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Neuropharmacology Flashcards

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1
Q

Which class of medications has the highest rate of being prescribed?

A

antidepressants

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2
Q

List the 6 major categories of psychiatric disorders:

A
  • neurosis
  • psychosis
  • depression
  • schizophrenia
  • Tourette’s syndrome
  • dementia
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3
Q

Which types of psychological disturbances are categorized under “neurosis”?

A

mild forms of mental disorders
- anxiety
- hysteria
- hypochondria
- phobias
- OCD
- panic disorders
- PTSD

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4
Q

Diseases classified as “psychosis”:

A
  • schizophrenia
  • organic psychoses
  • bipolar disorder
  • psychotic depression
  • drug-induced psychoses
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5
Q

How is the word “psychosis” derived?

A

psyche = mind/soul
osis = abnormal condition

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6
Q

Pharmacological treatment of depression presumes…

A

a brain deficiency in dopamine, norepi, serotonin, or altered receptor activities

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7
Q

Positive symptoms of schizophrenia:

A
  • delusion
  • hallucinations
  • disorganized speech/thinking
  • grossly disorganized behaviors/catatonic behaviors
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8
Q

Negative symptoms of schizophrenia:

A
  • lack of emotion
  • lack of interest/motivation
  • flat affect
  • alogia
  • inappropriate socializing/isolation
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9
Q

Cognitive symptoms of schizophrenia:

A
  • disorganized thinking
  • slow thinking
  • difficulty understanding, expressing
  • poor concentration & memory
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10
Q

How is dopamine related to schizophrenia?

A
  • schizophrenic individuals produce more dopamine than typical brain
  • increased activity at D2 receptor
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11
Q

4 dopamine pathways in the brain:

A

1) mesolimbic
2) mesocortical
3) nigrostriatal
4) tuberoinfundibular

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12
Q

Location of the mesolimbic pathway:

A

from the tegmentum (midbrain) to the nucleus accumbens (limbic system)

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13
Q

Blocking the mesolimbic dopamine pathway has what effect?

A

decrease in positive symptoms

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14
Q

Location of the mesocortical pathway:

A

from tegmentum (midbrain) to frontal & limbic cortex

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15
Q

Effect of blocking the mesocortical dopamine pathway:

A

may produce or worsen negative symptoms d/t an increase in 5HT which inhibits dopamine release
*explains why negative symptoms are unaffected or worsened by drugs that only block dopamine receptors

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16
Q

Location of the nigrostriatal pathway:

A

from the substantia nigra (midbrain) to basal nuclei

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17
Q

Importance of the nigrostriatal pathway:

A

regulates posture and voluntary movement
*first gen antipsychotics block receptors here and cause parkinson’s-like syndrome (EPS)

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18
Q

Location of the tuberoinfundibular pathway:

A

from hypothalamus to anterior pituitary

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19
Q

Effect of blocking the tuberoinfundibular pathway:

A

dopamine inhibits prolactin release, so blocking dopamine here may lead to galactorrhea, amenorrhea, sexual dysfxn

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20
Q

Where do FGAs work? What symptoms are they most successful at treating?

A
  • block D2 receptors in limbic system
  • (muscarinic, adrenergic, & histaminergic receptors affected too)
  • most effective against positive symptoms but may cause EPS
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21
Q

Most potent FGA?
Least potent FGA?

A

most = haloperidol
least = chlorpromazine

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22
Q

Clozapine effects and benefits?

A
  • effective for both positive and negative symptoms
  • no parkinsons-like symptoms
  • blocks D2 and 5HT receptors
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23
Q

Adverse effect of clozapine:

A

agranulocytosis

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24
Q

Common adverse effects of SGAs:

A
  • sedation
  • weight gain
  • orthostatic hypotension
  • EPS
  • parkinsonism
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25
Activation of 5-HT2 receptors causes what?
blocks release of dopamine
26
Blocking 5-HT2 receptors causes what?
increases release of dopamine
27
Effect of blocking 5-HT in each of the 4 dopamine pathways:
- nigrostriatal: increased DA release = less EPS than FGAs - mesocortical: increased DA release improves negative symptoms - tuberoinfundibular: increased DA release = less prolactinemia than FGAs - mesolimbic: less effect here than other 3 pathways; SGAs block DA receptors and improve positive symptoms
28
How does tardive dyskinesia differ from EPS?
- TD may be irreversible/take years to resolve - incidence higher in elderly with FGAs (53%) - lower incidence in elderly with SGAs (5)
29
Which drug produces a zero incidence of tardive dyskinesia?
Clozapine
30
Descibe parkinsonism:
- tremor - rigidity - akinesia/bradykinesia - cognitive fxn eventually declines - s/s d/t degeneration of inhibitory DA pathway from substantia nigra to caudate nucleus in striatum
31
Treatment for parkinson's disease?
- replacement therapy - Levodopa = drug of choice
32
Why don't we give dopamine to Parkinson's patients?
cannot cross the BBB
33
Why is Levodopa successful in treating Parkinson's disease?
- precursor to dopamine that can cross the BBB - orally effective (large doses) - decreases tremor and akinesia
34
Drugs that interact with Levodopa:
- Pyridoxine (Vit. B6) increases peripheral metabolism of levodopa -> DA (reverses effect) - Carbidopa, a peripheral decarboxylase inhibitor, decreases peripheral metabolism of leveopda - therefore, most effective treatment for Parkinson's dz = sinemet (carbidopa:levodopa)
35
Anesthetic considerations for patients on antiparkinsonian drugs:
- hemodynamic instability - gastric aspiration - laryngospasm - postop cognitive dysfxn - upper airway obstruction - sensitive to CV and resp depressant effects of anesthetics - caution with Fentanyl & Neostigmine - continue PD meds the AM of sx
36
How is dopamine related to psychosis?
- increase in DA - located in the limbic system - treatment is to block DA receptors - adverse effects = parkinsonism
37
MOA of SSRIs:
selectively block neuronal reuptake of serotonin at presynaptic membranes with little effect on other neurochemical systems
38
How long does it take SSRIs to work?
1-4 weeks (maybe up to 12 weeks for some patients)
39
Most important advantage of SSRIs compared to TCAs?
relative safety when taken in an overdose
40
List some common SSRIs:
- Fluoxetine - Paroxetine - Sertraline - Citalopram
41
MOA of SNRIs:
inhibit NE transporter as well as SERT
42
Which antidepressant class is preferred for patients with heart dz?
SNRIs
43
Body processes regulated by serotonin:
- GI motility - genital arousal - vascular tone - hematopoeisis - PLT aggregation - parts of the inflammatory response
44
SE of SNRIs:
- nausea - dry mouth - somnolence - HA - sexual dysfxn
45
One way SNRIs are superior to SSRIs:
chronic pain treatment
46
MOA of TCAs:
inhibit synaptic reuptake of NE and serotonin at presynaptic terminals; also affect other neurochemical systems (histaminergic and cholinergic)
47
SE of TCAs:
- postural hypotension - cardiac dysrhythmias (contraindicated in prolonged QT) - urinary retention
48
Major TCA:
Amitriptyline
49
MOA of MAOIs:
heterogenous group that block the enzyme that metabolizes biogenic amines (monamine oxidase A & B), increasing the bioavailability of catecholamines and serotonin in the CNS and peripheral ANS
50
MAIOs are typically (first/second/third) line treatment, except in which patient population?
typically second/third except in atypical depression (first line)
51
List 2 MAOIs:
phenelzine & tranylcyrpromine
52
Major SE of MAOIs:
HTN crisis - treat clinically with a peripheral vasodilator - patients should promptly report serious HA, N/V, CP
53
Lithium toxicity s/s:
- skeletal muscle weakness - ataxia - sedation - widened QRS - AV heart block - hypotension - seizures
54
Cause of neuroleptic malignant syndrome:
rapid increase or over administration of high doses of antipsychotics (esp haldol)
55
4 main syndromes characterized "extrapyramidal syndromes":
1) acute dystonia 2) akathisia 3) parkinsonism 4) tardive dyskinesia
56
s/s of discontinuation syndromes:
- N/V - anorexia - general somatic distress - insomnia - anxiety - agitation
57
Drugs that can cause serotonin syndrome:
- SSRIs - atypical & cyclic antidepressants - MAOIs - opiates - antibiotics etc
58
s/s of serotonin syndrome:
- agitation - delirium - autonomic hyperactivity - hyperreflexia - clonus - hyperthermia
59
What causes mortality with serotonin syndrome?
rhabdomyolysis (renal failure, hyperK+, DIC, ARDS)
60
Which neuropharmacological drug potentiates the action of NDMRs & succs?
Lithium
61
Most common antidepressants used for chronic pain:
- TCAs - SSRIs - SNRIs
62
Effect of rhodiola:
relieve occasional anxiety and support body during stress
63
Effect of valerian root:
promotes relaxation to relieve nervousness, tension, occasional anxiety
64
Effect of winter cherry:
thought to relieve intermittent anxiety

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