Psychosocial Integrity Flashcards
(104 cards)
1
Q
neurotransmitters
A
chemical messengers that carry impulses between nerve fibers across a synaptic junction
2
Q
catecholamines
A
several neurotransmitters that function outside the CNS as neurohormones. Includes epi, NE, and DA
3
Q
psychotherapeutics
A
drugs that tx psychological disorders
4
Q
synapse
A
a tiny gap/junction between two adjacent nerve cells
5
Q
glutamate
A
principle excitatory neurotransmitter; r/t memory function
6
Q
glycine
A
an inhibitory neurotransmitter; r/t motor fx, vision, and hearing
7
Q
acetylcholine
A
excitatory neurotransmitter; in CNS and PNS
8
Q
dopamine
A
special neurotransmitter, both excitatory and inhibitory
9
Q
epinephrine
A
excitatory neurotransmitter
10
Q
gamma-aminobutyric acid
A
principle inhibitory neurotransmitter; opposes glutamate
11
Q
norepinephrine
A
excitatory neurotransmitter
12
Q
serotonin
A
inhibitory neurotransmitter
13
Q
overview of the nervous system
A
- coordinates/controls all activities of the body
- receives internal and external stimuli
- processes information to determine appropriate response
- transmits information over varied motor pathways to effector organs
14
Q
neuron
A
- synapse: electrochemical signaling
- nodes of ranvier: propagate electrical signaling
15
Q
support cells of the nervous system
A
glial cells, outnumber neurons 10:1
16
Q
astrocytes
A
form BBB, rapid transport of nutrients
17
Q
oligodendroglia
A
form myelin sheath in the CNS
18
Q
schwann cells
A
form myelin sheath in the PNS
19
Q
microglia
A
clear cellular debris; phagocytosis
20
Q
3 parts of the brain
A
forebrain, midbrain, hindbrain
21
Q
spinal cord (31 segments)
A
- 8 cervical (neck/upper extremities)
- 12 thoracic (chest/abdomen)
- 5 lumbar (lower extremities)
- 5 sacral (lower extremities, bowel and bladder control)
- 1 coccygeal
22
Q
forebrain
A
basal ganglia, cerebral hemispheres/lobes, diencephalon
23
Q
basal ganglia
A
substantia nigra (produces dopamine)
24
Q
cerebral hemispheres and lobes
A
- frontal: inhibition and decision making
- temporal: emotion, long-term memory, speech/language formation
- parietal: sensory integration, language/linguistic understanding
- occipital: visual, visuospatial perception, visual regulation
25
diencephalon
- epithalamus
- thalamus
- hypothalamus
- subthalamus
26
limbic system
- group of structures that integrate emotion and high function (decision making, meaning and semantic memory)
- essential structures: amygdala, hypothalamus, hippocampus
27
midbrain
- corpora quadrigemina
- tegmentum
- basis pedunculi
28
hindbrain
- pons (autonomic functions)
- cerebellum (gross coordination)
- medulla oblongata (bridge to PNS)
29
CNS - reticular activation system
- coordinates cognitive tasks and 'filters' stimuli to prioritize response
- plays essential role in attention and alertness
- acts as nexus for efferent motor pathways
- conscious and preconscious activity
30
CNS - meninges
- 3 layers, membrane, protects the contents of the brain and spinal cord
-> dura mater, arachnoid mater, pia mater
31
Blood-brain barrier
- BBB
- neither neurotransmitters nor catecholamines cross the BBB
- many drugs do not cross; WBC transit restricted/reduced
32
CNS protective structures
- cranium; bony enclosure (8 bones)
- meninges
- cerebrospinal fluid (CSF) and ventricles
- vertebral column (33 vertebrae -> 7C, 12T, 5L, 5S, 4 coccygeal)
33
spinal cord
- portion of CNS in the vertebrae
- vertebral column
- motor and sensory pathways
34
descending (efferent) pathways
- 4 motor pathways
- anterior location
35
ascending (afferent) tracts
- 3 sensory pathways
- posterior location
36
2 main divisions of the PNS
somatic and autonomic
37
somatic system
involved in conscious, neuromotor function
38
autonomic system
- regulates unconscious, continuous innervation of cardiac and smooth muscle
- activates glandular tissues; neuroendocrine system
- sympathetic and parasympathetic subdivisions
39
synaptic function
- transmits nervous impulses from one neuron to another
- chemical transmission between nerve cells involve multiple steps
- electrochemical impulses transmit impulses down neuronal axon
40
where is synthesis of the neurotransmitter
presynaptic nerve
41
where are neurotransmitters stored
secretory vesicles
42
where is the regulated release of neurotransmitters in the synaptic space
between the pre- and post- synaptic neurons
43
why must specific receptors for the neurotransmitter on the postsynaptic membrane be present
so that the neurotransmitter can mimic the effects of nerve stimulation
44
glutamate
- key excitatory neurotransmitter, 'gas pedal'
- abundant in the CNS, especially in the brain - it plays an essential role in glial health
- assists in regulation of memory areas
- glutamate dysregulation is implicated in several neurological and psychiatric diseases
45
glycine
- inhibitory neurotransmitter
- simplest neurotransmitter, very small molecule
- helps regulate efferent and afferent tracts
- also a non-essential amino acid, glycine plays an important role in sleep regulation
46
Acetylcholine
- wide variety of neurochemical processes
- regulatory of activation in the PNS at the neuromuscular junction
- essential regulator of parasympathetic ANS activation
- muscarinic receptors are stimulated by acetylcholine
- in the CNS, plays a critical role in memory, formation, learning, cognition, and recall
47
epinephrine
- stimulant neurotransmitter
- sympathomimetic catecholamine; stimulates alpha and beta adrenergic receptors
- relatively small role in the CNS: alertness, excitement, focus, and panic responses
48
norepinephrine
- essential stimulating neurotransmitter
- important to neurological arousal, attention, cognition, and stress reactions
- peripherally acts as catecholamine - part of the sympathetic nervous system activation; like Epi
49
dopamine
- very complex neurotransmitter; both excitatory and inhibitory properties dependent on setting
- plays an integral role in reward center; also in limbic system risk/rear vs reward
- modulates motor coordination and afferent motor signaling
- has peripheral sympathetic effects -> vasostimulant
50
serotonin
- complex neurotransmitter; involved primarily in activation/modulation of emotion and memory in CNS
- increased levels in synapses in CNS correlated to elevated mood, increased mood stability -> primary target for psychotherapeutic drugs treating conditions with depression/anxiety
- low levels associated with emotional lability, depressive attributes, sleep dysregulation, irritability, and anhedonia
- serotonin plays a wide variety of roles outside the CNS; normal coagulation, cardiac contractility, vascular tone, endocrine signaling, and metabolism
51
gamma-aminobutyric acid
- primary inhibitory neurotransmitter, 'brake pedal'
- stress reduction, sleep enhancing effects
- suppresses the RAS, slows synaptic firing
- when activated, GABA receptors have muscle relaxant, amnestic, and antiseizure properties
52
addiction
a state of physical and psychological dependence on a substance in which an affected individual will engage in deleterious behavior to avoid cessation of a substance use
53
physical dependence
a physiological state in which the body is accustomed to the presence of a substance, where abstinence from the substance produces a characteristic withdrawal symptom
54
psychological dependence
a mental state characterized by compulsion to take in a particular substance. may be influenced by social norms; often described as 'craving' or 'obsession'
55
psychotropic drugs
any drug or substance that affects a persons mental state, typically denoting recreational or non-therapeutic use
56
substance use disorder
use of a substance in a way that is inconsistent with medical or social norms, or in a manor that is harmful to the individual
57
withdrawal
an unpleasant, and occasionally dangerous, physical reaction associated with cessation of use of a drug
58
antidepressant
any drug that works to elevate mood, relieve negative emotional affect, or remove the inability to feel pressure
59
antipsychotic
any drug used to treat psychotic features (psychosis), such as hallucinations, delusions, paranoia, and disordered thinking
60
anxiolytic
any drug used to reduce features of anxiety
61
hypnotic or sedative
any drug or substance that is sleep-inducing or which is taken for its calming effects
62
mood stabilizer
any drug that is used to treat disorders associated with intense and/or sustained shifts in mood
63
stimulant
any drug that raises levels of physiological or nervous system activity; usually CNS or cardiopulmonary activity
64
adaptation of the CNS to prolonged exposure to drugs
- increased therapeutic effects (some drugs take weeks to work due to adaptive physiological changes of the CNS)
- decreased side effects (with chronic use, diminished intensity of side effects can occur)
- multiple agents may need to be tried individually or in combination
65
tolerance and physical dependence
can occur with any drug, therapeutic or psychotropic
66
Monoamine oxidase inhibitor drugs (MAOI)
- antidepressants, may also be used for chronic anxiety-type conditions
- first antidepressants, 1950s
- monoamine hypothesis speculated that depleted concentrations of 5-HT, NE, and DA caused depression
- turns off enzyme that breaks down neurotransmitters (MAO) -> NE, Tyr, DA, 5-HT
- boosts the availability of neurotransmitters at the synapse -> allows for neurotransmitters to continue their influence for longer
67
Selegiline - MAOI
- first generation antidepressant
- selectively inhibits MAO-B, specifically in CNS
- PO or transdermal
- effect: resolve/reduce depressive and/or anxiety symptoms
- side effects: anticholinergic effects (dry mouth, dizziness, sleepiness)
- adverse reactions: hypertensive crisis, serotonin syndrome
- may take >2 weeks to show benefit, allow 3-5 weeks for 'washout' after dc
68
hypertensive crisis
extreme high BP >180/120, especially when combined with sympathomimetic drugs or aged/fermented foods (cheeses, cured meats, beer)
69
serotonin syndrome
dangerous altered mental state and autonomic dysregulation caused by high serotonin levels when combined with migraine medications, SSRIs, and ST Johns Wort
70
tricyclic antidepressants (TCAs)
- blocks synaptic reuptake of 5-HT and NE in the CNS
- prolongs the influence of 5-HT, NE; upregulates neuronal signaling
- depressive symptoms, neuropathic pain syndromes, and sleep dysregulation
- do NOT combine with MAOI (serotonin syndrome)
- overdose is notoriously fatal as there is NO antidote
71
amitriptyline
- TCA
- first generation antidepressant
- oldest and most widely used TCA
- can be used to promote sleep, reduce neuropathic pain
- NOT safe for pregnant clients
- route: PO
- effect: improvement of depressive symptoms, anxiety, pain, or insomnia
- side effects: strong anticholinergic effects (dry mouth, drowsiness, increased HR)
- adverse effects: rare, serotonin syndrome, hyper pyretic syndrome
- long half-life (up to 50 hours), allow two weeks for washout after dc
- do NOT combine with anticholinergics, MAOIs, seizure drugs, or sympathomimetic drugs
72
benzodiazepine drugs
- facilitate GABA binding to GABAminergic receptors, amplifies GABA
- potent anxiolytic, hypnogogic, and sedative effects, sometimes amnestic
- often used as needed, effect on first dose, some risk of dependence
- risk for significant CNS depression and/or dangerous respiratory depression
- antidote: FLUMAZENIL
73
anxiolytic and sedative/hypnotic drugs
- widely prescribed for at home and hospital use
- benzodiazepines
- nonbenzodiazepines
74
nonbenzodiazepines
- reduces anxious symptoms without acting on GABA or GABAminergic receptors
- may be a serotonin or dopamine agonist, exact mechanism unknown
- can't be used as needed, must be scheduled dosing for full effect
- no risk of abuse, minimal dependence
- lacks sedative, CNS depressant, and respiratory suppressing effects
75
Alprazolam, clonazepam, diazepam, lorazepam, chlordiazepoxide
- Benzodiazepines
- schedule 4 drugs, risk for dependence/abuse
- routes: PO, diazepam and lorazepam can be taken IM or IV
- effect: rapid relief of anxiety-type symptoms, significant reduction of neuroirritability, suppresses the reticular activating system (can be used to tx acute seizure activity and alcohol withdrawal)
- side effects: dizziness, drowsiness, confusion, muscle weakness
- adverse effects: potentially fatal CNS depression and/or respiratory depression, hepatotoxicity, amnesia
- do NOT combine with alcohol, increases the risk of CNS/respiratory depression
- avoid combo with oral contraceptives, antiseizure drugs, CNS depressants, SSRIs
76
buspirone
- nonbenzodiazepine
- no risk of abuse, trivial risk of dependence
- does not produce sedation, must be taken on a schedule for effect
- Route: PO
- effect: reduction in anxiety symptoms
- may take ~7 days for full therapeutic effect
- do not take in combination with MAOIs, high risk for hypertensive crisis
77
selective serotonin reuptake inhibitors (SSRIs)
- 1970s, fluoxetine was the first in the late 80s
- inhibit presynaptic reuptake of serotonin
- prolong the effects of serotonin
- negligibly also prolongs NE and DA
78
fluoxetine
- SSRI
- second generation antidepressant
- indicated for relief of depressive symptoms. Also used for OCD or panic disorders
- route: PO
- effect: reduction in depressive symptoms, improvement of features of other mental/physical disorders (mood, panic, eating disorder)
- side effects: dizziness, drowsiness, insomnia, GI upset, sexual dysfunction, HA
- do not abruptly dc, can be unpleasant withdrawal symptoms
- do not combine with MAOIs (serotonin syndrome), space by a minimum of 14 days
79
citalopram
- SSRI
- second generation antidepressant
- indicated for the relief of depressive symptoms. used for OCD as well
- route: PO
- effect: reduction in depressive symptoms, improvement of features of other mental/physical disorders
- escitalopram is chemically similar to citalopram, different molecular structure
- do not abruptly stop; significant, unpleasant withdrawal effects
- do not combine with MAOIs (serotonin syndrome)
80
selective norepinephrine reuptake inhibitors (SNRIs)
- late 80s, first drug (venlafaxine) approved in 93
- inhibit presynaptic reuptake of serotonin and norepinephrine
- prolong the effects of 5-HT and NE
- slightly prolongs DA
81
venlafaxine
- SNRI
- first one
- depressive or anxiety symptoms (also used for socially related and panic type symptoms. may be beneficial for migraine and neuropathic pain)
- SE: anticholinergic effects, HA, sexual dysfunction, N/V, and anorexia (especially when first starting)
- rarely causes serotonin syndrome, severe HTN
82
desvenlafaxine
- SNRI
- chemically, it is the active form of venlafaxine
- venlafaxine (prodrug) requires hepatic metabolism to activate
- same indications, SEs, and therapeutic profile as venlafaxine
83
buproprion
- inhibits NE and DA reuptake, prolongs synaptic activity, novel MOA
- mild antidepressant effects, SAD and smoking cessation
- route: PO
- SE: HA, weight loss, insomnia, anticholinergic effects
84
trazodone
- suppresses synaptic release of 5-HT, NE, DA, and Ach
- indicated for management of significant depression
- route: PO
- SE: drowsiness, dizziness, N/V/C, anticholinergic effects
85
antipsychotic agents
- psychosis is a feature of several psychiatric conditions
- antipsychotics diminish dopamine transmission
- abnormal dopamine transmission results in an aberrant limbic integration, inappropriate assignment of salience
- reducing dopamine activity correspondingly reduces perception of hallucination and delusional thinking
- best paired with behavioral and cognitive therapy interventions
86
hallucinations
seeing, hearing, feeling something that is not there
87
delusions
believing something that is not real
88
confused and disturbed thoughts
influenced by hallucinations/delusions
89
haloperidol
- typical antipsychotic
- strongly antagonizes DA receptors, also anticholinergic
- route: PO, IM, or IV
- SE: anticholinergic effects, sedation, weight gain, EPS
- not recommended for older adults
- can cause cardiac arrythmias, NMS, tardive dyskinesia
90
ziprasidone
- atypical antipsychotic
- strongly antagonizes DA receptors, 5-HT, and alpha 1 receptors
- route: PO or IM
- SE: anticholinergic effects, hypotension, sedation, N/V/D, HA, and EPS
- not recommended in older patients (over 65)
- can cause cardiac arrythmias, NMS, tardive dyskinesia
91
clozapine
- antipsychotic
- atypical
- antagonist to both DA and 5-HT receptors
- route: PO
- SE: drowsiness, dizziness, drooling, N/V/C, irritability
- black box warning: dangerous low WBC count, seizure
92
risperidone
- atypical antipsychotic
- antagonist to more 5-HT receptors than DA receptors
- route: PO or IM
- SE: drowsiness, dizziness, drooling, N/V/D, SSRI type side effects
- black box warning: dangerous low WBC count, seizure
93
mood stabilizers
- reduces swings in mood; prevent manic and depressive period symptoms
- taken on a schedule to prevent mood/affect lability, not PRN
- exact mechanism of mood stabilizers are not clear
94
lithium carbonate
- mood stabilizer
- route: PO
- used since the 19th century, first formally used as a med in the 40s
- SE: N/V/D, muscle weakness, slurred speech, hyperreflexia
- regular monitoring of serum Li+ levels required
- consistent fluid intake of 2+ L/day
- high risk of toxicity: tremor/seizure, confusion, blurred vision, coma
- do NOT restrict sodium intake, leads to increased risk of toxicity
95
lamotrigine
- mood stabilizer
- primarily anticonvulsant/classic antiseizure
- electrical conduction of CNS neurons
- does not change neurotransmitter levels
- reduces the ability of glutamate to act on the brain
- increases the effects of GABA on the brain
- route: PO
- SE: HA, sedation, drowsiness, N/V/D, aggression, dizziness
96
psychotropic drugs
- broad category. Change mood, thought processes, inhibition, behavior, or perception
- many can be used therapeutically
- several have strong abuse potentials, can be used as social/recreational drugs, or are illicit substances
- stimulants, depressants, psychedelics, dissociative drugs
97
caffeine
- psychotropic drug
- natural in many alkaloid plants
- reduces synaptic adenosine -> increases activity of Ach. Results in increased excitation in CNS, blunts fatigue, increases executive function
- in food/drink
- mild diuretic effect -> increases blood flow to the nephron
- withdrawal in tolerant/dependent patients -> irritability, fatigue, headache
98
alcohol
- psychotropic drug
- intoxication has profound CNS depressant effect (disinhibition, relaxation, somnolence, euphoria)
- hepatotoxic, neurotoxic
99
cannabinoids (marijuana)
- psychotropic drug
- complex mechanism of actions, cannabinoid receptors in CNS
- over 100 distinct compounds in cannabis (THC, CBD)
- relaxation, euphoria, disinhibition. GABAminergic activity may partially explain HIS, some anticholinergic/adrenergic effects noted
- inhaled or ingested
heavily fat bound, may extend distribution/effect
- federally illegal, legality depends on state/local jurisdiction
100
cocain
- psychotropic, stimulant
- prevents synaptic reuptake of DA, epi, 5-HT (increases synaptic responsivity)
- interferes with sodium channel activity in nerve cells
- strong adrenergic agonist (increases BP, HR, SVR)
- federally illegal, some dilute solutions used medically
101
opioids
- psychotropic
- derivatives of opium
- heroin is potent, produced from morphine. Illicit/street drug
- prescription drug abuse (hydrocodone, oxycodone), increasingly prevalent
- Mu opioid receptor activity can produce euphoria, sedation, relaxation
- overdose is major concern, national health crisis (significant respiratory depression, cardiovascular collapse)
- antidote: NALOXONE (nasal, SC, IM, or IV)
102
amphetamines
- psychotropic stimulant
- most common, methamphetamine (meth, crystal)
- strongly prevents synaptic reuptake of DA, epi, 5-HT
- behaves like an ultra potent MAOI, increases catecholamines in PNS
- net effect: profound stimulation of CNS/PNS, upregulation of sympathetic tone
- some versions are Rx, federally illegal as an unregulated/street drug
103
psychedelic agents
- psychotropic
- lysergic acid (LSD), Psilocybin (magic mushrooms), Lophophora (peyote, mescaline)
- exact mechanism of action is unknown, dopaminergic activity is upregulated
- vivid hallucinations, synesthetic activity
- federally illegal in most preparations
104
dissociative agents
- psychotropic
- ketamine, phencyclidine (PCP), dextromethorphan (DXM)
- interrupts associative pathways in the reticular activating center
- prevents sensory information from PNS from being perceived
- can also prevent efferent signaling from CNS to muscles, usually more apparent in overdose
- PCP federally illegal; street/non-medical use of other drugs is also illegal
