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Flashcards in Neuropsych Deck (177)
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123

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.

124

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.

125

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.

126

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.

127

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)

128

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
Wt gain
Nausea, diarrhea
Fine hand tremor
Mild cognitive impairment (confusion and disorientation)
Toxicity (vomit, ab pain, diarrhea, tremor, slurred speech and can lead to seizure, coma, death)

129

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.

130

What are the traditional antipsychotics?

What are the uses?

Phenothiazines (Thorazine and mellaril)

Butyrophenones (haloperidol)

Used for: schizophrenia
Psychotic sx (in other do)
Tourette's
Acute mania

131

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.

132

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).

Anticholenergic effects
(Dry mouth, blurred vision, gi, sexual prob, urine retention, tachycardia)

Extrapyramidal sx
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.

133

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.

134

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.

135

Treatment of OCD most likely includes:
A. Phenelzine
B. lithium
C. Clomipramine
D. Clozapine

C

136

Eating foods with tyramine while taking maoi should be avoided because doing so can cause:
A. Neuroleptic malignant syndrome
B. hypertensive crisis
C. Agranulocytosis
D. Severe rebound effect

B...includes elevated bld pressure, severe headache, stiff neck, nausea, vomiting, blurred vision, confusion

137

All are SSRIs but:
A. Clomipramine
B. sertraline
C. Fluoxetine
D. Paroxetine

A...anafranil is a tricyclics

138

Which antidepressant is least likely to cause cognitive impairment?
A. Imipramine
B. clomipramine
C. Fluoxetine
D. Amitryptyline

C. Only ssri

139

What is a dopamine antagonist?
A. Propranolol
B. fluoxetine
C. Mathylphenidate
D. Haloperidol

D. Traditional antipsychotic that blocks dopamine receptors .

140

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

1. Antiseizure
2.maoi plus tyramine
3. Antiseizure meds
4. SSRIs
5. Lithium
6. Ndris
7. Tricyclics
8. Traditional antipsychotics, no traditional antipsychotics

141

What are the newer antipsychotics, how do they work

Atypical affect different dopamine receptors as well as SE, NE, and glutamate receptors

Drugs include:
Clozapine (clozaril), risperidone (risperdal), olanzapine (zyprexa) and ariprazole (abilify)

142

What are the uses of the at typical antipsychotics and the side effects?

Schizophrenia
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)

143

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

C

144

Which would be most useful for alleviating sx of moderate to severe alcohol withdrawal?
A. Benzodiazepines
B. ssri
C. Li
D. Naltrexone

A

145

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

B

146

What are the benzodiazepines and what are their uses?

Treat: anxiety
Insomnia
Muscle spasms
Seizures
Moderate to severe alcohol withdrawal

Enhance GABA (inhibitory NT)
Diazepam (Valium)
Alprazolam (Xanax)
Clonazepam (klonapin)
Lorazepam (Ativan)
Triazolam (halcion)

147

What are he side effects of the benzodiazepines?
What are some disadvantages?

Most common..drowsie, sedation
Motor...ataxia, in coordination
Cognitive..anterograde amnesia
..poor concentration
Anticholenergic effects
Sexual dysfunction
Paradoxical effects ...anxiety, aggressive, excitability
Older ppl..confusion, disorientation

Disadvantages: addictive
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.

148

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

149

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

150

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

Side effects:
Nausea
Dizzy
Headaches
Lt headedness

151

What are the narcotics, their uses, and side effects?

Mimick body's natural analgesics, endorphins/enkephalins. Include natural opioids and heroine and methodone. Plus:
Oxycodone/percodan/OxyContin
Hydrocodon/Vicodin
Meperidine/Demerol

Uses: preop med(relax, sedate)
Acute and chronic pain
For heroine detox...
Methadone/dolophine/ methodose
(Decrease cravings and wdrawl )

Side effects: dry mouth, dilation, nausea, hypotension, cough suppression, respiratory depression
OD...death
Chronic..depend, toler, wdrawl
Eventually use just to keep from wdl
Wdrawl..cold or flu like. Later pain, vomit, hi bp...

152

What are the psychostimulants, their uses, and side effects?

Mimic or potentiate The action of NE and D

ADHD and narcolepsy
Methylphenidate (Ritalin/concerta)
Pemoline (cylert)
Amphetamine-dextroamphetamine (adderall)
Even low dose ..decrease motor and impulsivity and increase attention in those wout ADHD

Drug of abuse..cocaine, methamphetamine

Side effects: insomnia
Wt loss/decrease appetite, stomachaches
Dysphoric mood
Growth suppression can be reversed with drug holidays
Exacerbate tics