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Flashcards in Physchopharmacology Deck (107):
1

What are some psychotropic medications

Sedative hypotonic (anti-anxiety)
Anti-depressants
Antipsychotics
Treatments of dementia

2

Primary goals of the sedative Sedative Hypotonic; Anti anxiety drugs

Want to relax the patient
Have good quality sleep
Decrease their anxiety

3

How do we monitor their sleeping patterns

Look at electrocardiogram (EKG)

4

What are the primary agents for Sedative Hypotonic/Anti anxiety drugs

Benzodiazepine and many others

5

What is one thing we must monitor with anti anxiety drug dosage

Do not want to much sedation or sleep so they are still able to perform functions

6

Explain the Sedative hypotonic Benzodiazepine drugs

Popular 20-30 years ago
Were essentially sleeping pills

7

Explain the antidepressant Benzodiazepine drugs

These will have a less sedative effect unless it has a high dosage.
More focused for anxiety can be used for sleep

8

Types of Sedative hypotonic Benzodiazepine drugs

Estazolam
Quazepam
Temazepam
Triazolam (housien)

9

Types of Anti-Depressant Benzodiazepine drugs

Diazepam(Valium)
Chlordiazepoxide
Iorazepam
Alprazolam

10

How do Benzodiazepines work

Increase the inhibitory effects of GABA by binding to receptor
Allows Cl to enter and the neuron becomes harder to excite
Inhibit NT's and decrease excitation of CNS

11

What are the new sedative hypnotic drugs

Z- drugs (zolpidem and Zalepion)
Eszopiclone(lunesta)
Ramelteon (Rozerem)

12

Explain how the the z drugs differ and are similar to the benzodiazepines

They are chemically different but they will both bind to the GABA receptors.
Will bind to other subunits
May have less problems with discontinuing (less rebound)

13

Explain Eszopiclone (lunesta)

Works similar to benzodiazepine. Will bind to GABA receptor cite. chemically different

14

Explain Ramelteon

It is a melatonin receptor agonist

15

What are some of the benifits of the newer sedative hypnotic drugs

Have been used for treating insomnia(long term effects not established yet)
Having these drug options offer patients the ability to find the drug that works best for them

16

What are the newer anti-anxiety drugs

Azapirones: Buspirone (BuSpar)

17

How do the Azapirones work

Stimulate serotonin receptors in CNS

18

What are the benefits of Azapirones

May decrease anxiety with less sedation and less dependence

19

What are some drawbacks of the Azapirones

There is a slow onset and only moderate efficacy

20

Who would Azapirones work best for

Older patients with anxiety

21

What can be used with patients who have anxiety and depression

Use antidepressants as an anxiolytic (inhibit anxiety)

22

What are some benifits of using an antidepressant as an anxiolytic

Has less addictive effects may have less side effects

23

What does -quetiapine mean

Anti psychotic

24

What does gabapentin do

Anti Seizure

25

What is pregabalin

Anti seizure

26

What is hydroxygine

Anti-histamine

27

What are some side effects of the sedative hypnotic/anti-anxiety drugsdrugs (5)

Sleeping (hangover effect, confused, nauseous)
Agitated
Anterograde: loss of memory (short term memory)
Rebound effect (insomnia, increased anxiety)
Tolerance/Dependence

28

What are some complex behaviors that can occur from sedative hypnotic/anti-anxiety drugs

Sleep eating/walking/ even driving
Due to the dosage being too high

29

What disease may be associated with sedative hypnotic/anti-anxiety drugs

Alzheimer may be linked with benzodiazepines
Numbs the brain

30

What are some concerns with sedative hypnotic/anti-anxiety drugs

They treat the symptoms but do not treat the cause of insomnia or anxiety
Do the benefits outweigh the sedation

31

How can we make the sedative hypnotic/anti-anxiety drugs more effective

Pair the drugs with non pharmacy treatment such as physical therapy

32

What is the ideal situation while using sedative hypnotic/anti-anxiety drugs

Getting quality sleep with less anxiety
Becoming more active and participating socially

33

Define Depression

Sadness that is incapacitating (can't enjoy life, family or job)

34

How common is depression

Is the most common mental illness based on incidence and prevalence

35

What is the basis of neurochemical study of depression

If we understand the neurochemistry of depression we can better treat the pt

36

What is the current theory in neurophysiology on depression

Caused by a deficit of biogenic amines or neurotransmitters in the CNS

37

What are some biogenic amines that would cause depression if they were in deficit

Norepinephrine
Dopamine
Serotonin

38

What is the strategy of anti depression drugs

Prolong the effects of the biogenic amines

39

What are the types of antidepressants

Tricyclics
Monoamine oxidase (MAO) inhibitors
Second generation drugs
Selective serotonin reuptake Inhibitors (SSRI)
Serotonin-norenepherine Reuptake Inhibitor (SNRI)

40

What are some SSRI's

Prozac
Zoloft
Lexapro
Celexa

41

What are some SNRI.

Pristiq
Cymbalta
Effexor

42

What is the goal of SSRI

Works on the limbic system
Is a famous anti-depressant
Will have little to no effect on NEP or dopamine

43

What is the goal of SNRI

Works only on the serotonin and NEP.
No effect on dopamine

44

What are Tricyclics

Oldest form of antidepressants
Not well known but very effective

45

What are the names of some tricyclic drugs

Elavil
Ascending
Norpramin

46

What are the MAO drugs used for

Used as a last resort for ant depression

47

What do the drugs nefaodone and Trazodone do

Block serotonin receptors and serotonin uptake

48

What does the drug bupripion do

It is a Norepinephrine and dopamine reuptake inhibitor

49

What does the drug mirtazapine do

May clock the presynaptic but is very complicated

50

How do the antidepressant drugs work

They will prolong the effects of the amine neurotransmitter by
1) inhibiting the NT reuptake (SSRI/SNRI)
2) Preventing the NT breakdown (MAO inhibitor)

51

How will MAO inhibitors prevent the breakdown of NT's

1) They will recycle the NT by reuptaking them into the presynaptic neuron
2) Inhibit the enzymes that break down the NT's

52

How will tricyclics and 2nd generation drugs work on NT

They cause the NT to remain in the synapse so they activate the receptors on the postsynaptic neuron over and over

53

Adverse effects of Tricyclics

Sedation
Anticholinergic (dry mouth, seizures, could be fatal)
Orthostatic hypertension (sudden increase in blood pressure when someone stands up)

54

Adverse effects of MAO inhibitors

CNS excitation
Increase blood pressure (especially those who eat femented foods)

55

Adverse effects of Second generation drugs

These are generally better tolerated but can have some GI issues with overdose

56

Which second generation drugs are more tolerable

SSRI and SNRI

57

What is Serotonin syndrome

Occurs when the serotonin receptors are over stimulated

58

What are some symptoms of serotonin syndrome (5)

High blood pressure and HR
Shivering
Dyskinesia
Muscle pain
GI problems

59

Is serotonin syndrome reversible

Usually if it is caught early
If unchecked it could be fatal

60

What are some concerns with anti depressants

May be 1-2 weeks before we see effects
Could become more depressed if they are not getting better fast enough
Could cause harm to themselves (mood swing)

61

How long do we wait before the antidepressant is deemed ineffective

6 weeks

62

What drug is used to treat bipolar syndrome

Lithium

63

What is the mechanism of action for lithium

Unclear, thought to prevent manic episode
May stabilize neurons (neuroprotective)

64

How is lithium eliminated

Remains intact and eliminated through kidneys

65

What is lithium toxicity

Accumulation of lithium in the kidney

66

Symptoms of mild lithium toxicity (4)

Metallic taste
Fine Tremor in hands
Nausea
Generalized weakness

67

Symptoms of moderate lithium toxicity (5)

Vomiting
Diarrhea
Increased tremors
Dizziness/incoordination
Blurred vision

68

Symptoms of severe lithium toxicity

Confusion
Hallucinations
Nystagmus (involuntary eye movement)
Dysarthia (motor speech)
Fasciculation (muscle twitching)

69

How will lithium toxicity progress

It could be slow or rapid
Need to monitor closely
Need to catch early or it will damage the cerebellum

70

What are anti-manic effects

Prevent swing from manic to depressed

71

What are some other bipolar treatments

Anti-seizure
Antipsychotic

72

What are some drawbacks of using drugs other than lithium to treat bipolar disorders

May cause some movement disorders or other side effects associated with Anti-seizure or antipsychotic drugs

73

What is psychosis

More severe than depression or anxiety
May see or hear things
Have fragmented thoughts

74

What causes psychosis

Increase dopamine acting on the CNS as well as other NTs

75

How do antipsychotic drugs work

They block the dopamine receptors in the CNS specifically the D2 receptors

76

How much dopamine is blocked with antipsychotic drugs

Not all of the dopamine, just enough
Called normalize dopamine

77

Why are the new antipsychotic drugs called atypical agents

They do not have the typical side effects as the traditional drugs

78

What NT may antipsychotic drugs improve

Serotonin

79

What are some adverse side effects of the traditional antipsychotic drugs

Orthostatic hypertension
Sedation
Anticholinergic effects

80

What are some adverse side effects of atypical antipsychotic drugs

Weight gain
Disturbed fat and sugar digestion

81

What is the primary concern of antipsychotic drugs

Motor side effects (MOST IMPORTANT)

82

What are some extrapyramidal side effects of antipsychotic drugs (4)

Tardive Dyskinesia
Psuedoparkinsonism
Akathisia
Other dystonias or dyskensisa of extremities ( Chorea Athletoid)

83

What is Tardive Dyskinesia

Oral facial movements; lips, tongue, jaw, grimacing
*Could be permanent even if found early

84

What is Psuedoparkinsonism

Decrease in dopamine activity
We want to decrease it but in a different par of the brain
May go away after taken off drug

85

What is akathisia

Severe restlessness

86

What causes Tardive Dyskinesia

Denervation will occur and then new synapses are formed

87

What is the prevalence of Tardive Dyskinesia

1/4 of patients with long term antipsychotic drugs

88

What puts you at risk for Tardive Dyskinesia

Genetic issues
Mood disorders
Using antipsychotic drugs over 6 months

89

What is neuroleptic malignant syndrome

Cancerous
Can occur with all antipsychotic drugs
Can be fatal

90

What are some symptoms of neuroleptic malignant syndrome (4)

Rigidity
Catatonia(unresponsive)
Tremors
Fever

91

What is Alzheimer's disease

Irreversible dementia
Due to shrinking of the brain

92

What will change in the CNS (3)

Neuronal structure
Neuronal function (Loss of neuronal activity)
Will not be a minor change, will be profound throughout the entire brain

93

What are the goals when treating dementia

Improve their cognitive and intellectual abilities
Improve their behavior

94

How to improve function in patients with dementia

Neuronal changes decrease acetylcholine activity in brain
Effects the higher part of the cortex (involved in memory)
Cholinergic stimulants used to increase ACH activity either indirectly or directly

95

How do indirect Cholinergic drugs effect dementia

Will not directly effect the ACH receptor
Inhibits enzyme that breaks down ACH

96

What enzyme will break down ACH

Cholinesterase

97

What are the Cholinergic stimulants in Alzheimer disease

Aricept
Razadyne
Exelon
Cognex

98

What are some indications to use Cholinergic stimulants

To improve cognition
Behavior function
Memory

99

What determines the efficacy of Cholinergic stimulants

If it helps them retain more cognitive information in the early stages of Alzheimer's

100

When will Cholinergic stimulants be ineffective in treating AD

When there is rapid progression of the disease.
Due to not producing neurotransmitters

101

What is memantine

New form of AD drug which blocks NMDA-glutamate receptors in the brain

102

What does glutamate do to the brain

Excitatory amino acid that is used in memory and learning

103

What is the mechanism of Memantine

During AD glutamate activity is disrupted. Drug will normalize glutamate influence

104

What is a potential problem of memantine

Too little or too much dosage could be harmful and actually advance the disease.

105

What are some drugs used to modify or improve behavior

Antidepressants
Anti-Anxiety agents
Antipsychotic

106

What role did the government play in antipsychotic drugs

Placed regulations on the use of drugs due to OD
-Can't just use antipsychotic just because the pt's behavior is "unacceptable

107

What is symptom specific medication, and what disease is it associated with

Using the type of medication based on the problems the patient presents with.
Alzheimer's