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PDA neuropsycohparm Flashcards

1
Q

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

A

bipolar and related disorders

depressive disorders

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2
Q

What are the requirements for a major depressive episode?

A 
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
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3
Q

What is the monoamine theory of depression?

A

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

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4
Q

What are the effects of tricyclic antidepressants on noradrenergic transmission?

A

block norepi reuptake

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5
Q

What is the restated monoamine hypothesis?

A

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

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6
Q

What are the classes of anti-depressants?

A 
SSRI
SNRI (serotonin-norepi reuptake inhibitors)
atypical drugs
tricyclic antidepressants
MAO inhibitors
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7
Q

What are the symptoms of SSRI withdrawal?

A 
dizziness, light-headedness, vertigo or faint feeling
shock like
paresthesia
anxiety
diarrhea
fatigue
gait instability
headache
insomnia
irritability
nausea or vomitting
tremor
visual disturbances
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8
Q

What are approved uses of SSRI’s?

A 
major depression
OCD
panic disorder
social anxiety disorder
PTSD
Generalized anxiety disorder
PMS-now PDD
hot flashes
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9
Q

What are SSRI’s?

A

fluoxetine-first SSRI on market

Setraline-similar in action; shorterhalf life

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10
Q

What is the main SNRI drug?

A

block both 5-HT and NE reuptake

duloxetine-(12-18 hour half life)

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11
Q

What is duloxetine used to treat?

A

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

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12
Q

What are the common atypical antidepressants?

A

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

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13
Q

What is the tricyclic antidepressants?

A

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

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14
Q

What drug interactions occur with tricyclic antidepressants?

A

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

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15
Q

What are the therapeutic uses of tricyclic antidepressants?

A

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

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16
Q

What is the role of MAO inhibition in treating depressant?

A

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

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17
Q

What are other treatments for depression?

A

Electroconvulsive shock therapy

transcranial magnetic stimulation

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18
Q

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

A

Imipramine, amitriptyline

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19
Q

SSRI

A

fluoxetine, sertaline, paroxetine, citalopram, escitalopram

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20
Q

What is a SNRI?

A

Venlafaxine, Duloxetine

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21
Q

What are monoamine oxidase inhibitors

A

phenelzine

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22
Q

Other monoamine mechanisms

A

bupropion, mirtazapine

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23
Q

What are the symptoms of schizophrenia?

A 
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
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24
Q

What is the dopamine hypothesis?

A

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

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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

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