Psychobiology and Psychopharmacology Flashcards Preview

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Flashcards in Psychobiology and Psychopharmacology Deck (117):
1

Acetylcholine Function

1. Sleep wake cycle
2. Muscle coordination and motor activity
3. Pain perception
4. Learning, memory acquisition, and retention

2

Acetylcholine and Serotonin Relationship

They have an inverse relationship with each other

3

Decreased levels of acetylcholine are associated with what mental illnesses?

1. Alzheimer's disease
2. Dementia

4

Increased levels of acetylcholine are associated with what mental illnesses?

1. Aggression

5

Dopamine Function

1. Motor coordination
2. Metabolism
3. Motivation, emotion, pleasure/reward system in the brain
4. Temperature control
5. Sexual function
6. Increases BP

6

Decreased levels of dopamine are associated with what mental illnesses?

1. Parkinson's disease

7

Increased levels of dopamine are associated with what mental illnesses?

1. Schizophrenia
2. Mania

8

Norepinephrine Function

1. Associated with "fight or flight"
2. Regulation of mood
3. Can affect attention and learning
4. Wakefulness

9

Decreased levels of norepinephrine are associated with what mental illnesses?

1. Depression

10

Increased levels of norepinephrine are associated with what mental illnesses?

1. Anxiety
2. Manic symptoms

11

Serotonin Function

1. Affects sleep
2. Appetite
3. Hormone secretion
4. Thermoregulation
5. Emotions, mood, cognition
6. Sexual behavior and libido

12

Decreased levels of serotonin are associated with what mental illnesses?

1. Depression
2. Insomnia (serotonin breaks down into melatonin)
3. Anxiety
4. OCD

13

Increased levels of serotonin are associated with what mental illnesses?

1. Serotonin Syndrome

14

GABA Function

Controls spinal and cerebellar reflexes and decreases excitability of neurons in the brain

15

Decreased levels of GABA are associated with what mental illnesses?

1. Seizures
2. Anxiety
3. Panic disorders

16

Increased levels of GABA are associated with what mental illnesses?

Excessive Relaxation or sedation

17

Glutamate Function

Widely distributed excitatory neurotransmitter in the brain with some role in learning and memory

18

Decreased levels of glutamate are associated with what mental illnesses?

1. Agitation
2. Memory loss
3. Depression
4. Loss of energy

19

Increased levels of glutamate are associated with what mental illnesses?

1. Neurotoxicity by overstimulation of nerves
2. Huntington's
3. AIDS related dementia
4. Schizophrenia
5. Anxiety

20

Efficacy

Ability of drug to produce a response

21

Potency

Dose of drug required to produce a specific effect

22

Tolerance

Gradual decrease in the action of a drug at a given dose or concentration in the blood

23

Toxicity

The point when concentrations of a drug in the bloodstream are high enough to become harmful or poisonous

24

Therapeutic Index

Ratio of the maximum nontoxic dose to the minimum effective dose

* Always start at the lowest possible dosage and then work your way up if needed

25

How does advancing age affect drug toxicity?

Elderly population is vulnerable to drug toxicity due to decreasing kidney function. The kidney isn't excreting the drug, so it stays in the body too long

26

How can race affect what medications are prescribed?

Asians lack Cytochrome P450 which aids in metabolizing medications so they require smaller doses of alprazolam, haloperidol, and beta blockers

* Also African Americans do not respond will to ACE inhibitors

27

How can gender affect what medications are prescribed?

1. Women respond better than males to SSRIs
2. Women with schizophrenia require smaller doses of antipsychotics

28

Common Conventional Antipsychotics (Typical)

1. Thioridazine
2. Chlorpromazine
3. Fluephenazine
4. Thiothixene
5. Haloperidol
6. Droperidol

29

Conventional Antipsychotics: Indication for Use

1. Most common indication is schizophrenia
2. Mania, autism, disorganized thinking, agitations, Tourette's syndrome, intractable hiccups
3. Psychotics symptoms associated with head trauma, tumor, stroke, alcohol withdrawal

30

Conventional Antipsychotics: Mechanism of Action

Blocks the action of dopamine (D2, D3, D4)

* Suppresses only the positive signs of schizophrenia (hallucinations)

31

Conventional Antipsychotics: Side Effects

1. Anticholinergic effects
2. Hypotension/Orthostatic hypotension
3. Antihistamine effects: sedation and weight gain
4. Lowers the seizure threshold
5. Photosensitivity
6. Increased Prolactin level (galactorrhea)
7. Extrapyramidal symptoms
8. Tardive dyskinesia
9. Neuroleptic Malignant Syndrome

32

Extrapyramidal Symptoms

1. Dystonia
2. Akathisia
3. Pseudoparkinsonism

33

Dystonia

- Facial grimacing
- Involuntary upward eye movement
- Muscle spasms of the tongue, face, neck, and back (back muscle spasms cause trunk to arch forward)
- Laryngeal spasms

34

Akathisia

- Restless
- Trouble standing still
- Paces the floor
- Feet in constant motion, rocking back and forth

35

Pseudoparkinsonism

- Stooped posture
- Shuffling gait
- Rigidity
- Bradykinesia (slow movement)
- Tremors at rest
- Pill-rolling motion of the hand

36

Tardive Dyskinesia

- Protrusion and rolling of the tongue
- Sucking and smacking movement of the lips
- Chewing motion
- Facial dyskinesia (involuntary movement of the face)
- Involuntary movement of the body and extremeties
- Constant eye blinking
- Bonbon sign

37

Why can extrapyramidal symptoms present when on conventional antipsychotics?

Occurs when there is an imbalance of acetylcholine, dopamine, and GABA in the basal ganglia as a result of blocking dopamine

38

Treatment for Acute Dystonia

Anticholinergic medications such as benztropine which inhibits acetylcholine and restores balance

39

Treatment for Akathisia

Switch medication to atypical antipsychotic or decrease the dose of medication to see if improved

40

Treatment for Pseudoparkinsonism

Switch medications and sometimes benztropine is given

41

Bonbon Sign

Appears with Tardive Dyskinesia
- The tongue rolls around in the mouth and protrudes into the cheek

42

Long Term Health Issues of Tardive Dyskinesia

Choking associated with loss of control of swallowing muscles and respiratory function compromised

43

Treatment for Tardive Dyskinesia

1. The best management is PREVENTION
- Use the lowest possible dose of antipsychotic medications over time that will minimize the target symptoms without EPS or TD
2. Change antipsychotic medication to a second generation antipsychotic

44

Neuroleptic Malignant Syndrome

MEDICAL EMERGENCY
- Only occurs with antipsychotic medications

45

S/Sx of Neuroleptic Malignant Syndrome

F = Fever
E = Encephalopathy
V = Vitals unstable
E = Elevated enzymes (CPK)
R = Rigidity of muscles

* Also mental status change

46

Risk Factors for NMS

1. Dehydration
2. History of NMS
3. Recent dosage increase of antipsychotic medications
4. Psychomotor agitation
5. Lithium and antipsychotics taken together

47

Restarting Antipsychotics After NMS

At least 2 weeks should be allowed to elapse after recovery from NMS before low-potency conventional antipsychotics or atypical antipsychotics should be titrated gradually after a test dose; and patients should be carefully monitored for early signs of NMS

48

Common Atypical Antipsychotics

1. Aripiprazole
2. Clozapaine
3. Iloperidone
4. Olanzapine
5. Quetiapine
6. Risperidone
7. Asenapine
8. Ziprasidone

49

Atypical Antipsychotics: Indications for Use

- Drugs of choice for psychosis, schizophrenia, mania, and autism
- Associated with less EPS and TD

* Treats both positive and negative symptoms associated with schizophrenia

50

Atypical Antipsychotics: Mechanism of Action

Blocks dopamine and serotonin receptors

51

Atypical Antipsychotics: Side Effects

1. Weight gain
2. Cataracts
3. Sexual side effects
4. Hyperlipidemia
5. Myocarditis
6. Diabetes mellitus
7. Prolonged QTC interval
8. EPS

52

Atypical Antipsychotics: Nursing Implications

1. Weight with BMI: weight gain can be extreme (this can influence their compliance)
2. Waist circumference: increase abdominal visceral fat
3. Baseline of patient and family history for dyslipidemia, HTN, CVD, DM, hyperglycemia
4. LABS: serum glucose (fasting), lipid profile (HDL/LDL)

53

What do mood stabilizers do?

1. Relieve symptoms during manic and depressive episodes of bipolar disorder
2. Prevent recurrence of manic and depressive episodes
3. Do not worsen symptoms of mania or depression, or accelerate the rate of cycling

54

Gold Standard for Mood Stabilizers

Lithium

55

Anticonvulsants used as mood stabilizers

1. Carbamazepine
2. Lamotrigine
3. Divalproex sodium

56

Anticonvulsants that are off label used as mood stabilizers

1. Gabapentin
2. Topimirate
3. Oxcarbazepine

57

Lithium: Mechanism of Action

1. Unknown
2. Salt and acts like sodium
3. Increases serotonin
4. Decreases norepinephrine

58

Lithium: Indications for Use

1. Treatment and prevention of acute manic episodes in bipolar
2. Maintenance bipolar
3. Aggression
4. Impulsivity
5. Antisocial personality
6. Mania

59

Lithium: Adverse Effects

1. Cardiac dysrhythmias
2. Seizures
3. Weight gain
4. N/V and GI upset
5. Fine hand tremors
6. Dry mouth
7. Polyuria
8. Thyroid enlargement
9. Goiter
10. Hypothyroidism
11. Fatigue and lethargy

60

Normal Serum Lithium Level

0.6 - 1.2

61

How often are lithium levels monitored?

- Lithium levels are monitored every 1-3 days at the beginning of therapy, then once every several months after that
- Levels must be drawn 12 hours after last dose taken because lithium peak is 4-12 hours

62

What kind of labs should be drawn prior to starting a patient on lithium?

1. Renal
2. Cardiac
3. Thyroid

63

Symptoms of Lithium Toxicity (1.5 - 2.0)

1. Nausea
2. Ataxia
3. Tinnitus
4. Blurred vision
5. Severe diarrhea

64

Symptoms of Lithium Toxicity (2.1 - 3.5)

1. Excessive output of dilute urine
2. Increasing tremors
3. Muscular irritability
4. Psychomotor retardation
5. Mental confusion
6. Giddiness

65

Symptoms of Lithium Toxicity (Above 3.5)

1. Impaired consciousness
2. Nystagmus
3. Seizures
4. Oliguria/anuria
5. Cardiac dysrhythmias (V-tach, SVT)
6. Cardiovascular collpase
7. Coma

66

Treatment for Lithium Toxicity

1. Hold next lithium dose and toxicity will usually resolve within 24-48 hours
2. In severe cases hemodialysis is effective for removing drug from the body

67

If Lithium level is high but the patient shows no symptoms of toxicity

- Make sure and ask the patient when they took the last dose of Lithium
- Labs need to be drawn 12 hours after the last dose

68

Lithium: Nutrition Requirements

- It is important to eat a normal diet with normal salt and fluid intake (1500-3000 mL/day)

69

If you have these symptoms you should stop taking Lithium

1. Diarrhea
2. Vomiting
3. Sweating

* These can dehydrate you and can raise lithium levels in the blood to toxic levels

70

Lithium: Patient Teaching

1. Nutrition
2. When to stop taking it (dehydration, toxicity)
3. Do not take diuretics
4. Take with meals
5. Kidney, thyroid function should be routinely monitored
6. If discontinued, it needs to be tapered
7. Do not take if pregnant or breastfeeding

71

When is divalproex administered as a mood stabilizer?

1. Acute mania
2. Maintenance treatment of bipolar disorder
3. Migraine prophylaxis

72

When is lamotrigine administered as a mood stabilizer?

Maintenance treatment of bipolar 1 disorder

73

When is carbamazepine administered as a mood stabilizer?

Acute mania

74

Contraindications for Antidepressants

1. Acute schizophrenia
2. Severe renal, hepatic, or cardiovascular disease
3. Suicidal tendencies
4. Narrow angle glaucoma
5. Seizures

75

Tricyclic Antidepressants: Indications for Use

1. Depression
2. Bipolar disorders
3. Anxiety disorders
4. OCD

76

Tricyclic Antidepressants: Mechanism of Action

- Blocks the reuptake of norepinephrine and serotonin
- The effects of tricyclics are attributed to changes in receptors rather than changes in neurotransmitters

77

Tricyclic Antidepressants: Watch for Signs of

1. Sedation
2. Orthostatic hypotension
3. Decreased sexual ability or desire
4. Dry mouth
5. Urinary retention
6. Tachycardia

78

MAOIs: Mechanism of Action

- Inhibit monoamine oxidase (MAO) that breaks down the neurotransmitters serotonin, norepinephrine, and others
- By inhibiting MAO, serotonin and norepinephrine activity is increased in the nerve synapse

79

MAOIs: Indications for Use

Depression

** Not usually 1st line antidepressants

80

Why should you avoid tyramine when taking MAOIs?

- MAOIs interact with foods that are rich in tyramine
- Tyramine has a vasopressor effect that when increased causes significant hypertension crisis

81

Foods to Avoid that Contain Tyramine

1. Avocados
2. Bananas
3. Beef or chicken liver
4. Brewer's yeast
5. Broad beans
6. Caffeine
7. Cheese, especially aged except for cottage cheese
8. Meat extracts and tenderizers
9. Overripe fruit
10. Papaya
11. Pickled herring
12. Raisins
13. Red wine, beer, sherry
14. Sausage, bologna, pepperoni, salami
15. Sour cream
16. Soy sauce
17. Yogurt

82

Drug-Drug Interactions with MAOIs

1. Cough and cold medicines
2. St. Johns Wort
3. SSRIs/SNRIs
4. Trycyclics
5. General anesthesia
6. Vasoconstrictors

83

Serotonin Syndrome

- Can occur when MAOIs and SSRIs/SNRIs are used together OR too close together
- If switching from MAOI to SSRI (or vice versa) MUST not be given within 2 weeks (14 days) of each other

84

S/Sx of Serotonin Syndrome

1. Mental status changes
2. Autonomic instability
3. Neuromuscular hyperactivity

85

Serotonin Syndrome: Autonomic Instability

1. Hyperthermia
2. Tachycardia
3. Mydriasis (pupil dilation)
4. Diaphoresis
5. N/V/D

86

Serotonin Syndrome: Neuromuscular Hyperactivity

1. Hyperkinesia
2. Hyperreflexia
3. Trismus (lockjaw)
4. Myoclonus (twitching/jerking)
5. Cogwheel rigidity (jerky feeling in your arm or leg that you can sense when rotating that limb or joint)
6. Bruxism (teeth grinding)

87

Trycyclic Drugs

1. Amitriptyline
2. Doxepin
3. Nortriptyline
4. Imipramine

88

MAOI Drugs

1. Phenelzine
2. Tranycypromine
3. Isocarboxazid

89

SSRI Drugs

1. Citalopram
2. Escitalopram
3. Fluvoxamine
4. Fluoxetine
5. Paroxetine
6. Sertraline

90

Side Effects of SSRIs

1. HA
2. Nausea
3. Lethargy
4. Fatigue
5. Insomnia
6. Sexual dysfunction
7. Weight gain

* Do NOT take with MAOIs or abruptly stop taking medication

91

Discontinuation Syndrome

Caused from abrupt discontinuation of SSRI and other antidepressants

92

S/Sx of Discontinuation Syndrome

1. Flu like symptoms
2. Insomnia
3. Nausea
4. Imbalance
5. Sensory disturbances
6. Hyperarousal (agitation/anxiety)

93

SNRI Drugs

1. Venlofaxine
2. Duloxetine
3. Desvenlafaxine

94

SNRI: Mechanism of Action

Acts by blocking serotonin and norepinephrine reuptake, but has side effects similar to SSRI

95

SNRI: Drug-Drug Interactions

1. MAOI = Serotonin Syndrome
2. Warfarin and NSAIDs = increase risk of bleeding

96

Nursing Considerations for SNRIs

Check the patients baseline BP because these meds can raise BP

97

Bupropion: Indications for Use

1. Depression
2. Smoking cessation

98

Bupropion: Side Effects

1. Lowers seizure threshold so do not use in patients with seizures
2. Weight loss

* Be sure to check patient's baseline BP because this med can raise BP

99

Mirtazapine: Indications for Use

Depression

100

Mirtazapine: Side Effects

1. Sedation
2. Dizziness
3. Weight gain
4. Dry mouth
5. Constipation

101

Trazadone: Indications for Use

1. Depression
2. Off Label: insomnia and anxiety

102

Trazadone: Side Effects

1. Sedation
2. Weight gain
3. N/V
4. Dizziness
5. Tremors

103

Benzodiazepines: Indications for Use

1. Panic and anxiety disorders
2. Drug of choice for short-term treatment of insomnia

104

Benzodiazepines: Mechanism of Action

Targets GABA receptors and enhances the levels of GABA

105

Benzodiazepine Drugs (FYI)

1. Triazolam
2. Oxazepam
3. Temazepam
4. Lorazepam
5. Alprazolam
6. Chlordiazepoxide
7. Diazepam
8. Halazepam
9. Clorazepate
10. Prazepam
11. Clonazepam
12. Flurazepam

106

Non-Benzodiazepine Drugs

1. Zolpidem
2. Diphenhydramine
3. Zaleplon
4. Eszopiclone
5. Ramelteon
6. Buspirone

107

Non-Benzodiazepine Action

Bind preferentially to GABA receptors and have a less widespread effect than benzodiazepines

108

Benzodiazepines: Adverse Effects

1. Drowsiness, sedation
2. Psychomotor and cognitive impairment
3. Vertigo
4. Confusion
5. Increased appetite and weight gain
6. Alterations in sexual function
7. Rashes are uncommon
8. Some women fail to ovulate
9. Adictive

109

Non-Benzodiazepine Drugs Used to Treat Insomnia

1. Eszopiclone
2. Zaleplon
3. Zolpidem

110

Why is propanolol used to treat anxiety?

Used to decrease BP and HR

111

Stimulants for ADHD

1. Methylphenidate (Concerta/Ritalin)
2. Amphetamine/Dextroamphetamine (Adderall)
3. Dexmethylphenidate (Focalin)

112

Why do we give stimulants to ADHD clients?

1. They cause the release of norepinephrine and dopamine into the synapse and block the reuptake of these neurotransmitters
2. Stimulants produce a paradoxical calming of the increased motor activity characteristics of ADHD
3. Kids with ADHD are low in dopamine and they constantly self-stimulate by wiggling, talking out of turn, running around, etc. by giving them stimulants that increase dopamine they can focus and they don't need to self-stimulate

113

Common Effects of Stimulants

1. Enhanced alertness, awareness, wakefulness, endurance, productivity, and motivation
2. Increased arousal
3. Increase HR and BP
4. A perception of a diminished requirement for food and sleep
5. Can improve mood and relieve anxiety

114

Side Effects of Stimulants

1. Insomnia
2. Decreased appetite
3. HA
4. Stomach aches
5. Mood changes
6. Increase HR and BP
7. Tics
8. Psychosis
9. Seizures

115

Non-Stimulant Medication for ADHD

Atomoxetine (Strattera)

116

Atomoxetine

- A norepinephrine reuptake inhibitor initially developed to be an antidepressant
- 2nd line ADHD agent in ADHD: Only after stimulants failed or when side effects of stimulants are intolerable
- Lower efficacy but fewer and less severe side effects

117

Nursing Considerations for ADHD Drugs

1. Weigh client at least weekly
2. Reduce anorexia by encouraging client to take meds after meals
3. Administer last dose of the day at least 6 hours before bed to prevent insomnia
4. Encourage a "drug holiday" on weekends or when out of school
5. Avoid OTC medications due to drug interactions