Mental Health Comprehensive Pharmacology
Terms in this set (107)
Neurotransmitter involved in motor coordination, reward/pleasure pathway, emotions, and memory
Major EXCITATORY neutrotransmitter
Major INHIBITORY neurotransmitter (AGONISM of this neurotransmitter's receptors reduces anxiety, aggression, pain transmission, and cognitive activity; agonism = more than usual state)
Neurotransmitter involved in sleep, hunger, mood, pain transmission, and sex drive
D2 (a dopamine receptor)
Which receptor is the primary target of current antipsychotics for ANTAGONISM (antagonism = reversal of agonist action and stabilization at resting state)
This term describes something that functions as an "on switch" for the brain (ex. increased cognitive performance)
This term describes something that functions as an "off switch" for the brain (ex. reduce aggression)
Atypical (second generation)
Which type of antipsychotics diminish both negative and positive symptoms of schizophrenia?
Which drug, out of all of the second generation antipsychotics, has the highest risk for EPS? It also causes weight gain, sexual dysfunction, and sedation, which may cause problems with adherence.
Which second generation antipsychotic does NOT cause weight gain?
Dopamine and serotonin
Second generation antipsychotics mainly block which two neurotransmitters?
They promote weight gain and are more expensive than first generation antipsychotics
What are the cons of atypical antipsychotics?
Clozapine (monitor blood counts frequently)
Which atypical antipsychotic carries the risk of bone marrow suppression and agranulocytosis?
These drugs cause few or no extrapyramidal side effects or tardive dyskinesia and may improve the neuro-cognitive defects associated with schizophrenia
increased weight, increased blood glucose and triglycerides (this is why we measured waist circumference at Betty Shirley)
Second generation (atypical) antipsychotics can lead to metabolic syndrome. What are the manifestations of this adverse effect?
What class do these drugs belong to: clozapine, risperdone, olanzepine, quetiapine, ziprasidone, gripiprazole?
Which drug may be considered a "Third Generation Antipsychotic" and acts as a partial agonist: it lowers or raises dopamine in areas of the brain as needed? Side effects are insomnia and akathisia
First Generation (conventional) Antipsychotics
This drug class relieves only the POSITIVE symptoms of schizophrenia
Conventional (first generation/typical) Antipsychotics
Haloperidol (Haldol), thioridazine (Mellaril), fluphenazine (Prolixin), and chlorpromazine (Thorazine) are all examples of which drug class?
Dopamine (it is thought that excess dopamine is responsible for the positive symptoms of schizophrenia like delusions and hallucinations)
First generation antipsychotics block the action of which neurotransmitter?
D2 (dopamine receptor)
Which receptors in the brain do conventional antipsychotics target? (antagonism of these receptors encourages return to resting state, reduction of positive symptoms)
First Generation Antipsychotics
Which drug class is known for causing the dangerous side effects tardive dyskinesia and neuroleptic malignant syndrome?
amenorrhea, galactorrhea, and gynecomastia
First generation antipsychotics block dopamine; dopamine blockage can lead to increased prolactin, which causes which adverse effects?
1. Extrapyramidal side effects (dystonia, akathisia, and pseudoparkinsonism)
2. Anticholinergic side effects (dry mouth, urinary retention, constipation, blurred vision)
4. Lowered seizure threshold (increased risk for seizures)
5. Orthostatic hypotension
List 6 side effects of conventional antipsychotics (other than tardive dyskinesia and NMS).
involuntary tonic muscular spasms of the tongue, lips, fingers, toes, jaw, neck, and trunk
Neuroleptic Malignant Syndrome
a side effect of conventional antipsychotics that is potentially fatal; it is characterized by lowered LOC, increased muscle tone, and autonomic dysfunction
First generation (conventional) antipsychotics
To which class do these drugs belong: Phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dihydroindolones
This drug class works by AGONISM of GABA receptors, which causes an inhibitory effect, reducing anxiety and aggression and slowing cognition - calming effect
Though this drug class is primarily an anti-anxiety agent, it is also used for anticonvulsant effects and in alcohol withdrawal
Life-threatening CNS and respiratory depression
What can happen when benzodiazepines are combined with other sedatives (such as alcohol)?
To which class do these drugs belong: flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion), estazolam (Prosom), quazepam (Doral), lorazepam (Ativan), alprazolam (Xanax)
Short-Acting Sedative Hypnotic Sleep Agents
Which drug class provides sedative effects without the anti-anxiety, anti-convulsant, and muscle relaxing effects of benzos?
Short-Acting Sedative Hypnotics have a ___1___ onset and a ___2___ half life.
Which receptors do short-acting sedative hypnotic sleep agents work on? (agonism of these receptors increases the INHIBITORY effect of its neurotransmitter, reducing cognitive activity to promote sleep)
Unpleasant taste in the mouth
Lunesta, a sedative-hypnotic, causes which side effect upon waking?
Sedative Hypnotic Sleep Agents (remember, patient may have secret behaviors, sleep-walking; safety!)
To which class do these drugs belong: zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta)
Melatonin Receptor Agonists
Which drug class is only used for insomnia?
A hormone excreted at night that is responsible for normal circadian rhythm
Melatonin Receptor Agonists
To which drug class does ramelteon (Rozerem) belong?
Which antidepressant may be used at a low dose to treat insomnia? (it is thought to block histamine - causes sedation/drowsiness)
Which drug is used to reduce anxiety WITHOUT SEDATION? This drug works well for people with addiction (because it has no major interactions with alcohol and other drugs), geriatrics (sedation for them reduces safety), and long-term patients.
Tricyclic Antidepressants (TCAs)
Which class of antidepressants is thought to block the re-uptake of norepinephrine and serotonin, but is no longer the first line of treament? (blocking re-uptake makes more of these neurotransmitters available at the synapse - increases their amounts)
1. Anticholinergic effects (because TCAs block muscarinic receptors)
2. Sedation and drowsiness (because TCAs block histamine receptors; for example: anti-histamines like Benadryl usually make you sleepy)
These side effects cause issues with ADHERENCE.
List 2 common side effects that can result from taking TCAs.
They have a potential for lethal overdose and they take a long time to reach optimal dosage.
Why are TCAs no longer the first line drugs for treatment of depression?
A full cardiac workup (TCAs can cause dysrhythmias, MI, tachycardia, and heart block.)
What is necessary to obtain before starting a patient on treatment with TCAs?
Bedtime (sedation/drowsiness are side effects of this drug class)
What time of day should you teach patients who are prescribed TCAs to take their medicine?
May take 10-14 days to start working, with full effect taking 6-8 weeks.
Do not stop abruptly: these drugs can cause withdrawals.
What is important family/patient teaching for TCAs concerning the time it takes for their full effect?
What is important teaching about adherence?
To what class do these drugs belong: nortriptyline (Pamelor), amitriptyline (Elavil), imipramine (Tofranil)?
This drug class increases levels of norepinephrine and serotonin by blocking their re-uptake for the treatment of depression, but they may also be used for neuropathic pain (resulting from DM or fibromyalgia)
What is the main side effect of SNRIs?
To which class do these drugs belong: venlafaxine (Effexor), desvenlafaxine (Pristiq), duloxetine (Cymbalta)?
SSRI (selective serotonin re-uptake inhibitors)
Which drug class is the first line of treatment for almost all types of depression (except psychotic, melancholic, and mild) and is also useful to stabilize mood?
1. Sexual side effects
2. Dry mouth
5. Increased agitation/anxiety
List 5 common side effects of SSRIs.
What is a life-threatening side effect of SSRIs?
Tachycardia, fever, increased BP, tonic rigidity --> seizures, apnea, death
What are the manifestations of serotonin syndrome?
Cyproheptadine (Periactin) and/or Propanolol; this causes receptor blockade (reducing the use of the excessive amounts of serotonin that are causing the syndrome)
Which medicines are given if someone has serotonin syndrome?
To which class do these drugs belong: fluoxetine (Prozac), setraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox)?
Which drug class that is used as an antidepressant works by increasing norepinephrine and serotonin transmission by blocking presynaptic transmission?
They reduce anxiety/depression and promote sleep WITHOUT as many sexual side effects; also has an ANTIEMETIC effect
Why are SNDIs sometimes preferred over SSRIs?
1. Weight gain
What are two common side effects of SNDIs?
To which class does the drug mirtazepine (Remeron) belong?
MAO is an enzyme used by the liver to break down monoamine substances (such as TYRAMINE); when MAO is inhibited (through MAOI drugs), tyramine and other monoamines build up in the body and cause profound vasoconstriction/hypertension
Why do MAOIs cause problems with other body functions?
Other antidepressants, sympathomimetic drugs (OTC decongestants)
MAOIs are contraindicated with which other drug classes?
What is a life-threatening side effect of MAOIs?
Increased BP that can lead to intracranial hemorrhage, fever, seizures, coma, and death
What are the manifestations of a hypertensive crisis?
What is crucial to assess for the first few weeks after initiating MAOI therapy?
Do not eat foods containing tyramine (wine, expensive aged cheeses, aged meats)
What teaching is important for patients starting MAOI therapy?
Aimed at lowering BP, IV Regitine or sublingual Nifedipine
How is hypertensive crisis treated?
To which class do these drugs belong: isocarboxazid (Marplan), phenelzine (Nardil), selegiline (EMSAM), tranylcypromine (Parnate)?
Cymbalta ("depression hurts, Cymbalta can help")
A person with depression and co-morbid pain may be prescribed this new atypical antidepressant
A person with depression and impaired social functioning may be prescribed this atypical antidepressant
This atypical antidepressant may help with smoking cessation
This atypical antidepressant may aid sleep when taken at night
Wellbutrin increases the risk of ___________.
(It is the first line treatment for BD1 because it reduces elation, grandiosity, irritability, and anxiety)
Which mood stabilizer is indicated for Bipolar I acute and recurrent manic and depressive episodes?
Either an antipsychotic or a benzodiazepine
Lithium is generally given concurrently with which medicines (2 types) that are gradually discontinued as the Lithium takes effect?
Between 0.4 and 1.3 mEq/L
What are safe blood levels for Lithium?
Patient will have increasing tremors, N/V, confusion that progresses, polyuria, clonic movements/seizures, hypotension --> coma and death.
How would you recognize Lithium toxicity?
hypothyroidism, kidney impairment
What are the long-term risks of taking Lithium?
Sodium (decreased sodium can cause lithium retention - because the body tries to use Lithium in place of sodium - and lead to toxicity)
*Be aware of conditions that cause sodium loss, as these can lead to Lithium toxicity (diarrhea, sweating, vomiting)
Taking Lithium can lead to a deficiency of which electrolyte?
Which drug class alter the firing rate of high-frequency neurons in the brain, stabilizing the cell membrane and are used to treat BIPOLAR DISORDER?
1. Valproate (Depakote/Depakene)
2. Carbamazepine (Tegretol)
3. Lamotigrine (Lamictal)
Name 3 anticonvulsant drugs that are used as mood stabilizers in Bipolar Disorder.
Side effects: thrombocytopenia, pancreatitis, hepatic failure
Monitor: LFTs, CBC, and collect drug levels
What are side effects of valproate (Depakote) and what should be monitored periodically?
Which anticonvulsant drug used for mood stabilization in BD is useful for patients who have an angry/paranoid mania?
Anticholinergic side effects, STEVENS-JOHNSON SYNDROME, bone marrow suppression, liver inflammation
What are adverse effects of carbamazepine (Tegretol)?
Which anticonvulsant drug used for bipolar disorder is useful for patients who have depression related to their BD, not for patients with acute mania?
What is an adverse effect of lamotigine (Lamictal)
1. Gabapentin (Neurontin)
2. Topiramate (Topamax)
3. Oxcarbazepine (Trileptal)
Which 3 drugs are considered mood stabilizers, but are not approved for Bipolar Disorder?
Which drugs, given for ADHD, are thought to inhibit overactive parts of the limbic system?
Ritalin, Daytrana, Concerta
Examples of methylphenidates used for the management of ADHD
Examples of dextroamphetamines used for the management of ADHD
Norepinephrine Re-uptake Inhibitors
Which drug class, used to treat ADHD, are non-stimulant medications that inhibit the re-uptake of norepinephrine?
Atmozetine (Strattera), guanfacine (Intuiv), clonidine (Kapvay)
Examples of norepinephrine re-uptake inhibitors used for ADHD
Decreased appetite, fatigue, dizziness
Name three common side effects of Strattera.
Which drug class, used for the treatment of Alzheimer's Disease, inhibits the breakdown of acetylcholine? (ACh regulates learning, memory, mood, and behavior)
To which class do these drugs belong: tacrine (Cognex), donepezil (Aricept), galantamine (Razadyne), rivastigmine (Exelon)
Treatment with tacrine (Cognex) can lead to which adverse effect
To which class does the drug memantine (Namenda) belong?
It works differently; Namenda binds to glutamate receptors, blocking excess glutamate. This is thought to reduce amyloid plaques or tangles in the brain.
Memantine (Namenda) can be taken with other Alzheimer's drugs because ... ?
1. Decreased platelets (do not use with anticoagulant therapy)
2. Increased risk for stroke
Ginkgo Biloba may improve memory in Alzheimer's Disease, but it has adverse effects. What are these two effects?
1. Clonazepam (Klonopin)
2. Lorazepam (Ativan)
Which 2 ANXIOLYTICS can be used in acute mania to reduce psychomotor agitation but should be avoided in patients with substance abuse?
Indicated for alcohol withdrawal, increases seizure threshold (reduces seizure activity), reduces agitation, and produces sedation
Indicated for alcohol withdrawal, produces sedation
Naltrexone (Vivitrol, ReVia, Depade)
Indicated for alcohol and opiate withdrawal, prevention of relapse, and decreasing cravings; may cause nausea, but it should go away within first month; may cause headache, sedation, and pain at the injection site
Indicated for detoxification of opiates; sedation is possible at initiation and with high doses; safe for pregnant women; induction period required
Buprenorphine (Subutex, Buprenex, Suboxone)
Indicated for detoxification of opiates; used for ACTIVE WITHDRAWAL; levels are adjusted over several days; typically used for 9-12 months then tapered
Naltrexone Hydrochloride (Trexan)
Indicated for heroin, opiates, and pathological gambling; used for detox, maintenance, and for reduction of impulsive and compulsive behaviors; contraindicated in pregnancy