How do monoamine oxidase inhibitors (MAOIs) work?
Inhibit the enzyme MAO (which deactivates DA, NE, & serotonin)
Synergistic action of 2+ drugs when this is more powerful than their additive effects
Cognitive deficits associated with long-term MDMA use
Persist up to 1 year postabstinence Learning & memory, exec fx & planning, attention & vigilance, verbal fluency, visual scanning
Mercury exposure is associated with
Encephalopathy of cerebellum, BG, primary visual corteix, spinal cord Motor slowing, clumsiness, tremor, paresthesia, visual & hearing defects, agitation Long-term exposure associated with depression, slowing, impaired STM
Caused by high brain aluminum levels Marked by stuttering & dysfluent speech, myoclonus & difficulty swallowing, concentration & memory problems
Neuroimaging findings among cocaine users
Cerebral atrophy correlated w/ length of use, demyelination, hyperintensities, vasospasm, stroke-like defects, multiple patchy areas of hypoperfusion, EEG - marked reduced alpha power in frontal & temporal regions
Typical antipsychotics work by
How do beta-blockers work?
Block beta-adrenergic receptors, which respond to epinephrine & NE
How do tricyclics work?
Block reuptake of NE & serotonin (DA?)
Name some common tricyclics
ANDI: amitriptyline, nortirptyline, doxepin, imipramine
How do benzodiazepines work?
Side effects of benzodiazepines
Can cause sedation/drowsiness, confusion, disorientation in elderly, disturbed sleep, potential for withdrawal If stopped, see rebound hyperexcitability leading to seizures, depersonalization, panic, & stroke
Neuroimaging findings in recently detoxified alcoholics
Cerebral atrophy & white & gray matter volume loss
Neuropsych deficits associated with glue sniffing
Dose-related deficits in attention, memory, visuospatial fx, complex cognition, naming, reading/writing
How do barbiturates work?
Interrupt impulses to RAS
MAOIs are used for
Used for atypical depression, hostility, anxiety, hypochondriasis
Alcohol-induced persisting dementia
Dysfx of general intellectual abilities, memory, visuospatial abilities, abstraction, problem solving Orientation to time & place, language abilities remain well-preserved May be on average 10 yrs younger than those w/ other dementias, 2x the avg length of institutionalization
Symptoms of cocaine withdrawal
Crash, disrupted sleep, appetite, psychomotor fx, vivid disturbing dreams due to REM rebound
How do amphetamines work in the CNS?
Provoke discharge of DA & then blocks reuptake Increases activity of NE that produces sympathomimetic effects
Tricyclics are used for
Used for somatic & vegetative symptoms of depression, panic attacks, agoraphobia, & obsessive states
Long term cognitive deficits among amphetamine users
Attentional & motor skills, verbal memory & attention
How do atypical antipsychotics work?
Work on D2 & other DA receptors, serotonin, & glutamate
Neuroleptic malignant syndrome
High fever, severe muscle rigidity, altered consciousness, ANS dysregulation
Perform worse on STM, eye tracking, hand-eye coordination Many deficits improve following liver transplantation, memory does not Subclinical can cause sig. memory impairment & motor slowing w/ intact intellectual fx & abstraction
Primary CNS target of manganese
Dopaminergic neurons in striatum
NP findings among sober moderate-heavy cocaine users
Memory flexibility & control, attention & concentration, visuomotor ability, verbal & visual learning/memory
Multiple exposures to PCP may produce what chronic impairments?
Memory & confusion
How do SSRIs work, and what are they used for?
Block reuptake of serotonin; used for depression, OCD, eating disorders
CNS damage from carbon monoxide is centered in
GP, cortex, hippocampus, cerebellum, fornix, CC
Characteristic triad of opioid overdose
Coma, miosis, respiratory depression
Long-term cognitive deficits associated with alcohol use
Complex memory deficits due to use of inefficient organization strategies during encoding; problem-solving, perceptuomotor abilities, visual learning & memory, contextual memory
What are beta-blockers used for?
used for physical manifestations of anxiety, high BP, angina, tremors, migraines, glaucoma
How does MDMA work in the CNS?
Provokes sudden emptying of presynaptic serotonin stores With continued use, destroys serotoninergic neurons & creates cognitive impairments
Symptoms of mercury exposure
Cerebral encephalopathy, oral hemorrhage, auditory/visual hallucinations, fine motor tremor, insomnia, agitation
What are some contraindications for psychostimulants?
anxiety & tension, anorexia, HTN, hx of psychosis, recent hx of drug or ETOH abuse, pre-existing motor tics
How do psychostimulants work?
Works on catecholamines (DA, NE, epinephrine)
Neuroimaging findings among heavy MDMA users
Global decreases in 5-HT transporter densities in parieto-occipital, occipital, & sensory cortex
NP findings in current cocaine users
Deficits in verbal & visual recall, WM, attention
How does cocaine work in the CNS?
Provokes a discharge of DA from presynaptic storage vesicles & then blocks its reuptake (particularly in mesolimbic system) Blocks reuptake of NE => pronounced sympathomimetic effects (arrhythmias, HTN, vasospasm, pupillary dilation) Blocks reuptake of serotonin => euphoria
Central serotonin syndrome
Severe HA, nystagmus, tremor, dizziness, unsteady gait, irritability, confusion, delirium, cardiac arrhythmia