Psychopharmacology

neurotransmission

electrochem messages sent and received w/ neurotrasmitters

reuptake

neurotransmitter reabsorption by synapse

monoamine oxidase

enzyme that deactivate monoamine neurotransmitter

neurotransmitters are either stored (by reuptake), inactivated, or diffused of synaptic cleft

Dopamine

excitatory for emotion responses, complex moves, cognition

dopamine operates in _________ and is a product of ________

brainstem; amino acid: tyrosine

dopamine is responsible for _____ and can be affected by ____

pleasure and reward / stress

schizophrenia

high dopamine

use anti-psychotic to reg dopamine

serotonin

inhibitory responsible for

1. emotion reg,

2. sexual behavior,

3. temp reg,

4. sleep

5. pain management

• complex system

serotonin system can cause ____

anxiety, depression, and other psychotic due to complexity of system

ant depressed meds and serotonin

bloc reuptake of seratonin → improve neurotransmission

norepinephrine

excitatory for

1. learning

2. sleep

3. mood

4. memory

5. attention

derivative of epinephrine

low levels of norepinephrine =

anxiety, social withdrawn, depression, memory loss

meds for norepinephrine →

block presynapse reuptake

used for trauma pt due to high norepinephrine

histamine function

1. alert/ wakeful

2. reg of gastric response

3. allergic

4. cardiac stim

neuromodulation

histamine pre/post receptors reg : ____, _____, _____ , ______

histamine, glutamate, serotonin, GABA

histamine antagonist side effect

sedation and weight gain

Gamma amino butyric acid (GABA)

inhibitory neuromodulation

1. neuro develop

2. helps w/ sleeplessness

3. dec depression manifestation

benzodiazepines

inc binding of GABA → dec anxiety + inc sleep

glutamate

excitatory

functions + dopamine

1. motor

2. affective

3. cognitive

high glutamate →

psychosis

head injury/stroke

overtime → toxic to brain

acetylcholine

inhibit + excitory

mostly in skeletal muscle + sleep-wake reg

low acetylcholine →

Alzheimer

neurobiology

study of biology of nervous system

family study

study for behavior for people who share genetic history

adoptive study

study who seek cause of behavior for those w/ diff genetics but similar enviorment

twin study

cause of behavior w/ two people w/ identical genetics

psychiatric pharmacogenomic testing

study to see how genetics impact interaction of psychotropic meds

psychoimmunology

psychosocial stress and its affect on immune

ex depression and mood when inflammatory

there are studies related to the impact of viral due to change in genetic

neuroplasticity

ability to adapt synaptic connections

is not instantaneous and takes time → thus, why mental illness manifestation inc over time and chronic medicine for mental takes time to work

benzodiazepines are for _____ + mechanism

anxiety

benzodiazepines bind to GABA receptor → inc Cl- entering neuron = inhibitory effect

side effect → inc dopamine → physical dependence

benzodiazepines formulas

1. alprazolam

2. chlordiazepoxide

3. diazepam

4. lorazepam

are diff due to heal-life and onset speed

buspirone is for ________ + mechanism

chronic anxiety

partial serotonin receptor agonist / weak dopamine receptor antagonist

adverse effect of benzodiazepines

since inhibitor due to GABA binding → CNS depression [ sedation, poor concentration, impaired memory, drowsiness]

→ inc fall risk

next day sedation

for long half-life benzodiazepine

paradoxical response

opp side effect of desired therapeutic response

benzodiazepine toxicity

use flumazenil to reverse sedative effects

can cause seizures for hx of seizure or tricyclic antidepress

benzodiazepines warning

can be addicting due to dopamine influx

do not use w/ alcohol

MAOIs

monoamine oxidase inhibitor → inc serotonin life before being degraded

s/e = affect other neurotransmitter → weight gain, daytime sedation, sex dysfunction, insomnia

phenelzine

TCAs

tricyclic antidepressants

blocks reuptake of serotonin and norepinephrine

s/e: block cholinergic receptor → anticholinergic like dry mouth/ constipation

→ orthostatic hypotension, urinary retention

amitriptyline

SSRIs

selective serotonin reuptake inhibitor

4-6 week

s/e: nausea, agitation, sex dysfunction

fluoxetine

SNRI

serotonin norepinephrine reuptake inhibitor

s/e appetite suppression

venlafaxine

antidepressants observation

sp basically they make a way where they inc the time serotonin is in the synapse to inc seratonin effect which usually decrease anxiety and other stuff

other antidepress med

used when anitiepress had adverse effects or ineffective

trazodone, nefazodone, bupropion, mirtazapine

zuranolone = neurosteroid antidepress

when taking MAOI, refrain from eating foods w/ tyramine

→ lead to HTN crisis

aged or fermented food

smoked meat, red wone, beer, aged cheese, chocolate, avocado, soy product

dried or overripe food, fish

avoid taking MAOIs w/ TCA or OTC w/ ephedrine

Antipsychotics

neuroleptics

for schizophrenia spectrum and psychotic

s/e anticholinergic effects like dry mouthm constipation, blurred vission, orthostatic hypoTN

photosensitivity

high prolactin → low sex, mense irreg, weight gain

depot injection

long-term IM for maintainance of psychotic

FGA

1st gen antipsychotic

block dopamine receptor

for severe cases

haloperidol, fluphenazine, loxapine, chlorpromazine

SGA

2nd gen antipsych

block dopamine receptors less + inhibit reuptake of seratonin

risperidone, olanzapine, quetiapine, and clozapine.

metabolic s/e more common → inc BG, BP, cholesterol → inc DM II risk

TGA

3rd gen antipsych

dopamine system stabilizers + work by reg dopamine transmission when reception is too low/high

aripiprazole, brexpiprazole (used for dementia agitation), cariprazine

antipsych teaching

measure BG and absolute neutrophil count when clozapine

mood stabilizers

for bipolar

lithium, anticonvulsants, and SGA aripiprazole

lithium

0.5-1.5 (drink water to prevent toxicity)

reg uptake of monoamine neurotransmitter

help prevent relapse of maniac/ major depressive ep

baseline liver test and blood lithium to check for therapeutic range + kidney function test since kidneys process lithium

anticonvulsants

valproic acid, topiramate [ inhibit GABA]

carbamazepine

inhibit kindling effect (what causes seizure to inc in severity/ occurance)

lithium s/e

diarrhea, nausea, inc thirst, fine hand tremor, weight gain

anticonvulsant s/e

sedation, dry mouth

weight gain ( valproic acid)

weight loss (topiramate + lamotrigine)

sedative and hypnotics

insomnia

benzodiazepines, nonbenzodiazepine hypnotics, melatonin receptor agonist (rameleon)

s/e: h/a, fatigue, dizzy, nausea → sleep-walk, amnseia, halucination, suicidal ideation

nonbenzodiazepine hypnotics,

same mech as benzodiazepine but less s/e + short-term tx

zolpidem, zaleplon, and eszopiclone.

sedative and hypnotics teaching

do not take before operating vehicle

avoid alcohol, or other CNS depress

Stimulants

treat ADHD, narcolepsy

methylphenidate, dextroamphetamine: children and adolescent

amphetamine

stim release of dopamine, serotonin, norepinephrine + inhibit reuptake

→if excess→ tolerant to stimulants → addiction

use enteric coat pill to sustain release

stimulant s/e

nausea, dry mouth, heart palpitation, irritability, supress appetite

avoid foods w/ caffeine

herb remedies

St. John’s wort, ginseng, chamomile, and echinacea.

St. John + fluoxetine = serotine syndrome

serotonin syndrome

high influx of serotonin

by take multiple classes of anitdepressant, mix antidepress w/ migrane/ pain med, LSD ecstasy, anitdepress + St John

s/s restlessness, dilated pupils, tachycardia, high BP, muscle rigidity, sweating, loss of muscle coordination

VS stabilization, sedation w/ benzodiazepine, administration of serotonin antagonist ( cyproheptadine)

activation syndrome

after taking antidepressant (especially SSRI)

irritability, anxiety, impulsivity, aggressiveness, agitation, suicide ideation

antidepressant discontinuation syndrome (ADDS)

after taking antidepress over a month, sudden discontinuation

diff sleep, anxiety, depression, FLU-like s/s, electric shock sensation

if w/ MAOI, may develop psychosis

so slowly discontinue antidepress

lithium toxicity

early → poor coordination, confusion, sedation, GI discomfort, n/v, diarrhea

advance→ seizure + stupor, tinnitus, resp complication, jerking motor movement, extremely diluted urine

extreme → comatose state

agronulocytosis

clozapine

get a baseline WBC count before administering

if less than <3500 + s/s sore thorat, FLU like, muscle ache

neuroleptic malignant syndrome (NMS)

muscle rigidity, hyperthermia, VS instability (inc/dec BP + tachycard), inc creatine kinase

by initial exposure or abrupt discontinuation antipsych especially haloperidol

FEVER

for NMS

fever, encephalopathy, VS instability, high CK, rigidity

initiate cool measures, monitor fluid and electrolyte, place pt on cardiac monitoring, maybe dopaminergic agent ( bromocriptine) or skeletal muscle relax ( dantrolene)

extrapyramidal (EPS)

when blocking dopamine to midbrain to brainstem

acute dystonia, akathisia, pseudoparkinsonism, and tardive dyskinesia.

relieve w/ anitcholinergic drugs (benztropine, diphenhydramine) 

acute dystonia

muscle rigidity or spasm

oculogyric crisis (unable to control eye movement for hours)

akathisia

severe feeling of restless not relieved by moving

more suicide

pseudoparkinsonism

resemble Parkinson

slumped posture, shuffling gait, drooling, tremors, pill-rolling move of finger

tardive dyskinesia

permanent involuntary movement of face, tongue, neck, upper, lower extremities

smack lips, thrust their tongue, tilt head

valbenazine

alcohol

acts as CNs depressant → adapts → dec GABA and inc glutamate function = inc tolerance

witdrawal→ body is used to low inhibitory and high excitatory → high glutamate levels = inc CNS = inc HR, BP, N/V, seizure

use benzodiazepines

opiates

adaptation response = low reg of opiate receptor, desensitization of receptor signaling, upregulation or opiate metabolism

large amounts of norepinephrine are release → muscle ache, sweating, goose bump, GI discomfort -> nausea /diaherra → electrolyte imbalance

use replacement w/ methadone/ buprenorphine

in toxicity → norepinephrine are suppressed

detox protocol

plan to decrease substance

ex alcohol w/ benzodiazepine, opiate w/ opiate replacement

1. adm CIWA scale

2. rate severity of withdrawal

3. calculate sum of manifestation

4. calculate dose

5. adm ordered medication