Flashcards in Neuropsych Deck (177)
What is contained in the extra pyramidal system?
Basal ganglia (fine motor and muscle movement), cerebellum, and
Damage to the cerebellum causes ataxia which is like someone who drank too much. Problems with loss of balance, slurred speech, and Tremors.
What is the catecholamine hypothesis and what support is there for it?
It says that depression is due to lower than normal levels of norepinephrine.
Tricyclics support it.
What is serotonin syndrome? What are the symptoms?
Combining SSRIs with tricyclics or MAOIs or other drug that increases serotonin.
Characterized by altered consciousness, agitation, other mental status changes
Autonomic changes..sweating, dilated pupils
Tremor, muscle rigidity, akathisia (motor restlessness)
Other neuromuscular activities.
What drugs can cause a hypertensive crisis? What are the symptoms?
MAOIs combine with other drugs or foods containing the amino acid tyramine can cause a fatal crisis noted by elevated blood pressure, severe headache, stiff neck, nausea, and vomiting, and tychycardia and bradycardia.
Avoid beer, wine, aged cheese, smoked meat, soy sauce, avocados, bananas, eggplant, tomatoes and yogurt.
What are the newer antidepressants?
Serotonin-norepinephrine reuptake inhibitors (snris) are venlafaxine (Effexor), duloxetine (Cymbalta), and venlafaxine (pristiq) used for major depression, generalized anxiety and social anxiety do, and panic do.
Side effects...sleep, nausea, GI, sexual dysfx, headache, and increased bld pressure.
Norepinephrine-dopamine reuptake inhibitors (ndris) for depression and smoking cessation.
Bupropion (Wellbutrin, zyban)
Side effects...dry mouth, agitation, insomnia, itching, rash, decreased appetite.. Can aggravate preexisting seizures, psychosis, and cause anaphylaxis (allergic rx)
What are the names for the mood stabilizer lithium? What is it used for and give side effects.
Lithium is tx of house for classic bipolar (mania without rapid cycling). Reduces mania and levels swings.
Appears to effect ne, d, se
Lithium carbonate (eskalith, lithonat, duralith)
Lithium citrate (cibath)
Side effects: metallic taste
Fine motor tremor
Fine hand tremor
Mild cognitive impairment (confusion and disorientation)
Toxicity (vomit, ab pain, diarrhea, tremor, slurred speech and can lead to seizure, coma, death)
What antiseizure meds are used to treat psychological sx? How do they work, what sx do they treat and what are their side effects?
Carbamazepine (tegretol) and valproic acid (depakote) are two antiseizure meds that act on SE levels.
Used for dysphoric mania
Mania with rapid cycling
Side effects: nausea, vomit, lethargy, tremor, ataxia, visual disturbances,
Slight risk of liver failure w both
Agranulocytosis (low white bld cell) and aplastic anemia w carbamazepine.
What are the traditional antipsychotics?
What are the uses?
Phenothiazines (Thorazine and mellaril)
Used for: schizophrenia
Psychotic sx (in other do)
Discuss the dopamine hypothesis.
Thought that an excess of dopamine causes schizophrenia.
Antipsychotics work by blocking dopamine receptors in brain.
Support bc amphetamines and other dopamine elevating drugs can induce psychosis who don't have schizophrenia or worsen in those who do.
However, other research found it is more complex and may involve an imbalance of dopamine and other nt , like NE and SE.
What are the side effects if the traditional antipsychotics?
Disadvantage is they tx positive sx but little effect on negative sx (flat affect, anhedonia, withdrawal).
(Dry mouth, blurred vision, gi, sexual prob, urine retention, tachycardia)
Parkinsonism, dystopia, akathisia, tardive dyskinesia (abnormal involuntary movements, chewing..)
Neuroleptic malignant syndrome
Rare, life threatening
Rigid, fever,sweat, unstable bld pressure, altered mental status, autonomic dysfx. Occur anytime. Often first weeks. Rapid onset.
Discont drugs ASAP or fatal.
23 yr old gets tardive dyskinesia after taking a traditional antipsychotic for months. If gradually withdrawn, expect:
A. Increase sx temporary before decrease
B. increase permanently
C. Not be affected
D. Remit immediately
A. Gradual withdraw leads to gradual reduction in sx. Temporary increase before decrease.
Common lithium side effect, ESP with older people:
A. Impaired visual spatial perception
B. fine hand tremor
C. Verbal articulation problems
D. Shuffling gait
B...side effects more common in older peeps and occur at lower doses.
Treatment of OCD most likely includes:
Eating foods with tyramine while taking maoi should be avoided because doing so can cause:
A. Neuroleptic malignant syndrome
B. hypertensive crisis
D. Severe rebound effect
B...includes elevated bld pressure, severe headache, stiff neck, nausea, vomiting, blurred vision, confusion
All are SSRIs but:
A...anafranil is a tricyclics
Which antidepressant is least likely to cause cognitive impairment?
C. Only ssri
What is a dopamine antagonist?
D. Traditional antipsychotic that blocks dopamine receptors .
Severe side effects occur. March type of med with below problems:
1. Agranulocytosis. Aplastic anemia
2. Hypertensive crisis
3. Liver damage
4. Serotonin syndrome
5. Li toxicity
6. Aggravate preexisting seizure, psychotic do or allergic rx
7. Cautious if suicidality or heart do
8. Neuroleptic malignant syndrome
2.maoi plus tyramine
3. Antiseizure meds
8. Traditional antipsychotics, no traditional antipsychotics
What are the newer antipsychotics, how do they work
Atypical affect different dopamine receptors as well as SE, NE, and glutamate receptors
Clozapine (clozaril), risperidone (risperdal), olanzapine (zyprexa) and ariprazole (abilify)
What are the uses of the at typical antipsychotics and the side effects?
Other do with psychotic sx
Advantages..help pos and neg sx
Less likely cause extra pyramidal
Often help where other meds don't
Side effects: anticholenergic
Sedation, wt gain
Neuroleptic malignant syndrome
Clozapine...agranulocytosis (so last resort)
What is true about atypical (newer) antipsychotics?
A. less likely than traditional antipsychotics to affect negative sx, more likely produce tardive dysk
B. less likely than traditional to affect negative sx, just as likely tardive dysk
C. More likely to affect negative and less likely affect tardive dysk
D. More likely affect negative and just as likely affect tardive dysk
Which would be most useful for alleviating sx of moderate to severe alcohol withdrawal?
11 ur old taking methylphenidate for ADHD. Most likely have which side effects?
A. Dry eyes, blurred vision
B. insomnia, decrease appetite
C. Numbness arms and legs
D. Increase appetite, wt gain
What are the benzodiazepines and what are their uses?
Moderate to severe alcohol withdrawal
Enhance GABA (inhibitory NT)
What are he side effects of the benzodiazepines?
What are some disadvantages?
Most common..drowsie, sedation
Motor...ataxia, in coordination
Paradoxical effects ...anxiety, aggressive, excitability
Older ppl..confusion, disorientation
Chronic use..wdrawl, depend, tolerance...rebound anxiety even greater than original
Severe withdrawal (seizure, hallucinations, coma) can occur if abruptly stop after high dose for long time.
Combo with alcohol or other CNS depressant can be fatal.
What are the barbiturates and their uses?
Barbiturates exert effects on GABA receptors in RAS, medulla, cortex.
Thiopental (Pentothal)..general anesthetic
Amobarbital (Amytal)..acute management of agitated patients
Secobarbital (Seconal)..short term tx for insomnia
What are the side effects to the barbiturates?
Many are the same as for the benzodiazepines..
Drowsie, confusion, ataxia, cognitive, paradoxical excitement
Regular use leads to dependence, tolerance, withdrawal
Combo w alcohol can be lethal...potentiating effects
What is the azaspirone?
Pat prescribed is buspar for generalized anxiety do
Reduces anxiety wo prominent sedative or muscle relaxant effects
Doesn't lead to abuse, dep, wdrawl
Effects on anxiety via d, ne, se
What are the narcotics, their uses, and side effects?
Mimick body's natural analgesics, endorphins/enkephalins. Include natural opioids and heroine and methodone. Plus:
Uses: preop med(relax, sedate)
Acute and chronic pain
For heroine detox...
(Decrease cravings and wdrawl )
Side effects: dry mouth, dilation, nausea, hypotension, cough suppression, respiratory depression
Chronic..depend, toler, wdrawl
Eventually use just to keep from wdl
Wdrawl..cold or flu like. Later pain, vomit, hi bp...