Physio and Psychopharm Flashcards
(53 cards)
1
Q
Dopamine (MMSLR)
A
Mood, Movement, Sleep, Learning, Reinforcement effects of drugs
Abnormal levels related to:
- Parkinson’s
- Huntington’s
- Tourette’s
- ADHD
- Depression
- Schizophrenia
2
Q
Acetylcholine (MAAM)
A
Muscles (skeletal, smooth, cardiac), Attention, Arousal, Memory
- Low levels in the hippocampus associated with memory loss in Alzheimer’s
- Cholinesterase Inhibitors - Reduce the breakdown of Acetylcholine and temporarily reverse or slow down memory loss with mild to moderate Alzheimer’s disease
3
Q
Glutamate (MMEL)
A
Movement, Memory, Emotions, Learning
- Involved in LTP - essential for the formation of long-term memories
- Excessive glutamate = excitotoxicity:
- Stroke
- Seizures
- TBI
- Huntington’s
- ALzheimer’s
4
Q
Norepinephrine (SLAAMM)
A
Sleep, learning, Attention, Arousal, Memory, Mood
Abnormal levels associated with:
- ADHD
- Mania
- Depression
Loss of norepinephrine neurons in the Locus Coeruleus is linked to the non-motor sxs of Parkinson’s:
- Depression
- Cognitive deficits
- Sleep disturbances
**Catecholamine Hypothesis: some forms of depression are due to deficiency of norepinephrine while mania is due to excessive levels
5
Q
Serotonin (HAAMPSS)
A
Hunger, Arousal, Aggression, Mood, Pain, Sleep, Sex
Low levels:
- Depression
- Increased risk for suicide
- OCD
- Bulimia
- Migraines
Excessive levels:
- Schizophrenia
- Autism
- Anorexia
6
Q
GABA (MMMS)
A
Memory, Mood, Motor Control, Sleep
Abnormally low levels of GABA:
- Anxiety
- Mania
- Insomnia
- Seizure disorders
- Parkinson’s disease
- Huntington’s disease
*Benzos enhance GABA and reduce anxiety and induce sleep
7
Q
Locus Coeruleus
A
- Nucleus in the pons
- Involved with physiological responses to stress and panic
8
Q
Endorphins
A
- Inhibitory neurotransmitters
- Effects are similar to opioid drugs
- Contribute to feelings of pleasure, well-being, and reduce perception of pain
- Produced by the pituitary gland in the hypothalamus during running and exercise
9
Q
Hindbrain Structures
A
Cerebellum
Pons
Medulla Oblongata
10
Q
Medulla
A
- Involuntary throat and mouth movements - swallowing, coughing, sneezing
- Regulates vital autonomic NS: respiration, HR, BP, digestion
Brain injuries, certain diseases, and other drugs can disrupt the functioning of the medulla and result in death
11
Q
Pons
A
- Connects the 2 parts of the cerebellum (helps coordinate movements on 2 sides of body)
- Connected medulla to cerebellum
- Connects cerebellum to forebrain
Involved in:
- Arousal
- Sleep
- Regulation of respiration
12
Q
Cerebellum
A
- Coordinates and sequences complex voluntary movements initiated in the motor cortex
- Maintains posture and balance
- Processes and stores procedural memories
Damage can cause ataxia:
- Lack of muscle control
- Impaired balance and coordination
- Slurred speech
- Blurred or double vision
13
Q
Midbrain Structures
A
Reticular Activating System, Substantia Nigra, and Superior and inferior colliculi
14
Q
Reticular Activating System
A
- Alerts cortex to incoming sensory info
- Role in: Sleep & wakefulness, Attention, Behavioral arousal, consciousness
Lesions in the RAS can cause: comatose state
Extends from the medulla to the midbrain
Direct electrical stimulation of the RAS or stimulation by sensory input can awaken a sleeping person and cause an awake person to become more alert
15
Q
Substantia Nigra
A
Plays a role in:
- Reward seeking behaviors
- Drug addiction
- Motor control (thru connection to basal ganglia)
Degeneration of dopamine-producing cells in the Substantia Nigra contributes to the motor sxs associated with Parkinson’s Disease:
- Slowed movement
- Tremors
- Muscle rigidity
- & other motor sxs
16
Q
Frontal Lobe
A
- Execeutive cognitive functions
- Expressing emotions
- Speech production (Broca’s area)
17
Q
Damage to Dorsolateral area
A
- Damage to dorsolateral:
- Perseverative responses (inappropriate repetition)
- Depression, decreased range of emotions
- Impaired attention, working memory, judgment, abstract thinking
18
Q
Damage to orbitofrontal area
A
Disinhibited syndrome:
- Behavioral disinhibition, distractibility, emotion lability, inappropriate euphoria, and acquired sociopathy (risk taking behaviors, lack of empathy and insight, and a persistent need for immediate gratification)
19
Q
Damage to mediofrontal area
A
Apathetic-Akinetic syndrome:
- Decreased motor behavior and verbal output
- Lack of motivation and goal-directed activities
- Apathy and indifference
20
Q
Broca’s Area
A
Damage results in Broca’s aphasia (expressive aphasia)
- Slow, labored speech (primarily nouns & verbs)
- Impaired repetition
- Anomia (inability to recall the names of familiar objects)
- Relatively intact comprehension of written and spoken language
21
Q
Parietal Lobe & Damage
A
- Somatosensory cortex
Processes sensory info related to: touch, pressure, temp, pain, body position
Result of damage depends on the location:
- Somatosensory Agnosias:
- Tactile agnosia - inability to recognize objects by touch
- Asomatognosia - Lack of recognition of one or more parts of the body
- Anosognosia - denial of one’s own illness or disability - Contralateral Neglect - neglect of one side of the body
- Gerstmann’s Syndrome:
- Usually caused by damage to the dominant (usually left) hemisphere:- Finger agnosia
- Right/Left disorientation
- Agraphia - loss of writing skills
- Acalculia - loss of math skills
22
Q
Temporal Lobe
A
- Auditory cortex & Wernicke’s area
Damage to auditory cortex:
- Auditory agnosia - impairments in sound perception and identification
- Auditory hallucinations
- Cortical deafness (unresponsive to all sounds)
Wernicke’s area:
- Lives in dominant hemisphere
- Damage is Wernicke’s Aphasia or Receptive Aphasia
- Impaired comprehension of written and spoken language
- Impaired repetition
- Anomia
- Speech is fluent! but incoherent and meaningless
23
Q
Arcuate Fasciculus
A
Bundle of axons that connects Broca’s and Wernicke’s area
Damage - Conduction Aphasia!
- Comprehension is relatively intact
- Fluent speech w/ many errors
- Anomia
- Impaired repetition
24
Q
Occipital Lobe
A
- Visual cortex
- Damage to visual cortex:
- Visual agnosia - patients cannot recognize objects (w/ anomia, they recognize but cannot name them)
- Visual hallucinations
- Achromatopsia (loss of color vision)
- Cortical blindness (loss of vision)
- Damage (bilateral lesions) to the occipitotemporal junction
- Prosopagnosia - Inability to recognize the faces of familiar people
25
Structural Neuroimaging Techiques
1. CAT scan - uses x-rays to obtain images of horizontal slices of the brain
- costs less than an MRI
- provides images more rapidly
- doesn't require motionlessness
- can be used with pacemakers, metal
2. MRI - using strong magnetic fields and radio waves
- cross-sectional images of the brain
- produces 3 dimensional and more detailed images
- doesn't require the use of radiation
- can be used for brain and other parts of the body
26
Functional Neuroimaging Techniques
PET, SPECT, fMRI
1. PET - patient is injected with radioactive tracer that is taken up by active brain cells
2. SPECT - similar to PET but easier and less expensive - but less detailed images
3. fMRI - similar to MRI but provides information on changes in blood oxygenation and flow
27
TBI
Open vs. Closed
- Consequences of open injury depend on its location and severity
Closed injuries can share several characteristics:
- Cause more widespread damage
- Loss or alternation of consciousness
- Combo of emotional, cognitive, behavioral, and physical sxs
- Anterograde and retrograde amnesia are common
- Duration of anterograde (post-traumatic) amnesia is an indication of severity of TBI and a good predictor of recovery
- Most ppl and esp with mild TBI, experience significant recovery from sxs in the first 3 months and more recovery in the 1st year
- However, many ppl continue to have some sxs indefinitely, esp those with moderate to severe injuries
- Severe MDD is the most common diagnosis regardless of severity of injury
28
Cerebrovascular Accident (CVA) & risk factors
Stroke!
*Caused by sudden interruption of blood flow to the brain
Risk factors:
- Hypertension
- Cigarette smoking
- Alcohol use
- Atrial fibrillation (irregular heartbeat can lead to blood clots)
- Atherosclerosis (plaque build-up in the arteries)
- Diabetes
- High cholesterol
29
Cerebrovascular Accident Sxs & Artery
Middle Cerebral Artery:
*Most often involved!
- Supplies blood to the frontal lobe & lateral temporal and parietal lobe
Sxs:
- Contralateral sensory loss
- Weakness or paralysis (esp. in arm or face)
- Impaired vision
- DOMINANT hemisphere - Aphasia (inability to understand or express speech)
- NON-DOMINANT - Contralateral neglect & apraxia (inability to perform correct movement)
```
Aterior Cerebral Artery
- Supplies blood to frontal lobe and parietal lobes
Sxs:
- Contralateral sensory loss
- Weakness or paralysis, esp. in the leg
- Impaired insight and attention
- Impaired speech
- Confusion
- Apathy
```
Posterior Cerebral Artery
- Supplies blood to temporal and occipital lobes
Sxs:
- Memory deficits
- Unilateral cortical blindness
- Color agnosia (inability to name colors)
- Other visual impairments
30
Huntington's Disease
- Caused by autosomal dominant gene
- Linked to abnormal levels in the basal ganglia of:
- GABA
- Glutamate
- Dopamine
- Onset of sxs is between 30-50
SEQUENCE of sxs:
1. Affective
2. Cognitive
3. Motor
Initial sxs:
- Depression
- Apathy
- Or other affective sxs
Followed by:
- Forgetfulness (short term memory loss)
- Impaired concentration
- Impaired judgment
- Other cog sxs
& then:
- Clumsiness
- Fidgeting
- Facial twitches
- Other motor sxs
As the disease progresses...
- Athetosis - (slow, writhing movements)
- Chorea (abnormal involuntary rapid jerky movements in arms, legs, and trunk)
- Person may eventually develop mild or major neurocognitive disorder
* *Motor sxs become severe, person has trouble speaking and swallowing
31
Athetosis and Chorea
Sxs as Huntington's Disease progresses
- Athetosis - (slow, writhing movements)
- Chorea (abnormal involuntary rapid jerky movements in arms, legs, and trunk)
32
Parkinson's Disease
- Caused by a loss of dopamine-producing cells in the substantia nigra (which in turn affects the basal ganglia)
- Cause of the degeneration is not known - but some cases may be related to exposure to some toxins or chemicals
Primary sxs:
- Impaired balance & equilibrium
- Muscle rigidity
- Slowed voluntary movement
- Tremors (begins in hands, pill rolling)
Many ppl also experience:
- Depression (up to 50%)
- Anxiety (up to 40%)
- Delusions and/or hallucinations (usually in later stages of disorder)
- Some ppl may eventually develop mild or major neurocogitive disorder
* No cure for Parkinson's but tremors and other motor sxs are temporarily alleviated in the early stages with Aldopa!
- Aldopa acts as a dopamine agonist and increases dopamine
- Offspring have a 50% chance of inheriting it
33
Seizure Disorders
Caused by abnormal electrical activity in the brain
FOCAL ONSET VS. GENERALIZED ONSET
Focal Onset:
- Begin in a localized area in one side of the brain and affect one side of the body
- They may spread and become generalized seizures
Sxs:
- Depend on the origins of the seizure, may include:
- Abnormal sensations
- Hallucinations
- Sense of deja vu
- And/or automatisms (repetitive movements - grunts, founds, walking in circles)
Focal Onset AWARE VS. IMPAIRED AWARENESS SEIZURES
Focal Onset AWARE Seizures (AKA Simple Partial Seizures)
- Don't affect consciousness
- Usually last less than 2 minutes
Focal Onset Impaired Awareness Seizures (AKA Complex Partial Seizures)
- Cause a change in consciousness
- May begin with an Aura
- Usually last 1-2 minutes
GENERALIZED ONSET SEIZURES:
- Affect both sides of the brain
- MOTOR VS NON-MOTOR SEIZURES
Generalized onset MOTOR Seizures:
- AKA Tonic-Clonic Seizures or Grand Mal
- Change in consciousness
- Tonic Phase (stiffening of muscles in face and limbs)
- Followed by Clonic phase (Jerky, rhythmic movements)
- After - they may be depressed, confused, fatigued, and non memory of event
Generalized onset NON-MOTOR seizures
- AKA absent seizures and Petit Mal Seizures
- Loss of consciousness that lasts 10-20 seconds
- Blank or absent stare
- For some ppl, eye fluttering, head nodding, hand movements
- When seizure ends, person often continues doing what he or she was doing
34
First generation/Traditional/Conventional Antipsychotics Names
1. Chlorpromazine (Thorazone)
2. Haloperidol (Haldol)
3. Thioridazine (Mellaril)
4. Fluphenazine (Prolixin)
FLU-CHLOR-HALO-THIOR
35
First generation/Traditional/Conventional Antipsychotics Attributes
1. Chlorpromazine (Thorazone)
2. Haloperidol (Haldol)
3. Thioridazine (Mellaril)
4. Fluphenazine (Prolixin)
- Used to tx Schizophrenia and other disorders with psychotic sxs and are more effective for positive sxs than negative!
- Exert their effect by BLOCKING DOPAMINE (supported the dopamine hypothesis of Schizophrenia)
- Dopamine antagonists
Major Side Effects:
1. ANTICHOLINERGIC effects (Block acetylcholine)
- Dry mouth, blurred vision
- Constipation & Urinary retention
- Tachycardia (high ass HR)
- Confusion
- Impaired attention & concentration
2. EXTRAPYRAMIDAL Effects
1) Parkinsonism (resting tremor, muscle rigidity, slowed movement)
2) Dystonia - uncontrollable muscle spasms in head and neck
3) Akathisia - restlessness and pacing
4) Tardive Dyskinesia
* Potentially life threatening, usually begins after months or years
- Usually repetitive movements of tongue, face, jaw
- Over time, may affect limbs and trunk
* Irreversible for some pts
* TREATED by gradually waning off and switching to 2nd gen (OR dopamine depleting or GABA enhancing drug)
* For some, getting off the drug may not lessen sxs and it might get worse before they decrease
3. NEUROLEPTIC MALIGNANT SYNDROME
* *Rare, life-threatening side effect
1) Muscle rigidity
2) Hyperthermia
3) Autonomic dysfunction - unstable BP, Tachycardia, rapid breathing
4) Altered mental state - confusion, disorientation, agitation
* Have person stop taking the drug at the first sign of sxs
- Providing medical tx and supportive care for specific sxs
36
First generation/Traditional/Conventional Antipsychotics Attributes
1. Chlorpromazine (Thorazone)
2. Haloperidol (Haldol)
3. Thioridazine (Mellaril)
4. Fluphenazine (Prolixin)
- Used to tx Schizophrenia and other disorders with psychotic sxs and are more effective for positive sxs than negative!
- Exert their effect by BLOCKING DOPAMINE (supported the dopamine hypothesis of Schizophrenia)
- Dopamine antagonists
Major Side Effects:
1. ANTICHOLINERGIC effects (Block acetylcholine)
- Dry mouth, blurred vision
- Constipation & Urinary retention
- Tachycardia (high ass HR)
- Confusion
- Impaired attention & concentration
2. EXTRAPYRAMIDAL Effects
1) Parkinsonism (resting tremor, muscle rigidity, slowed movement)
2) Dystonia - uncontrollable muscle spasms in head and neck
3) Akathisia - restlessness and pacing
4) Tardive Dyskinesia
* Potentially life threatening, usually begins after months or years
- Usually repetitive movements of tongue, face, jaw
- Over time, may affect limbs and trunk
* Irreversible for some pts
* TREATED by gradually waning off and switching to 2nd gen (OR dopamine depleting or GABA enhancing drug)
* For some, getting off the drug may not lessen sxs and it might get worse before they decrease
3. NEUROLEPTIC MALIGNANT SYNDROME
* *Rare, life-threatening side effect
1) Muscle rigidity
2) Hyperthermia
3) Autonomic dysfunction - unstable BP, Tachycardia, rapid breathing
4) Altered mental state - confusion, disorientation, agitation
* Have person stop taking the drug at the first sign of sxs
- Providing medical tx and supportive care for specific sxs
36
First generation/Traditional/Conventional Antipsychotics Attributes
1. Chlorpromazine (Thorazone)
2. Haloperidol (Haldol)
3. Thioridazine (Mellaril)
4. Fluphenazine (Prolixin)
- Used to tx Schizophrenia and other disorders with psychotic sxs and are more effective for positive sxs than negative!
- Exert their effect by BLOCKING DOPAMINE (supported the dopamine hypothesis of Schizophrenia)
- Dopamine antagonists
Major Side Effects:
1. ANTICHOLINERGIC effects (Block acetylcholine)
- Dry mouth, blurred vision
- Constipation & Urinary retention
- Tachycardia (high ass HR)
- Confusion
- Impaired attention & concentration
2. EXTRAPYRAMIDAL Effects
1) Parkinsonism (resting tremor, muscle rigidity, slowed movement)
2) Dystonia - uncontrollable muscle spasms in head and neck
3) Akathisia - restlessness and pacing
4) Tardive Dyskinesia
* Potentially life threatening, usually begins after months or years
- Usually repetitive movements of tongue, face, jaw
- Over time, may affect limbs and trunk
* Irreversible for some pts
* TREATED by gradually waning off and switching to 2nd gen (OR dopamine depleting or GABA enhancing drug)
* For some, getting off the drug may not lessen sxs and it might get worse before they decrease
3. NEUROLEPTIC MALIGNANT SYNDROME
* *Rare, life-threatening side effect
1) Muscle rigidity
2) Hyperthermia
3) Autonomic dysfunction - unstable BP, Tachycardia, rapid breathing
4) Altered mental state - confusion, disorientation, agitation
* Have person stop taking the drug at the first sign of sxs
- Providing medical tx and supportive care for specific sxs
37
First generation/Traditional/Conventional Antipsychotics Attributes
1. Chlorpromazine (Thorazone)
2. Haloperidol (Haldol)
3. Thioridazine (Mellaril)
4. Fluphenazine (Prolixin)
- Used to tx Schizophrenia and other disorders with psychotic sxs and are more effective for positive sxs than negative!
- Exert their effect by BLOCKING DOPAMINE (supported the dopamine hypothesis of Schizophrenia)
- Dopamine antagonists
Major Side Effects:
1. ANTICHOLINERGIC effects (Block acetylcholine)
- Dry mouth, blurred vision
- Constipation & Urinary retention
- Tachycardia (high ass HR)
- Confusion
- Impaired attention & concentration
2. EXTRAPYRAMIDAL Effects
1) Parkinsonism (resting tremor, muscle rigidity, slowed movement)
2) Dystonia - uncontrollable muscle spasms in head and neck
3) Akathisia - restlessness and pacing
4) Tardive Dyskinesia
* Potentially life threatening, usually begins after months or years
- Usually repetitive movements of tongue, face, jaw
- Over time, may affect limbs and trunk
* Irreversible for some pts
* TREATED by gradually waning off and switching to 2nd gen (OR dopamine depleting or GABA enhancing drug)
* For some, getting off the drug may not lessen sxs and it might get worse before they decrease
3. NEUROLEPTIC MALIGNANT SYNDROME
* *Rare, life-threatening side effect
1) Muscle rigidity
2) Hyperthermia
3) Autonomic dysfunction - unstable BP, Tachycardia, rapid breathing
4) Altered mental state - confusion, disorientation, agitation
* Have person stop taking the drug at the first sign of sxs
- Providing medical tx and supportive care for specific sxs
37
First generation/Traditional/Conventional Antipsychotics Attributes
1. Chlorpromazine (Thorazone)
2. Haloperidol (Haldol)
3. Thioridazine (Mellaril)
4. Fluphenazine (Prolixin)
- Used to tx Schizophrenia and other disorders with psychotic sxs and are more effective for positive sxs than negative!
- Exert their effect by BLOCKING DOPAMINE (supported the dopamine hypothesis of Schizophrenia)
- Dopamine antagonists
Major Side Effects:
1. ANTICHOLINERGIC effects (Block acetylcholine)
- Dry mouth, blurred vision
- Constipation & Urinary retention
- Tachycardia (high ass HR)
- Confusion
- Impaired attention & concentration
2. EXTRAPYRAMIDAL Effects
1) Parkinsonism (resting tremor, muscle rigidity, slowed movement)
2) Dystonia - uncontrollable muscle spasms in head and neck
3) Akathisia - restlessness and pacing
4) Tardive Dyskinesia
* Potentially life threatening, usually begins after months or years
- Usually repetitive movements of tongue, face, jaw
- Over time, may affect limbs and trunk
* Irreversible for some pts
* TREATED by gradually waning off and switching to 2nd gen (OR dopamine depleting or GABA enhancing drug)
* For some, getting off the drug may not lessen sxs and it might get worse before they decrease
3. NEUROLEPTIC MALIGNANT SYNDROME
* *Rare, life-threatening side effect
1) Muscle rigidity
2) Hyperthermia
3) Autonomic dysfunction - unstable BP, Tachycardia, rapid breathing
4) Altered mental state - confusion, disorientation, agitation
* Have person stop taking the drug at the first sign of sxs
- Providing medical tx and supportive care for specific sxs
38
Second Generation Antipsychotics (AKA Atypical) Names
1. Clozapine (Clozaril)
2. Risperidone (Risperdal)
3. Olanzapine (Zyprexa)
And...
4. Quetiapine (Seroquel)
5. Ziprasidone (Geodon)
6. Aripiprazole (Abilify)
7. Paliperidone (Invega)
39
Second Generation Antipsychotics (AKA Atypical) Attributes
Used to treat schizophrenia and other disorders with psychotic sxs
- Some are also used for monotherapy or as an adjunctive treatment for bipolar disorder or MDD
- As effective or more effective than FGA for tx of positive sxs and more affective for tx of negative sxs!
- SGA may be effective when FGA aren't (esp Clozapine)
- SGAs exert their effects by REDUCING DOPAMINE AND SEROTONIN
- Dopamine and Serotonin antagonists OR inverse agonists
- And affect several neurotransmitters (dopamine, serotonin, norepinephrine, and glutamate!)
SIDE EFFECTS:
1. Anticholinergic effects
2. Neuroleptic Malignant Syndrome
- Risk for and severity is less than FGA!
3. Metabolic Syndrome
- Weight gain, high BP, insulin resistance, increased risk for diabetes and heart disease
4. Agranulocytosis
- Potentially life threatening
- Dangerously low white blood cell count - requires regular blood monitoring
- Clozapine and to a lesser extent the other atypicals
3 advantages of SGA:
1) Alleviate positive AND negative sxs
2) Typically effective when FGA fail
3) Less likely to cause Tardive dyskinesia
40
SSRIs names
1. Fluoxetine (Prozac, Sarafem)
2. Sertraline (Zoloft)
3. Citalopram (Celexa)
4. Fluvoxamine (Luvox)
5. Paroxetine (Paxil)
41
SSRI attributes
Considered to be the first line psychopharmacological tx to treat depression!
- Have a faster onset than tricyclics (and are now prescribed more than tricyclics)
- Less severe cholinergic effects
- BUT are more likely to cause serotonin syndrome than tricyclics when combined with other serotinergic agents
ALSO CAN TREAT:
- Premenstrual Dysphoric Disorder
- OCD
- Panic disorder
- GAD
- PTSD
- Bulimia
- Premature ejaculation
Exert their effects by block the reuptake of Serotonin - Increases serotonin! Serotonin agonist
SIDE EFFECTS:
- Mild cholinergic effects
- Gastrointestinal issues
- Insomnia
- Nausea and vomiting
- Anxiety
- Headaches
- Sexual dysfunction
ADVANTAGES OVER TRICYCLICS:
1) Produce fewer anticholinergic side effects
2) Less cardiotoxic
3) Safer in overdose
4) Faster onset of therapeutic effects
Disadvantages of some SSRIS - Can cause a withdrawal or discontinuation syndrome when decreased or abruptly stopped:
- Dizziness
- Headache
- Numbness or tingling
- Anxiety, agitation, irritability
- Mood lability
- Impaired concentration
- Sleep disturbances
- Flu like sxs
* *SEROTONIN SYNDROME
- Combining SSRI with MAOI or other serotonergic drug can cause it
- Potentially fatal!
- Extreme agitation
- Confusion
- Autonomic instability
- Hyperthermia
- Tremor
- Seizures
- Delirium
TREATMENT FOR SEROTONIN SYNDROME:
- Immediate withdrawal of the serotonergic drugs
- Medical treatment for its symptoms
42
SNRI Names
* VennDiagram w/ SSRIs
1. Venlafaxine (Effexor)
2. Duloxetine (Cymbalta)
3. Desvenlafaxine (Pristiq)
43
SNRI attributes
Used to treat:
- Depression
- Anxiety
- Chronic Pain & several other dxs
* Evidence that they are similar to SSRIs in effectiveness to treat depression
* *And May be more effective than SSRIs for severe depression!
Exert their effects by blocking reuptake of Serotonin and Norepinephrine
SIDE EFFECTS (similar to SSRIs!)
- Mild anticholinergic effects
- Insomnia
- Headaches
- Sexual dysfunction
Because of their effects on norepinephrine, can ELEVATE BP!! Might be contraindicated for pts with hypertension or heart problems
Also can cause a discontinuation syndrome
And combining an SNRI with an MAOI or other serotonergic drug can cause serotonin syndrome!
44
Tricyclic Antidepressant Names
1. Amitriptyline
2. Imipramine
3. Clomipramine
4. Nortriptyline
5. Doxepin
45
Tricyclic Attributes
**Cardiotoxic!!
Used to treat: depression, anxiety, panic disorder, OCD, and neuropathic pain
EXERT THEIR EFFECTS BY inhibiting uptake of norepinephrine, serotonin, and dopamine
*Most useful for typical depression: Anhedonia and vegetative sxs (appetite and sleep)
SIDE EFFECTS:
- Anticholinergic effects
- Gastrointestinal issues
- Confusion and memory problems
- Tremor
- Impaired sexual functioning
- Hypertension
- Tachycardia
Because they're CARDIOTOXIC and can be lethal in overdose, prescribe with caution ppl with heart disease or SI!!
Caridotoxic because you can't ride a tricycle with heart problems!
46
MAOIs names
```
o Phenelzine (Nardil)
o Isocarboxazid (Marplan)
o Tranylcypromine (Parnate)
```
47
MAOI
* Used to treat atypical depression!
- Include phobic features
- Hypersomnia
- Mood reactivity
- Rejection sensitivity
EXERT THEIR EFFECTS - block the action of enzymes that break down norepinephrine, serotonin, and dopamine and increase these neurotransmitters
SIDE EFFECTS:
- Anticholinergic effects
- Orthostatic hypertension
- Daytime sleepiness
- Insomnia
- Headache
- Confusion
- Tremor
- Sexual dysfunction
```
CAN CAUSE A FATAL HYPERTENSIVE CRISIS:
- When taken in conjunction with other drugs (amphetamines, antihistamines) or foods containing tyramine (cheese, meat, beer, ripe bananas)
- Sxs:
- Severe throbbing headache
- Sharp increase in BP
- Stiff Neck
- Rapid HR
- Nausea and vomiting
- Sweating
- Photo sensitivity
- Confusion & dizziness
Extreme cases - Heart Attack or Stroke!
```
48
Mood Stabilizers names
1. Lithium
2. Several anticonvulsant drugs:
- Carbamazepine
- Valproic acid
49
Mood Stabilizer attributes
Lithium is tx of choice to treat bipolar disorder (first line for acute mania and classic bipolar dx - w/out rapid cycling)
- Reduces manic sxs and levels out mood swings
BUT anticonvulsant drugs may be more effective when lithium is not & useful for:
- Atypical forms of mania
- Mania with dysphoric mood or rapid cycling
- Acute mania
- How lithium and anticonvulsant drugs exert their therapeutic effects is not well understood
o But both have been linked to alterations in several neurotransmitters:
Dopamine
Glutamate
Norepinephrine
Serotonin
```
- Side effects of Lithium:
o Nausea
o Increased thirst & frequency of urination
o Blurred vision
o Fine Hand tremor
o Vomiting
o Metallic taste
o Weight gain
o Fatigue
o Impaired memory and concentration
- **Blood lithium levels must be monitored to avoid lithium toxicity:
o Confusion
o Slurred Speech
o Ataxia
o Course tremor
o Vomiting
o Diarrhea
o **And can lead to:
Seizures
Coma
Death
- **Several factors can precipitate toxicity, including:
o An overdose of the drug
o Sodium depletion
o And simultaneous use of some other drugs:
Diuretic
Non-steroidal anti-inflammatory agent
- Side effects of anticonvulsant drugs (Carbamazepine):
o Nausea & vomiting
o Dizziness
o Slurred speech
o Ataxia
o Tremor
o Sleepiness
o Lethargy
o Visual disturbances
o Impaired concentration
- To maintain therapeutic levels of Carbamazepine and to avoid toxicity:
o Blood levels must be monitored!
- **Blood levels must be monitored to avoid liver failure when taking the anticonvulsants: carbamazepine or valproic acid
o And to avoid Agranulocytosis and aplastic anemia when taking carbamazepine
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Benzos
- Central nervous system depressants
- Stimulate the inhibitory action of GABA
- Barbiturates and benzos increase GABA
Most common side effects:
- Drowsiness, lethargy
- Slurred speech
- Ataxia
- Impaired cognitive and psychomotor functioning
Abrupt cessation of a Benzo may produce:
- Rebound excitability
o Produces levels of anxiety, insomnia & other sxs that were more intense than prior to taking the benzo
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Psychostimulants
- Mimic or increase the activity of dopamine and norepinephrine
- used to treat ADHD:
Methylphenidate
- Alleviates the core sxs of ADHD - inattention, hyperactivity, and impulsivity
* Less evidence for its long-term benefits for academic achievement and social interactions
Pemoline
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- Methylphenidate side effects:
o Decreased appetite
o Abdominal pain
o Insomnia
o Anxiety and irritability
o *Some children experience growth suppression
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- But this sx can be alleviated by providing drug holidays over summer and winter vacations
