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Behavioral Health Chapter 3: Psychobiology and Psychopharmacology

Terms in this set (245)

TEXTBOOK
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Brain Functions
- maintenance of homeostasis
- regulation of the ANS and hormones
- control of biological drives and behavior
- conscious mental activity
- memory
- social skills
Hypothalamic-Pituitary-Adrenal Axis (HPTA)
- hypothalamus secretes CRH
- CRH stimulates the pituitary to release adrenocorticotropic hormone
- adrenocorticotropin stimulates the cortex of each adrenal gland to secrete cortisol
- all 3 hormones influence the functions of nerve cells
Where are elevated cortisol levels often found?
in people with major depressive disorder
What can elevated cortisol levels do?
suppress immune function
Circadian Rhythms
fluctuation of various psychological and behavioral patterns over a 24-hour cycle
What do circadian rhythms influence?
- changes in sleep
- body temperature
- secretion of hormones such as corticotropin and cortisol
- secretion of neurotransmitters such as norepinephrine and serotonin
What 3 actions do all neurons carry out?
1.) responding to stimuli
2.) conducting electrical impulses
3.) releasing chemicals called neurotransmitters
What is communication between neurons mainly done through?
sodium (+) and potassium (+) ions
Sodium/Potassium
- at a resting state, there is an unequal distribution
- potassium inside and sodium outside
- intracellular space is more negative than the extracellular space
- stimulation of the nerve changes the resting state
- sodium flows in, and potassium flows out
When is a neurotransmitter released?
when a nerve impulse reaches the end of an axon
Neurotransmitter
a chemical substance that functions as a neuromessenger
Reuptake
a neurotransmitter's reabsorption by the sending neuron
Dopamine Function
- fine muscle movement
- integration of emotions and thoughts
- decision making
- stimulates hypothalamus to release hormones
Decreased Dopamine
- Parkinson's
- depression
Norepinephrine Function
- affects mood
- attention
- arousal
- stimulates sympathetic branch of autonomic nervous system for "fight or flight" in response to stress
Decreased Norepinephrine
depression
Increased Norepinephrine
- anxiety
- schizophrenia
Serotonin Function
- sleep regulation
- hunger
- mood
- pain perception
- hormonal activity
- aggression
- sexual behavior
Decreased Serotonin
depression
Histamine Function
- alertness
- inflammatory response
- stimulates gastric secretion
Decreased Histamine
- sedation
- weight gain
GABA Function
- inhibition
- reduces aggression, excitation, and anxiety
- pain perception
- anticonvulsant
- muscle-relaxing
- may impair cognition and psychomotor functioning
Decreased GABA
- anxiety
- schizophrenia
- mania
- Huntington's disease
Increased GABA
reduction of anxiety
Glutamate Function
- excitatory
- learning
- memory
Decreased Glutamate
psychosis
Increased Glutamate
- prolonged increased state can be neurotoxic
- neurodegeneration in Alzheimer's disease
- improvement of cognitive performance in behavioral tasks
Acetylcholine Function
- learning
- memory
- mood
- regulates mania and sexual aggression
- stimulates PNS
Decreased Acetylcholine
- Alzheimer's
- Huntington's
- Parkinson's
Increased Acetylcholine
depression
Substance P Function
- antidepressant
- anti-anxiety
- memory
- pain reception
Somatostatin Function
altered levels associated with cognitive disease
Decreased Somatostatin
- Alzheimer's
- depression (in spinal fluid)
Increased Somatostatin
Huntington's disease
Neurotensin Function
antipsychotic
Decreased Neurotensin
schizophrenia (in spinal fluid)
Hypothalamus Function
- hunger, thirst, sex
- thought
- emotion
- internal organs functioning
- processing sensory information
- regulating sleep cycle
Cerebellum Function
movement
Cerebrum Function
- mental activities
- conscious sense of being (body, emotional status, memory, and control of skeletal muscles)
- language
- communication
What is the surface of the cerebrum called?
cerbral cortex
Basal Ganglia Function
movement
Amygdala Function
emotion
Hippocampus Function
learning and memory
What do PET scans of individuals with depression show?
decreased activity in the prefrontal cortex
Concordance
how often an illness will affect both twins even when they are raised apart
ADME
absorption, distribution, metabolism, excretion
Agonist
mimics the action of a neurotransmitter by binding to and stimulating the receptor site
Antagonist
block neurotransmitters
What is the major inhibitory neurotransmitter in the CNS?
GABA
(Benzodiazepines) Function
- promote GABA by binding to a specific receptor on the GABA receptor complex; causes increased chloride channel openings, which reduces cell excitation
- quick acting
(Benzodiazepines) Examples
- diazepam (Valium)
- clonazepam (Klonopin)
- alprazolam (Xanax)
- Ativan
(Benzodiazepines) What should they not be combined with to avoid CNS depression?
- alcohol
- opiates
- tricyclic antidepressants
(Benzodiazepines) Side Effects
- interfere with motor ability, attention, and judgement
- falls
- bone fractures
- ataxia
(Benzodiazepines) Issues
- dependency
- need to be tapered off (rebound effect)
- use cautiously with the elderly
(Benzodiazepines) Antidote
Flumazenil
(Short-Acting Sedative-Hypnotic Sleep Agents) Examples
- zolpidem (Ambien)
- zaleplon (Sonata)
- eszopiclone (Lunesta)
(Short-Acting Sedative-Hypnotic Sleep Agents) How are they different from benzos?
sedative without antianxiety, anticonvulsant, or muscle relaxant effects
(Short-Acting Sedative-Hypnotic Sleep Agents) Side Effects
- amnesia
- ataxia
- quick onset of action
(Short-Acting Sedative-Hypnotic Sleep Agents) What is usually short?
half-life
(Melatonin Receptor Agonists) Examples
ramelteon (Rozerem)
(Melatonin Receptor Agonists) Why is it good?
- not a controlled substance
- no abuse potential
(Melatonin Receptor Agonists) Side Effects
- headache
- dizziness
(Melatonin Receptor Agonists) What can prolonged long-term use cause?
- increased prolactin
- sexual dysfunction
(Doxepin) What is this?
Silenor
low-dose formulation of an old tricyclic antidepressant
(Doxepin) Indications
insomnia
(Doxepin) Who should avoid this medication?
- severe urinary retention
- patients on MAOIs, CNS depressants, and sedating antihistamines
(Suovrexant) What is this?
Belsomra
an orexin receptor antagonist
(Suovrexant) Side Effects
- daytime impairment
- abnormal thinking and behavioral changes
- worsening depression or increases in suicidal ideation
- sleep paralysis
- hypnagogic and hypnopomic hallucinations
- cataplexy-like symptoms associated with higher doses
(Suovrexant) What should you avoid use with?
other CNS depressants
(Buspirone) What is this?
reduces anxiety without strong sedative properties; not a CNS depressant; taken on a regular basis (not acute)
(Buspirone) Side Effects
- dizziness
- insomnia
What are SSRIs used for?
- depression
- OCD
- SAD
- GAD
- PD
PTSD
SSRI Examples
Fluoxetine (Paxil), Sertraline (Zoloft), Fluvoxamine (Luvox), Citalopram (Celexa), Escitalopram (Lexapro)
Venlafaxine (Effexor XR)
dyloextine (Cymbalta)
(NaSSA) What are these?
norepinephrine and serotonin specific antidepressant (NaSSA)
(NaSSA) Examples
Mirtazapine (Remeron)
(NaSSA) Side Effects
- sedation
- appetite stimulation
- weight gain
(NaSSA) Why are they often used?
- minimal dysfunction
- improved sleep
- fewer GI symptoms
(Bupropion) What is this?
- antidepressant
- also used for smoking cessation
- seems to act as an NDRI
(Bupropion) Side Effects
- insomnia
- tremor
- anorexia
- weight loss
(Bupropion) Who is it contraindicated in?
- seizure disorder
- current or prior diagnosis or bulimia or anorexia
- undergoing abrupt discontinuation of alcohol or sedatives
(Nefadozone) What is this?
Serzone
- used only for depression
- SARI
(Nefadozone) Side Effects
- sedation
- headache
- fatigue
- dry mouth
- nausea
- constipation
- dizziness
- blurred vision
(Nefadozone) What can it cause?
life-threatening liver failure
(Nefadozone) Contraindications
pre-existing liver problems
(Trazodone) Side Effects
- sedation
- dizziness
- orthostatic hypotension
- priapism
(Trazodone) What should you avoid?
- ETOH
- other sedatives
(Brexpiprazole) What is this?
Rexulti
depression that accompanies schizophrenia
(Brexpiprazole) Side Effects
- akathisia
- weight gain
(Vortioxetine) Trintellix
- serotonin modulator and stimulator
- may improve cognitive deficits for geriatric patients
(Vortioxetine) Side Effects
- constipation
- nausea
- vomiting
- hyponatremia
- hypomania/mania
(Venlafaxine) Effexor
SNRI
(Venlafaxine) Side Effects
hypertension
(Duloxetine) Cymbalta
- SNRI
- depression and GAD, diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain
(Vilazodone) Viibryd
serotonin partial agonist and reuptake inhibitor
(Vilazodone) Side Effects
- diarrhea
- nausea
- insomnia
- vomiting
(Vilazodone) How should it be taken?
- take with food
- avoid taking at night
(TCAs) Tricyclic Antidepressants
no longer used often because of side effects, take a long time to reach therapeutic dose, and are more lethal in overdoses
(TCAs) Side Effects
- blurred vision
- dry mouth
- tachycardia
- urinary retention
- constipation
- sedation
- drowsiness
- photophobia
- sweaty
- seizures
- sedation
(Mood Stabilizers: Lithium) Examples
- Eskalith
- Lithobid
(Mood Stabilizers: Lithium) Uses
bipolar
(Mood Stabilizers: Lithium) Side Effects
- sinus bradycardia
- tremor
- ataxia
- confusion
- convulsions
- nausea
- vomiting
- diarrhea
- arrhythmias
- polyuria
- polydipsia
- edema
- goiter
- hypothyroidism
(Mood Stabilizers: Lithium) What can increase the risk of toxicity?
hyponatremia
(Mood Stabilizers: Lithium) What should users be taught to do?
maintain normal fluid and sodium intake
(Valproate) Examples
Depakote
Depakene
(Valproate) Use
- anticonvulsant
- bipolar
- do not stop abruptly
(Valproate) Side Effects
- tremor
- weight gain
- sedation
- thrombocytopenia
- pancreatitis
- hepatic failure (liver toxic)
- birth defects/accidental pregnancy
(Carbamazepine) Examples
Equetro
Tegretol
(Carbamazepine) Use
- anticonvulsant
- acute mania
(Carbamazepine) What should be obtained?
- liver function tests
- CBC
- electrocardiogram
- electrolyte levels
- blood values to avoid toxicity
(Carbamazepine) Levels
> 12 mcg/mL
(Carbamazepine) Side Effects
- dry mouth
- constipation
- urinary retention
- blurred vision
- orthostasis
- sedation
- ataxia
- leukopenia (report fever and sore throat)
(Carbamazepine) What side effect should be reported immediately?
rash
(Carbamazepine) Why?
can lead to life-threatening dermatitis or Stevens-Johnson syndrome
(Carbamazepine) What does the FDA require?
genetic testing before it is used in people of Asian descent
(Carbamazepine) What can it cause?
accidental pregnancy
(Lamictal) Use
- anticonvulsant
- bipolar
- acute mania
(Lamictal) What should patients report immediately?
rashes
(Lamictal) What may use with valproate cause?
double blood levels of lamotrigine and increase risk of Stevens-Johnson syndrome
(First-Generation Antipsychotics) Use
- strong agonists
- work on delusions and hallucinations in schizophrenia
(First-Generation Antipsychotics) Examples
phenothiazines
thiozanthenes
butyrophenones
(First-Generation Antipsychotics) Side Effects
- acute dystonic reactions
- parkinsonism
- akathisia
- tardive dyskinesia
- amenorrhea
- galactorrhea
- gynecomastia
- galactorrhea
- blurred vision
- dry mouth
- constipation
- urinary hesitancy
- sedation
- weight gain
(Second-Generation Antipsychotics) Use
- first-line
(Second-Generation Antipsychotics) Side Effects
- weight gain
- increased blood glucose and triglycerides
(Second-Generation Antipsychotics) Examples
Clozapine (clozaril), olanzapine (zyprexa), quetiapine (Seroquel), risperidone (Risperdal), Paliperidone (Invega), ziprasidone (Geodon), aripiprazole (Abilify)
(Second-Generation Antipsychotics) Clozapine
can suppress bone marrow and induce agranulocytosis
(Second-Generation Antipsychotics) What is necessary for clozapine?
neutrophil count
(Second-Generation Antipsychotics) Clozapine Side Effects
convulsions
(Second-Generation Antipsychotics) Risperidone
- high doses may cause motor difficulties
- sexual dysfunction
- orthostatic hypotension
- sedation
- weight gain
(Second-Generation Antipsychotics) Quietiapine (Seroquel)
- weight gain
- metabolic syndrome
(Second-Generation Antipsychotics) Olanzapine (Zyprexa)
- sedation
- weight gain
- hyperglycemia
- higher risk for metabolic syndrome
(Second-Generation Antipsychotics) Ziprasidone (Geodon)
- CI for patients with QT interval prolongation, recent acute MI, or uncompensated heart failure
- take with food
(Second-Generation Antipsychotics) Ariprazole
...
(Second-Generation Antipsychotics) Paliperidone (Invega)
...
(Second-Generation Antipsychotics) Iloperidone (Fanapt)
- orthostatic hypotension
- increase in mean QT interval
(Second-Generation Antipsychotics) Asenapine (Saphris)
avoid food and water 10 minutes after administration
(Second-Generation Antipsychotics) Lurasidone (Latuda)
...
ADHD Treatment
- methylphenidate (Ritalin), dextroamphetamine (Adderall, Vyvanse)
Nonstimulant ADHD medications
atomexetine (strattera)
guanfacine (intuniv)
clonidine (kapvay)
ADHD Nonstimulant Side Effects
- decreased appetite
- weight loss
- fatigue
- dizziness
ADHD Nonstimulant Contraindications
severe cardiovascular disease
Guanfacine Side Effects
- sleepiness
- low blood pressure
- nausea
- stomach pain
- dizziness
Clonidine Side Effects
- fatigue
- irritability
- throat pain
- insomnia
- nightmares
- emotional disorder
- constipation
- increased body temperature
- dry mouth
- ear pain
Alzheimer's Medications
1) Donepezil (Aricept)
2) Galantamine (Razadyne)
3) Rivastigmine (Exelon)
4) Tacrine (Cognex)
5) NMDA Antagonist
6) Memantine (Namenda)
POWERPOINT/NOTES
...
PET Scan
can diagnose mental illness when compared to a normal brain
What happens once an electrical impulse reaches the end of a neuron?
a neurotransmitter is released, crossing the synapse to attach to receptors on the postsynaptic cell to inhibit or excite it
Transmission of Neurotransmitters Concept
All activities of the brain involve actions of neurons, neurotransmitters, and receptors. These are the targets of pharmacologic intervention.
Most psychotropic drugs act by either increasing or decreasing the activity of certain neurotransmitter-receptor systems.
Thought disorders such as schizophrenia are physiologically associated with
the excess transmission of the neurotransmitter dopamine.
(Monoamines) Dopamine
involved in the reward pathway (substance disorders)
(Monoamines) What may too much dopamine cause?
hallucinations
(Monoamines) Decreased Dopamine
- Parkinson disease
- depression
(Monoamines) Increased Dopamine
- schizophrenia
- mania
(Monoamines) Decreased Norepinephrine
depression
(Monoamines) Increased Norepinephrine
anxiety states
(Monoamines) Decreased Serotonin
depression
(Monoamines) Increased Serotonin
anxiety states
(Monoamines) Histamine
- high levels associated with anxiety and depression
- can cause sedation and weight gain
(Amino Acids) What do benzodiazepines affect?
GABA
(Amino Acids) GABA
produces relaxation
(Amino Acids) Decreased GABA
- anxiety disorders
- schizophrenia
- mania
- Huntington chorea
(Amino Acids) Increased GABA
- reduction of anxiety
- schizophrenia
- mania
(Amino Acids) Glutamate
- is the major mediator of excitatory signals in the central nervous system
- is involved in most aspects of normal brain function, including cognition, memory, and learning
(Cholinergics) Acetylcholine
involved in memory
(Cholinergics) Increased ACh
depression
(Cholinergics) Decreased ACh
- Alzheimer disease
- Huntington chorea
- Parkinson disease
(Peptides-Neuromodulators) Substance P
- regulation of mood and anxiety
- role in pain management
(Peptides-Neuromodulators) Decreased Somatostatin
Alzheimer disease
(Peptides-Neuromodulators) Increased Somatostatin
Huntington disease
(Peptides-Neuromodulators) Neurotensin
decreased levels in spinal fluid of patients with schizophrenia
Antidepressants Neurotransmitter
serotonin
Antianxiety Neurotransmitter
GABA
Sedative Hypnotic Neurotransmitter
histamine
Mood Stabilizer Neurotransmitter
norepinephrine
Antipsychotic Neurotransmitter
dopamine
Anticholinesterase Neurotransmitter
acetylcholine
(Monoamine Oxidase Inhibitors) MAO
enzyme that destroys monoamines
Indolamines
serotonin and histamine
Catecholamines
dopamine, norepinephrine, epinephrine
(Monoamine Oxidase Inhibitors) MAOIs
drugs that increase concentrations of monoamines by inhibiting the action of MAO
(Monoamine Oxidase Inhibitors) Examples
Phenelzine (Nardil)
Tranylcypromine (Parnate)
(Monoamine Oxidase Inhibitors) What should patients avoid eating?
tyramine
(Monoamine Oxidase Inhibitors) Where can tyramine be found?
- some OTC medications
- beer
- wine
- aged cheese
- organ meats
- avocados
(Monoamine Oxidase Inhibitors) How long should a patient avoid tyramine after stopping MAOIs?
2 weeks
(Monoamine Oxidase Inhibitors) Use
- depression
- panic disorder
- social phobia
(Monoamine Oxidase Inhibitors) What is there a risk for?
massive hypertension
(TCAs) Examples
amitriptyline, nortriptyline
(Monoamine Oxidase Inhibitors) What can cause a hypertension crisis?
- tyramine
- OTCs (calcium, antacids, Tylenol, and NSAIDs)
(Monoamine Oxidase Inhibitors) What is a symptom of massive hypertension?
headache
(TCAs) What does it do?
increases norepinephrine
(TCAs) Side Effects
anticholingeric - dry mouth, blurred vision, constipation, memory problems
antiadrengeric - orthostatic hypotension
antihistaminergic - sedation and wgt gain
ekg changes, cardiac dysrhythmias
known to induce hypomania
photophobia
(SSRIs) Examples
Prozac, Zoloft, Paxil, Celexa, Lexapro
(SSRIs) Uses
- depression
- anxiety
- PTSD
(SSRIs) What does it do?
increases serotonin
(SSRIs) Side Effects
- fewer anticholinergic effects
- nausea
- vomiting
- weight gain
- sexual dysfunction
- insomnia
- suicide risk increased
(SSRIs) What should you never mix SSRIs with?
- St. John's Wort
- MAOI
- Tramadol
(SSRIs) What can mixing with these drugs cause?
serotonin syndrome
(SSRIs) Serotonin Syndrome Symptoms
- sweaty, hot
- fever
- rigid muscles
- restlessness
- agitation
- tachycardia
(SNRIs) Examples
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
(SNRIs) What does it do?
increases serotonin and norepinephrine
(SNRIs) Side Effects
fewer anticholinergic effects
(SNDIs) Examples
mirtazapine (Remeron)
(SNDIs) What does it do?
increases serotonin and norepinephrine
(SNDIs) What is it often combined with?
SSRIs
(NDRIs) Examples
Bupropion (Wellbutrin)
(NDRIs) Function
inhibit nicotin acetylcholine receptors to reduce addictive effects
(SARIs) Examples
trazodone (Desyrel)
(SARIs) Trazodone Use
insomnia
(SARIs) What can they cause?
priapism
(NRIs) Examples
atomoxetine (Strattera)
(NRIs) Use
ADHD; no significant antidepressant benefits
(Benzodiazepines) Examples
Lorazepam (Ativan)
Diazepam (Valium)
clonazepam (Klonopin)
alprazolam (Xanax)
(Benzodiazepines) Use
- anxiety
- insomnia
(Benzodiazepines) Insomnia Use
flurazepam (Dalmane)
triazolam (Halcion)
(NonBenzodiazepines) Examples
- buspirone
- z-hypnotics
- melatonin-receptor agonist (ramelteon/rozeram)
(NonBenzodiazepines) Buspirone (Buspar)
less potential for dependence
(NonBenzodiazepines) Z-Hypnotic Examples
zopidem (Ambien)
zaleplon (Sonata)
eszopiclone (Lunesta)
(NonBenzodiazepines) Z-Hypnotics
- short-acting sedative and hypnotic sleep agents
- provide sedative effects without the antianxiety, anticonvulsant, or muscle relaxant effects of benzos
(NonBenzodiazepines) Melatonin-Receptor Agonist
- acts similar to melatonin
- thought to regulate circadian rhythms
Mood Stabilizers
lithium
(Lithium) Examples
- Eskalith
- Lithobid
(Lithium) Use
- depression
- mania (bipolar disorder)
(Lithium) Therapeutic Index
0.6-1.2 mEq/L (narrow); toxicity: over 1.5
(Lithium) Toxicity Symptoms
- tremor
- ataxia
- confusion
- convulsions
- nausea
- vomiting
(Lithium) Who is at a higher risk for toxicity?
- patients with decreased renal function
- patients with the stomach flu
(Lithium) Symptoms of Toxicity
- creatinine over 1.3
- urine 30 mL/hr or less
- tinnitus
(Lithium) What can it cause an increase in?
- fluid
- sodium
do not limit sodium or water intake
(Lithium) Contraindications
- dehydration
- hyponatremia (< 135)
(Anticonvulsant Mood Stabilizers) Examples
- valproate
- carbazepine
- lamotrigine
(Anticonvulsant Mood Stabilizers) Valproate
impulsive aggression
(Anticonvulsant Mood Stabilizers) Carbamazepine
acute mania
(Anticonvulsant Mood Stabilizers) Lamotrigine
maintenance therapy
(Anticonvulsant Mood Stabilizers) What should you assess for when giving lamotrigine?
rash (Stevens-Johnson syndrome)
(Off-Label Mood Stabilizers) Examples
- oxcarbazepine (Trileptal)
- gabapentin (Neurontin)
- topiramate (Topamax)
(Antipsychotic Drugs) What do they do?
reduce dopamine transmission
(Antipsychotic Drugs) FGA Examples
- chlorpromazine (Thorazine)
- fluphenazine (Prolixin)
- haloperidol (Haldol)
(Antipsychotic Drugs) Second-Generation (AGA) Atypical Examples
•clozapine (Clozaril)
•risperadone (Risperdal)
•quetiapine (Seroquel)
•olanzapine (Zyprexa)
•iloperidone (Fanapt)
•lurasidone HCl (Latuda)
•ziprasidone HCl (Geodon)
•aripiprazole (Abilify)
•paliperidone (Invega)
(Antipsychotic Drugs) Side Effects
extrapyramidal
- dystonia
- akathisia
- tardive dyskinesia
- drug-induced parkinsonism
- neuroleptic malignant syndrome (NMS; rare but life-threatening)
- orthostatic hypotension
strong dopamine blocking agent in basal ganglia can lead to motor abnormalities (EPS), increase secretion of prolactin, galactorrhea, amenorrhea, gynecomastia, and galactorrhea; AIMS test
- sun sensitivity
(Antipsychotic Drugs) Second-Generation
- fewer extrapyramidal side effects
- target negative and positive symptoms of schizophrenia
(Antipsychotic Drug) SGA Side Effects
- risk of metabolic syndrome (increased weight, glucose, triglcerides, insulin resistance)
- lower risk of EPS
REVIEW
...
Frontal Lobe
associated with reasoning, planning, parts of speech, movement, emotions, and problem solving
Parietal Lobe
receives sensory input for touch and body position
Occipital Lobe
visual processing
Temporal Lobe
A region of the cerebral cortex responsible for hearing and language.
Which drugs have anticholinergic effects?
- antidepressants
- antipsychotics
- antihistamines
- antiparkinsonian
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