryonic Neuro development and synaptic signaling
34
BDNF signaling modulates what?
CREB activity and gene expression ( neuroplasticity)
35
Included processes in the brain that continue into adulthood such as neurogenesis
Neurodevelopment
36
The capacity of the neural system to change in response to internal or external stimuli following predetermined rules
Neuroplasticity
37
Nerve fiber that carries away nerve impulses from the cell body
Axon
38
Branched extensions of a nerve cell that propagate the electrical stimulation received from another neuron
Dendrite
39
abnormally high or low concentrations of neurotransmitters in the area between two neurons
synapse. Can inhibit neurotransmitter synthesis, inhibit transport, vescicle formation, release/block post synaptic efforts or increase clearance rate from the synapse.
40
Can induce second messenger cascades that can influence intra-cellular processes, including gene transcription.
Enzymes via G proteins embedded within the cell membrane
41
Most conventional antipsychotic agents are extensively metabolized by the 2D6 isoenzyme of the....
Hepatic P450 enzyme system
42
Neurotransmitter is synthesized where?
presynaptic neuron
43
Biogenic amines
Serotonin and Histamine
44
catecholamines
Dopamine Norepinephrine Epinephrine
45
Amino acid neurotransmitters
Glutamate Gaba Glycine
46
An enzyme dopamine beta hydroxylase wil convert Dopamine into what?
Norepinephrine within the vescicle
47
Hormone and neurotransmitter synthesized by norepinephrine in the cytoplasm by enzyme
Epinephrine
48
What is innervation
The nervous excitation necessary for the maintenance of the life
49
Involves a multi-enzyme cascade that work via slow messenger systems
G-protein-coupled receptors
50
Linked to cytoplasmic enzymes via proteins embedded within the cell membrane
G-protein-coupled receptors
51
2 G-protein-coupled receptors
Glutamate | GABA
52
transmembrane channel that opens or closes in response to binding
Ligand gated ion channel
53
When a ligand binds to a ligand gated ion channel what happens ?
A channel opens and allows ions like K, Ca, CL, NA through)
54
voltage gated ions rely on???
The difference in membrane potential. Not the same as a ligand gated ion channel
55
Glutamate is a what?
Ligand
56
what alters gene expression?
Chromatin. Seen in child abuse - chromatin structure changes
57
influencing monoaminergic function has been shown to result in several different changes in second-messenger systems and....
Gene expression/downstream effects
58
Gene function may be changed without a specific alteration in the code. This change in function may also be heritable.
Epigenetics
59
Bipolar modification of chromatin is an example of....
epigenetics
60
drug capable of producing a maximum response that the target system is capable of
Full agonist
61
drugs that bind to and activate a given receptor but not fully
Partial agonist
62
Ligand that binds to the same receptor binding site as an agonist and not only antagonizes of the agonist but exerts the opposite effects by suppressing receptor signaling.
Inverse agonist
63
compound that has the opposite effect. Decreases the activation of a synaptic receptor by binding and blocking neurotransmitters from binding or decreasing the ammt of time neurotransmitters are in the synaptic cleft
Antagonists
64
system level treatment adherence
mental health care coverage fragmentation of pt care distance to care financial barriers
65
sociocultural adherence to treatment barriers
attitudes and beliefs about psychiatric symptoms and treatment
66
clinical influence on tx adherence
cognitive impairment substance misuse psychiatric sx
67
tx related influences to adherence
tx efficacy side effects dose timing/frequency psychotherapy modality
68
SSRI mechanism of action
interact with the monoamine neurotransmitter system including the reuptake transporters that terminate the action of NE, SE, DOPAMINE
69
TCA's and MAOI's were postulated to work by
increasing noradrenergic or serotonergic neurotransmission and compensating for monoamine "deficiency"
70
More recent theory on how antidepressants work is that they help by creating >>>?
slower adaptive responses within neurons to these initial biochemical changes - downstream effects
71
SSRI's have effects on what neurotransmitters?
Serotonin reuptake and some modest dopamine and norepine reuptake
72
SSRIs have shown to have NON monoaminergic effects including moderate and selective effects on ________receptor expression and editing
glutamate
73
SNRI's inhibit and do what?
Inhibit reuptake of Serotonin and NE with minimal to no affinity to muscarinic cholinergic, histaminergic and adrenergic receptors
74
SNRI duloxetine has been shown to
provide marked upregulation of BDNF and protein and redistribution of neurotrophin=potential improvement of synaptic plasticity
75
Norepinephrine reuptake inhibitors mechanism of action
significant NE reuptake inhibition, weak affinity to serotonin reuptake, with several non-monoaminergic properties
76
Reboxitine
NRI that inhibits nicotinic acetylcholine receptors and increasing extracellular levels of ACH Partial agonist of kappa opioid receptor ANTIDEPRESSANT THAT AFFECTS GLUTAMATE RECEPTORS WITH A DECREASE OF GLUR3 EXPRESSION
77
mechanism of action of serotonin agonists/antagonists
trazodone and nefazodone are weak inhibitors of serotonin and NE reuptake. They primarily block serotonin 5HT2A receptors and demonstrate partial agonist properties as well Able to release Serotonin presynaptically stimulates Mu opioid receptors may inhibit NMDA induced cyclic GMP elevation Overall effect in the brain appears to be an increase in extracellular levels of serotonin- possible serotonin syndrome
78
Buspirone
full serotonin agonist at 5HT1A and partial agonist at 5TH1A post synaptic receptors FDA approved for anxiety
79
Vortioxetine
Recently approved antidepressant multiple 5HT receptor antagonist Increases extracellular SE, NE, DOP in PFC and hippocampus-increases cell proliferation and survival stimulates maturation of immature granul cells in hippocampus
80
NDRI's mechanism of action
Primarily block reuptake of NE and DOP Buproprion- dose dependent extracellular dopamine levels and NE
81
Alpha2 Adrenergic receptor antagonists
mirtazepine and mianserin appears to enhance release of serotonin and NE by blocking alpha receptors Mirtazepine appears to block 5HT receptors as well Enhance release of NE and serotonergic transmission First alpha 2 receptor antagonist approved for depression Also a potent H1 receptor antagonist
82
TCA mechanism of action
Inhibit reuptake of NE and more potently than SE Exhibits effects on glutamatergic system Doxepine, amytriptyline, Nortriptyline-inhibity glycine Trimipramine and clomiprimine - affinity for D2 receptors Fairly potent blockers of HI, SE, ACH and Alpha receptors
83
MAOI mechanism of action
Inhibit MAO- enzyme found on outer membrane of the mitochondria= catabolizes(degrades) DOP, NE, SE following reuptake from the synapse Either loaded into vesicles for subsequent re-release or broken down by MAO
84
MAO catabolizes a number of dietary pressor amines (DOP, Tyramine, triptamine, phenylithiamine. Whats the concern?
Hypertensive crisis when consumption of dietary amines
85
Co-administering of Dopaminergic agents and MAOI's can
cause hypertensive crisis | serotonin syndrome
86
How many days until MAO enzymatic activity is complete?
14 days
87
SNRI drugs
Venlafaxine Desvenlafaxine Duloxetine Levomilnacipran ER
88
NRI antidepressants
Stratera-Atomoxetine | Reboxetine
89
Serotonin receptor antagonists/agonists antidepressants
``` trazodone nefazodone vilazodone(viibryd) vortioxetine(brintellix) ```
90
NDRI antidepressants
Buproprion
91
alpha 2 receptor antagonist antidepressants
Mirtazepine (Remeron)
92
TCA antidepressants
``` Imipramine Desiprimine Amitriptyline Nortriptyline Doxepine Trimipramine Protriptyline Maprotyline Amoxepine Clomiprimine (Anafranil) ```
93
MAOI antidepressants
Selegiline phenelzine Isocarboxazid Tranylcypromine
94
eldery considerations for antidepressants
may have alterations in hepatic metabolic pathways alteration in demethylation&hydroxylation(involved in metabolism of ssri's and tca
95
Most common side effects of SSRI's
``` nausea tremor excessive sweating flushing headache insomnia activation or sedation jitteriness dizzyness rash dry mouth sexual dysfunciton emergence ```
96
SSRI cognitive symptoms
mental slowing apathy and emotional blunting motor-bruxism (grind teeth)and akathisia(agitation, restlessness)
97
Less common side effects of ssri's
``` diarrhea tremor bruxism rash hyponatremia SIADH worsening parkinson's tremors- pts needing more levodopa abnormal bleeding with normal labs hyperprolactinemia ```
98
which SSRI has the most research on reproductive safety?
Fluoxetine
99
Discontinuation syndrome sx from SSRI's
``` Dizzyness insomnia nervousness irritabilty nausea agitation ```
100
Venlafaxine facts
SNRI several meta analysis show superior to SSRI's (w/exception to escitalopram) Often used as a front line tx Often used for TRD DC for ECT- study showed asystole
101
Venlafaxine common side effects
``` nausea insomnia sedation sexual dysfunction HA tremor palpitations dizzyness sweating tachycardia ```
102
Desvenlafaxine facts
``` SNRI CYP450 3A4/weak 2D6 common s/e- nausea, dry mouth, vomiting, constipation sweating tremor somnolence nervousness abnormal vision sexual dysfunction ```
103
Duloxetine facts
``` SNRI as effective as SSRI's primarily excreted in urine metabolized by CYP 450 2D6 good for somatic sx of depression such as pain ```
104
Duloxetine side effects
``` dry mouth HA Nausea somnolence sweating insomnia fatigue does NOT cause HTN ```
105
Atomoxetine facts
``` Strattera NE reuptake inhibitor FDA approved for ADHD single open trial for tx of depression s/e- nausea, increased BP, decreased appetite, insomnia ```
106
Buproprion facts
``` NDRI tx of depression and anxiety lacks anticholinergic properties CYP 450 2D6- if combined with other 2d6's- can increase levels lower incidence of gi side effects lower risk of wt gain ```
107
Buproprion common side effects
``` agitation insomnia wt loss dry mouth ha constipation tremor ``` Major: Sz- more likely with bulimia and head trauma
108
Trazodone facts
Serotonin antagonist shown to be as effective as ssri's but ordered less frequently short half life but still sedating common s/e- sedation, orthostatic hypotension, headaches should be used with caution with pts with cardiac disease LOWEST RISK OF ALL ANTIDEPRESSANTS FOR SZ rare hepatoxicity/ reported overdoses rare/serious-priapism penis and clitoris
109
Nefazodone facts
serotonin receptor agonist CYP 3A4- serotonin syndrom when combined w/ssri's lower risk of wt gain than ssri's(appetite reducing effects) lower risk of sexual side effects rare/serious s/e- priapism male and female s/e-nausea, dry mouth, constipation, headache,blurred vision increased risk of hepatoxicity
110
Vilazodone
``` Viibryd serotonin 5ht1a partial agonist and ssri studies show superiority for mdd possible less sexual side effects than ssri's GI and insomnia sx ```
111
Vortioxetine facts
Brintellix serotonin agonist/antagonist New for depression
112
Mirtazepine facts
alpha 2 adrenergic receptor antagonist more sedation and wt gain than ssris lower risk of HA or sexual dysfunction
113
TRD tx
combine SSRI or SNRI with a DNRI or two meds from different classes
114
Antipsychotic side effects
metabolic syndromes TD extrapyramidal sx
115
MS patients are at risk for?
2X more likely to be bipolar
116
Epidemiology risk factors for BP
similar for men and women, may have gender differences in illness features no difference with race, ethnicity or socioeconomic strongest established risk factor is family hx
117
Environmental risks for BP
``` pregnancy and obstetrical complications stressful life events TBI MS Epilepsy Decrease in omega fatty acid consumption ```
118
Clinical features of BP
increased activity or agitation for one week or more If irritable-4 rather than 3 associated sx If hospitalized, 1 wk criteria is null Sx must be associated with market impairment-social, occupational or psychotic sx
119
Cyclothymia
2 yrs marked by periods of hypomania as well as periods of depressed mood and no more than two months without sx.
120
manic episode criteria
1 wk or more of elevated or irritated mood/increase in energy during mood disturbance 3-4 sx of: inflated self esteem, decreased need for sleep, talkative, flight of ideas, distractibility, increase in goal directed activity, increase in pleasurable activities Marked impairment in social and occupational functioning Not attributable to a drug physiological effects
121
rapid cycling
patients with at least 4 distinct episodes in a year with switch to other pole or full recovery
122
Bipolar pathophysiology
``` impairment in inositol signaling Wnt/Gsk3 pathway abnormality circadian rhythm disruption Decreased density of oligodendrocytes changes in gene expression Increased volume in striatum and amygdala increased perfusion in PFC during mania decrease in perfusion in PFC during depression Metabolic abnormalities ```
123
Genetic changes in bipolar
Chromatin modification | acute and chronic stress may exert epigenetic effects
124
what drug can modify chromatin expression?
Clozapine
125
atypical bipolar depression sx
``` Reverse neurovegetative signs overeating carb craving hypersomnia some say irritability during depression is marked for bipolarity ```
126
median age of onset for MDD and BP
later on for MDD greater onset of childhood sx is possible indicator for BP Greater recurrence of bp episodes is indicator for BP
127
personality disorder sx facts
more pervasive, less episodic will not typically remit like a mood episode will although bpd pt's have mania or hypomania or depressive sx they don't meet full criteria for Bipolar
128
secondary mania
manic sx in the context of a medical illness exposure to corticosteroids late onset in a pt with no prior mood sx other neurological or systemic sx
129
frequently used tool to assist in bipolar recognition
Mood DQ
130
Treatment strategies for bipolar
anticonvulsants antipsychotics traditional therapy- mood stabilizer (lithium or valproate) psychoeducation and disease mgmt strategies
131
Mania treatment
``` Lithium Valproate SGA's combo. therapy may have greater efficacy start 1, if no improvement in a short period, add another or switch ```
132
first line for euphoric mania
``` lithium quetiapine valproate aripiprazole risperidone zipprazidone ```
133
mixed episode bipolar first line tx
valproate aripiprazole risperidone ziprasidone
134
mixed state bipolar drug class of choice for first line
atypical antipsychotics
135
bipolar depression first line tx
Lamotrigine if without severe or recent hx of mania | if severe and or recent mania- antimanic + Lamotrigine
136
antidepressants for Bipolar facts
should be avoided | If given, needs to be with a mood stabilizer
137
psychosocial interventions for bipolar
cbt interpersonal/social rhythm therapy (IPSRT) family focused therapy
138
treatment intervention for bipolar
treat the predominant mood type (mania, hypomania, depression or mixed state)
139
other factors that may be contributing to cycling
thyroid | substance abuse
140
residual mood symptoms (manic and depressive) following an acute episode appear to be predictive of......
earlier recurrence
141
earlier onset of mood symptoms has been associated with?
increased severity, greater chronicity and recurrence
142
panic disorder treatment
SSRI or SNRI | raise doses a week or so after acclimation
143
quetiapine drug class
atypical antipsychotic
144
individuals with social anxiety disorder are more at risk for what?
substance abuse
145
treatments for social anxiety disorder
SSRI, SNRI first line tx Possible quetiapine benzos, tca and maoi's if necessary propanolol and atenolol
146
lithium mechanism of action
recycling of inositol is inhibited regulating intracellular ca protein kinase activation
147
pharmacokinetics and pharmacodynamics of lithium
``` absorbed in the gut, rapidly distributed peak plasma in 1-2 hrs after first dose renal clearance half life renal clearance-24hrs steady levels reached in about 5 days ```
148
meds to avoid on lithium
NSAIDs and cox inhibitors (decrease renal flow and increase Li levels) Thiazide Diuretics
149
lithium for children
No RCTs supporting it
150
lithium in psychotic disorders
ineffective in the tx of psychosis but has been studied as an adjunct in for schizophrenia and schizoaffective
151
lithium and etoh dependence
No proven effects
152
principles of lithium tx
labs- bun, cr, thyroid, ekg, electrolytes check levels after 5 days and on every change in sx. every 2 mo for first 6 mo for lithium levels bun, cr and thyroid check every 6 mo
153
lithium dosing
0.6-0.8 (used to be 0.8-1.2) begin at 600 once daily can divide doses
154
adverse events lithium
``` hypothyroidism polyuria but may be helpful to carefully consider a diuretic like amiloride edema- give spironolactone decrease in Cr clearance-decrease in GFR rare sinus arrhythmias GI sx-give slow release formula tremor- propanolol or atenolol psoriasis acne ```
155
lithium toxicity s/s
``` lethargy tremor nv confusion visual changes vertigo hyperreflexia ``` sz coma arrythmia
156
lithium toxicity tx
Hold IV fluids tx electrolyte imbalance
157
anticonvulsants ineffective in tx bipolar
``` gabapentin topiramate oxcarbazepine pregabalin zonisamide tigabine ```
158
valproate and lithium facts
valproate proved to be an effective antimanic valproate is an anticonvulsant valproate slightly more tolerable than lithium may be slightly efficacious than lithium antipsychotics overall more effective in tx mania than anticonvulsants valproate not fda approved for bp maintence and not suggested inadequate data to support valproate as effective for acute bp depression
159
lamotrigine facts
``` anticonvulsant/mood stabilizer approved for maintenance tx of bp lamotrigine may not help with depression lamotrigine plus lithium effective in small randomized double blind -limited research Not efficacious for mania ```
160
carbamazepine facts
anticonvulsant may be efficacious for mania but no solid data showing it effective for maintenance significant withdrawal sx
161
oxcarbamazepine and gabapentin and levetiracetam for bp
no published placebo controlled studies | levetiracetam may cause sz
162
pregabalin facts
binds to voltage gated ca channels good for fibromyalgia maybe good for anxiety not enough evidence to use for bipolar
163
tiagabine, zonisamide and topiramate facts for bp
anticonvulsants Not effective for bp topiramate (inhibit na gated ion channels)
164
tiagabine mechanism of action
inhibitor of gaba transporter
165
3 anticonvulsants that may help with bipolar
valproate lamotrigine carbamazepine

Midterm Psychopharm (2 decks)

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