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Pathophysiology & Pharmacology > Psychiatric Disorders > Flashcards

Psychiatric Disorders Flashcards

1
Q

Neurotransmitters

A
  • Released from the nerve terminal and one of three things can happen
    ~ Bind to receptors
    > Interaction is by chance
    ~ Inactivated by enzymes
    ~ Reputake into nerve terminal
    > Released again
    > Broken down by monoamine
    oxidase (MAO)
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2
Q

Major Depression

A
  • Mood disorder diminishing person’s ability to function
    ~ Tied to decreased serotonin and/or
    norepinephrine activity
  • Symptoms are measured but serotonin should be measured instead of
    ~ Very difficult because it can’t cross the
    BBB
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3
Q

Major Depression: Antidepressant Drugs

A
  • Most drugs related to serotonin or norepinephrine.
    ~ Norepinephrine and serotonin are
    related to mood.
    > Many parts of the brain
    responsible for mood are
    stimulated by both serotonin and
    norepinephrine.
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4
Q

Antidepressant Drugs: Tricyclic Antidepressants (TCAs)

A
  • Ex: Elavil
  • Mechanism
    ~ Block reputake of norepinephrine and
    serotonin
    > Increases chance of receptor
    binding, enhances effects of
    neurotransmitter
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5
Q

Antidepressant Drugs: Tricyclic Antidepressants (TCAs) Adverse Effects

A
  • Many adverse effects.
  • In addition to effect on norepinephrine and serotonin
    ~ Block alpha-adrenergic receptors
    ~ Block cholinergic receptors
    (Anticholinergics)
  • Sexual Dysfunction
    ~ Overactive serotonin
  • Alpha-adrenergic Block
    ~ Receptor activation causes
    vasoconstriction.
    > Block does not allow
    vasoconstriction.
    • Orthostatic Hypotension
    * Body can’t increase BP =
    fainting
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6
Q

Antidepressant Drugs: Tricyclic Antidepressants (TCAs) Anticholinergic Effects

A
  • Blurred Vision
  • Constipation
  • Decreased Sweating
  • Dry Mouth
  • Throat Irritation
  • Pupil Dilation
  • Urinary Hesitancy/Retention
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7
Q

Antidepressant Drugs: Selective Serotonin Reputake Inhibitors (SSRI)

A
  • Ex: Prozac, Laxapro, Zoloft
  • Mechanism
    ~ Block reputake of serotonin
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8
Q

Antidepressant Drugs: Selective Serotonin Reputake Inhibitors (SSRI) Adverse Effects

A
  • Fewer than TCAs
    ~ Don’t block alpha-adrenergic
    receptors
    ~ Not Anticholinergic
  • Sexual Dysfunction
  • Nausea/Vomiting
  • Headache
  • Restlessness
  • Anxiety
    ~ Due to increased serotonin in a
    specific part of the brain
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9
Q

Antidepressant Drugs: Monoamine Oxidase Inhibitors (MAOIs)

A
  • Ex: Marplan, Nardil, Parnate
  • Mechanism
    ~ Inhibit MAO which increases
    availability of serotonin and
    norepinephrine
  • Used most often when TCAs or SSRIs do not work.
  • Not first line because of adverse effects and food/drug interactions associated with MAOIs.
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10
Q

Antidepressant Drugs: Monoamine Oxidase Inhibitors (MAOIs) Adverse Effects

A
  • Sexual Dysfunction
  • Alpha-adrenergic
    ~ Orthostatic Hypotension
  • Anticholinergic Effects
    ~ Blurred Vision
    ~ Constipation
    ~ Decreased Sweating
    ~ Dry Mouth
    ~ Throat Irritation
    ~ Pupil Dilation
    ~ Urinary Hesitancy/Retention
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11
Q

Monoamine Oxidase Inhibitors (MAOIs) Adverse Effects: Hypertensive Crisis

A
  • Increased BP from excess norepinephrine (due to it not being broken down because MAO was inhibited)
    ~ Norepinephrine activates alpha-
    adrenergic receptors.
  • Combining MAOls with TCAs.
  • Combining with sympathomimetic.
  • Combining with foods high in tyramine
    ~ Tyramine increases norepinephrine
    release.
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12
Q

Antidepressant Drugs: Serotonin/Norepinephrine Reputake Inhibitors (SNRIs)

A
  • Ex: Cymbalta, Effexor
  • Mechanism
    ~ Block reputake of serotonin and
    norepinephrine
    ~ Similar to TCAs but don’t block alpha-
    adrenergic receptors and are not
    Anticholinergic
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13
Q

Antidepressant Drugs: Serotonin/Norepinephrine Reputake Inhibitors (SNRIs) Adverse Effects

A
  • Sexual Dysfunction
  • Nausea
  • Constipation
  • Headache
  • Weight Loss
  • Nervousness
  • Sweating
  • Insomnia
  • Hypertension
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14
Q

Serotonin Syndrome

A
  • Excess serotonin levels
    ~ Happens most often when combing
    drugs that increase serotonin levels
    > TCAS, MAOIS, SSRIs, SNRIs.
    ~ Some OTC drugs, illegal drugs and
    dietary supplements can also increase
    levels.
    ~ Reaction can be severe resulting in
    death.
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15
Q

Serotonin Syndrome Symptoms

A
  • Hyperthermia
  • Agitation
  • Seizures
  • Tremor
  • Confusion
  • Sweating
  • Tachycardia
  • Hypertension
  • Anxiety
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16
Q

Schizophrenia

A

Chronic disturbances of perception, mood and cognitive function

17
Q

Schizophrenia Cause

A
  • Multiple factors but brain chemistry may be one
  • Dopamine: Excitatory
    ~ Efficient Movement
    ~ Pleasure/Reward
    ~ Memory
    ~ Focus
    ~ Cognition
  • Serotonin
    ~ Mood
18
Q

Schizophrenia: Positive Symptoms

A
  • Exaggeration of normal function
  • Hallucinations: Experiencing something not present.
    ~ Sight
    ~ Sound
    ~ Taste
    ~ Smell
  • Delusions: Strong belief despite evidence to the contrary.
  • Paranoia: Belief that others are hostile without supporting evidence.
  • Psychomotor Agitation/Hyperactivity
19
Q

Schizophrenia: Negative Symptoms

A
  • Diminished normal function
  • Social/Emotional Withdrawal
  • Apathy
  • Loss of Drive
  • Psychomotor Depression
20
Q

Schizophrenia: Antipsychotic Drugs - Typical/First Generation

A
  • Ex: Ex. Thorazine, Haldol
  • Block receptors for dopamine
21
Q

Schizophrenia: Antipsychotic Drugs - Atypical/Second Generation

A
  • Ex: Abilify
  • Generally less blocking of dopamine (helps w/ + symptoms)
  • May increase glutamate levels (helps w/ - symptoms)
    ~ Glutamate is excitatory to neurons of
    the brain
  • Fewer adverse effects
22
Q

Schizophrenia: Antipsychotic Drugs Adverse Effects

A
  • Movement Disorders
    ~ Dystonia
    ~ Pseudo Parkinsonism
    ~ Tardive Dyskinesia
  • Orthostatic Hypotension
    ~ Alpha-adrenergic receptors are
    blocked
  • Anticholinergic Effects
    ~ Blurred Vision
    ~ Constipation
    ~ Decreased Sweating
    ~ Dry Mouth
    ~ Throat Irritation
    ~ Pupil Dilation
    ~ Urinary Hesitancy/Retention
23
Q

Bipolar Disorder

A
  • Mood disorder alternating between periods of major depression and mania
    ~ Mania
    > Elevated Mood
    > Unrealistic Optimism
    > Hyperactivity
    > Decreased Need for Sleep
    > Poor Attention
    > Poor Judgement
    > Hallucinations/Delusions
  • Antipsychotic drugs are used along w/mood stabilizers to treat mania
24
Q

Mood Stabilizers: Lithium

A

~ Initially used for gout
~ Mechanism (not well understood)
> Appears to decrease the function of
dopamine and glutamate receptors
both at which are excitatory to
neurons

25
Q

Mood Stabilizers: Lithium Adverse Effects

A
  • Can cause toxicity even at therapeutic levels
    ~ May result in seizure, coma, or death
  • Early S&S
    ~ Nausea
    ~ Diarrhea
    ~ Confusion
    ~ Muscle Weakness
    ~ Headache
    ~ Polyuria
    ~ Polydipsia
    ~ Fine Hand Tremor
26
Q

Mood Stabilizers: Valproic Acid

A
  • Initially used for epilepsy.
  • Just as effective as lithium with fewer adverse effects.
  • Mechanism (Not well understood)
    ~ Appears to increase Gamma-
    Aminobutyric Acid (GABA) levels
    > GABA is inhibitory to neurons
27
Q

Mood Stabilizers: Valproic Acid Adverse Effects

A
  • Nausea/Vomiting
  • Diarrhea
  • Indigestion
  • Tremor
  • Sedation
28
Q

Mood Stabilizers: Carbamezpine

A
  • Initially used for epilepsy
  • Mechanism
    ~ Inhibits neurons
    > Decreases influx of Na
    • helps neurons to depolarize =
    less activity
    > Inhibits glutamate release
29
Q

Mood Stabilizers: Carbamezpine Adverse Effects

A
  • Nausea/Vomiting
  • Diarrhea
  • Sedation
  • Confusion
  • Headache
  • Blurred Vision
  • Slurred Speech
30
Q

Anxiety Disorders

A

Stressful situation that creates a sense of uncertainty making one fearful or apprehensive.

31
Q

Anxiety Disorders: Generalized Anxiety Disorder

A

Excessive and uncontrollable worry about several events or activities.

32
Q

Anxiety Disorders: Panic Disorder

A

Sudden onset of fear with racing heart, sweating, dyspnea, chest pain, nausea.

33
Q

Anxiety Disorders: Social Anxiety Disorder

A

Fear of social or performance situations.

34
Q

Drugs for Anxiety Disorders: Benzodiazepine

A
  • Ex: Xanax, Librium, Valium
  • Mechanism
    ~ Enhances the action of GABA
    > Binds to a portion of the GABA
    receptor and that binding causes
    changes to the GABA receptor
    • Makes receptors more
    sensitive to GABA
35
Q

Drugs for Anxiety Disorders: Benzodiazepine Adverse Effects

A
  • Physical dependence
  • Sedation
  • Amnesia
36
Q

Drugs for Anxiety Disorders: Buspirone

A
  • Slower acting than benzodiazepine, but fewer adverse effects.
    ~ Does not cause dependence.
  • Ex: BuSpar
  • Mechanism (Not well understood)
    ~ High serotonin levels in some areas of
    the brain increase feelings of fear/
    anxiety
    > Appears to block serotonin
    receptors in these areas
37
Q

Drugs for Anxiety Disorders: Buspirone Adverse Effects

A
  • Headache
  • Dizziness

Pathophysiology & Pharmacology (20 decks)

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