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Flashcards in PDA neuropsycohparm Deck (61):
1

What are the two classification of mood disorders in the DSM-5?

bipolar and related disorders
depressive disorders

2

What are the requirements for a major depressive episode?

5 of the below
diminished interst or pleasure
weight change
insomnia/hypersomia
fatigue
feelings of worthlessness
innappropiate guilt
agitation/retardation
difficulty concentrating
preoccupation with death/suicidal ideation
depressed mood

3

What is the monoamine theory of depression?

results from functionally defficient monomaine transmission
based on pharm evidence
simple monoamine hypothesis no longer tenable as explanation

4

What are the effects of tricyclic antidepressants on noradrenergic transmission?

block norepi reuptake

5

What is the restated monoamine hypothesis?

depression is due to biogenic amine receptor or transmission imbalance. Various drugs that we are discussing today, act to change the imbalance and restor a more normal affect

6

What are the classes of anti-depressants?

SSRI
SNRI (serotonin-norepi reuptake inhibitors)
atypical drugs
tricyclic antidepressants
MAO inhibitors

7

What are the symptoms of SSRI withdrawal?

dizziness, light-headedness, vertigo or faint feeling
shock like
paresthesia
anxiety
diarrhea
fatigue
gait instability
headache
insomnia
irritability
nausea or vomitting
tremor
visual disturbances

8

What are approved uses of SSRI's?

major depression
OCD
panic disorder
social anxiety disorder
PTSD
Generalized anxiety disorder
PMS-now PDD
hot flashes

9

What are SSRI's?

fluoxetine-first SSRI on market
Setraline-similar in action; shorterhalf life

10

What is the main SNRI drug?

block both 5-HT and NE reuptake
duloxetine-(12-18 hour half life)

11

What is duloxetine used to treat?

depression, neuropathic pain, fibromyalgia, back pain, and osteoarthritis, caution with liver disease

12

What are the common atypical antidepressants?

Bupropion-approved for nicotine withdrawal and SAD; weakly blocks NE and dopamine uptake.
Mirtazapine-blocks presynaptic alpha2 receptors in braine increases appeptide in AIDS pts

13

What is the tricyclic antidepressants?

first highly effective drug for tx of depression. Block NE and 5HT reuptake
long plasma half life

14

What drug interactions occur with tricyclic antidepressants?

guanethidine-blocks guanethidine uptake
sympathomiimetic drugs-particulary indrect acting agents
effects absorption and metabolism

15

What are the therapeutic uses of tricyclic antidepressants?

major depressive disorder
enursis in childhood\
chonic pain-(amitriptyline)
OCD-clomipramine and SSRIs

16

What is the role of MAO inhibition in treating depressant?

action takes about 2 weeks
may trigger hypomainia in bipolar
corrects sleep disorder in depressed patient
produce normal stimulation

17

What are other treatments for depression?

Electroconvulsive shock therapy
transcranial magnetic stimulation

18

What drugs are nonspecifci blockers of NE and 5-HT reuptake?

Imipramine, amitriptyline

19

SSRI

fluoxetine, sertaline, paroxetine, citalopram, escitalopram

20

What is a SNRI?

Venlafaxine, Duloxetine

21

What are monoamine oxidase inhibitors

phenelzine

22

Other monoamine mechanisms

bupropion, mirtazapine

23

What are the symptoms of schizophrenia?

1 positive, 2 minimum for 1 month
positive:
delusions
hallucinations
disorganized speech
other
grossly disorganized or catatonic behavior
blunted affect
poor abstract
poverty of thought
social withdrawal

24

What is the dopamine hypothesis?

Schizophrenia results from hyperactivity of dopaminergic neruosn or their receptors particulary with terminals in limbic area
MA-all effective antipsychotics interact with dopamine

25

What are hte dopaminergic pathways?

mesolimbic tract
mesocortical tract
nigrostriatal pathway
tuberonifundibular tract

26

atypical antipsychotics are what?

most of hte newer drugs such as clozapine, risperidone; have additional effect in addition to DA receptor blockade
block 5-HT2 receptor in forebrain often with greater potency than for DA receptors

27

Actions of antipsychotic drugs?

decrease in psychotic behavior, sedation, extrapyradmial effects
orthostatic hypertension, anticholinergic, allergic and idiosyncratic effects, neuroendocrin effects
decreased seizure threshold, weight gain

28

What atypical antipsychotic has cardiac effects?

Thioridazine

29

What is neruoleptic malignant syndrome?

Potentially lethal hypodopaminergic side effect of antipsychotic drugs; hyperthermia

30

What is phenothiazine?

original antipsychotic, currently less commonly used

31

What is haloperidol used for?

not chemically related to phenothiazine but it is a pharm similar to high-potency piperazine derivative; typical antipsychotic

32

What is the difference of atypical drugs?

Need for better antipsychotic drugs, more acceptable side-effect profile, more efficacious in tx negative symptpms of schizophrenia

33

What is clozapine?

block D4 and 5-HT2; muscarinic antagonists. Improve positive symptoms even in pts not helped by other drugs
improves negatives symptoms
lower seizure thresholds

34

What is olanzapine?

related to colzapine
potent 5-HT2 antagonist
D1 and 2 antagonist
few extrapyramidal symptoms
less seizure incidence than clozapine
no agranulocytosis

35

What is risperidone?

Combined D2 adn 5HT2 antagonist
greater reduction in negative symptoms and less extrapyramidal symptoms
less seizure activity

36

WHat is the DSM4 criteria for manic episodes?

inflated self-esteem/grandiosity
decreased need for sleep
talkativeness
flight of ideas/racing thoughts
distractability
increased goal-directed activity
excessive involvement in pleasureable activities

37

What is lithium?

monovalent cation; one of few psychotherapeutic drugs that has no behavioral effects in "normals"
blocks manic behavior

38

What has an effect on Lithium levels?

Na levels; increased Na secretion causes increase in Li levels;
thiazide diuretics, losses of fluids or electrolytes
ACE inhibitors and Angiotensin 2 receptor blockers can also raise Li levels

39

Side effects and toxic raections of Lithium?

fatigue and muscular weakness
tremor-may be treated with beta-blcokers
GI symptoms; slurred speech and ataxia
serious toxicity at plasma lvels about 2 to 3 times levels

40

What are the clinical uses of lithium?

treat mania na dpreven recurrences of bipolar disease
may be useful in preventing recurrences of unipolar depression
cluster headaches

41

Alternatives to lithium are what?

carbamazepine
Valproic acid
haloperidol
olanzapine and fluoxetine

42

What is Carbamazepine mechanism of action?

Mechanism of action similar to phenytoin; blocks sodium channel at therapeutic concentration
; doesn't appear to interact with GABA systems

43

What is the mechanism of action of valproic acid?

blocks repetitive neuronal firing; may reduce t type Ca2+ currents; increase GABA concentrations

44

What is the clinical uses of Valproic acid?

absence seizures
absence seizures with concomitant-gernalized tonic-clonic seizures
generalized tonic-clonic seizures and partial seizures
myoclonic seizures

45

What are the side effects of valproic acid?

GI upset, weight gain, hair loss, idiosyncratic hepatotoxicity, tetraogenicity-spinal bifida

46

What are the DSM-5 anxiety disorders?

Key syndrome is excessive fear and anxiety;
ANS fight or flight sympoms
muscle tesnsion and vigilance

47

What are the disorders in anxiety classification?

separation anxiety disorder
selective mutism
specific phobia
social anxiety disorder
panic disorder
agoraphobia
GAD

48

Generalized anxiety disorder classifications are what?

generalized persistent anxiety for at least 1 month duration
absence of specific symptoms and patterns

49

Tx of anxiety and insomnia is done with what classes of drugs?

benzos
SSRIs
Buspirone
classical antihistamines
Barbituates

50

What is mechanism of action of Buspirone?

partial agonist for 5HT1A inhibition of adenylate cyclase and opens K+ channels

51

What are hte three common benzodiazepines used to treat anxiety?

diazepam, alprazolam, Lorazepam

52

What drugs have desmethyldiazepam and oxazepam as active metabolites?

Chlordiazepoxide, Diazepam, Prazepam, Clorazepate

53

What are the CNS effects of benzothiazepines?

decreased anxiety, sedation, hypnosis, muscle relaxation, anterograde amnesia, anticonvulsant action,
minimal CV and respiratory actions at Tx dose

54

What are the clinical uses of diazepam?

anxiety states, sleep disorders, muscle relaxant, seizure treatment, IV sedation and anesthesia

55

What benzothiazepine is used for alcohol withdrawal?

chlordiazepoxide

56

What benzothiazepine is used for acute manic episodes?

clonazepam

57

What are the benzodiazepine withdrawal symptoms?

anxiety, insomnia, irritability, headache, hyperacusis, hallucinations, seizures

58

What drugs used as hypnotics?

flurazepam
Triazolam
lorazepam
zolpidem

59

What non-benzodiazepine binds BDZ receptor on GABA complex?

Zolpidem

60

What two GABAergic agents are used treat skeletal muscles?

Diazepam
Baclofen

61

What alpha2 adrenergic agonists that is used to relate to clonidine?

Tizanidine