Neurological System Part 2

Serotonin, GAB, and Dopamine are all

neurotransmitters

3 types of psychotherapeutic drugs

anxiolytic, mood stabilizing, and antipsychotic drugs

The goal of drug therapy

depress or increase the activity of the CNS, regulate amounts of neurotransmitters, stimulate or block receptors

These antidepressants were the first to be used but now they are more of a 2nd line of defense

monoamine oxidase inhibitors (MAOIs)

These antidepressants are the first line of defense

SSRI and SNRI

The action of anxiety (anxiolytic) medications

enhance GABA and reduce anxiety

2 types of sedative drugs used to treat anxiety disorders

benzodiazepines and non benzodiazepines

The ending of most benzodiazepines

"-pam"

The most common benzo used to treat anxiety

alprazolam (Xanax)

This medication reverses the respiratory depression that can be caused by alprazolam

flumazenil

This non benzodiazepine is used to treat anxiety

buspirone

Non benzos are sometimes better because

dependency is less common and there is no sedative effects

Adverse effects of buspirone

paradoxical anxiety, blurred vision, headache, and nausea

Tip to remember anti-anxiety meds

"anxious Pam sits on the bus alone and decides to wean herself off her benzos"

These antidepressant meds are used as a second line of defense and adjunctly with other meds

tricyclic antidepressants

Tricyclic antidepressants typically end in this term

"pramine" or "tyline"

The prototype drug of tricyclic antidepressants

amitriptyline

Common uses for tricyclic antidepressants

depression, childhood bed wetting, OCD

Action of tricyclic antidepressants

block reuptake of neurotransmitters (may take several weeks for full effect)

Adverse effects of tricyclic antidepressants

sedation, sweating, seizures, anticholinergic effects, orthostatic hypotension, overdose

Anticholinergic effects

blurred vision, urinary retention, dry mouth, constipation

Overdose of tricyclic antidepressants

lethal, CNS and cardio systems affected, activated charcoal to treat, no known antidote

Tip for remembering tricyclic antidepressants

"Ami tripped over a tricycle in the desert"

This class of drugs is used when depression has not responded to other antidepressants

MAOIs

MAOIs typically end in

"ine"

MAOIs do not interact well with

tyramine or other medications

The prototype drug for MAOIs

phenelzine (Nardil)

If MAOIs are taken with tyramine

hypertensive crisis will occur

Antidepressants should not be taken with

holistic antidepressants

This holistic antidepressant is used to reduce stress and improve physical endurance and concentration

Ginseng

3 types of second generation antidepressants

SSRI, SNRI, and atypical antidepressants

Second generation antidepressants take longer to take effect. They take approximately

4-6 weeks

Action of SSRIs

inhibit serotonin reuptake

Action of SNRIs

block reuptake of norepinephrine and serotonin

Second generation antidepressants typically end in

"ine" and "pram"

SSRI examples

fluoxetine (Prozac), paroxetine, sertraline, fluvoxamine, citalopram, escitalopram

SNRI examples

venlafaxine (Effexor), desvenlafaxine, duloxetine

Adverse effects of second generation antidepressants

anxiety, insomnia, weight gain, nausea, increased risk for suicide, serotonin syndrome

Symptoms of serotonin syndrome

delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, hyperthermia, seizures, cardiac dysrhythmias

Serotonin syndrome

too much serotonin in the body causing extreme excitement of the body systems

When on second generation antidepressants, you should avoid

MAOIs, St. John's wort, blood thinners, NSAIDs

Tip to remember SSRIs

a "teen" in the house sometimes means anxiety and depression

This atypical antidepressant inhibits dopamine uptake and is an NDRI

bupropion

Adverse effects to look for with bupropion

seizures and weight loss

This medication is commonly used for bipolar disorder

lithium carbonate

Action of lithium carbonate

changes transport of sodium ions in nerve cells and alters metabolism of catecholamines

Adverse effects of lithium

fine hand tremors, weight gain, polyuria, kidney toxicity, electrolyte imbalances

Therapeutic range of lithium

0.6 to 1.2 mEq/L

When taking lithium, avoid

diuretics, NSAIDs, anticholinergics

Signs of lithium toxicity

diarrhea, vomiting, coarse tremors, sedation, blurred vision, ataxia, seizures, severe hypotension

These 3 anti-epileptic drugs are often used to treat bipolar disorder

valproic acid (Depakote)

carbamazepine (Tegretol)

lamotrigine (Lamictal)

This chronic psychological disorder is characterized by disordered thought process

schizophrenia

Positive symptoms of schizophrenia

agitation, bizarre behavior, delusions, hallucinations, flight of ideas, illogical thinking patterns

Negative symptoms of schizophrenia

social withdrawal, lacking emotion, lack of energy, flattened affect, decreased motivation

Use of conventional antipsychotics

positive symptoms of schizophrenia, bipolar disorder

3 conventional antipsychotics

chlorpromazine (Thorazine)

haloperidol (Haldol)

fluphenazine (Prolixin)

Side effects of antipsychotic medications

anticholinergic effects, extrapyramidal side effects, sexual dysfunction, neuroleptic syndrome, photosensitivity

Akathisia

EPS characterized by restlessness, trouble standing still, pacing

Onset of akathisia

2 months from beginning meds

Treatment for akathisia

beta blocker, benzo, or anticholinergic

Pseudo-Parkinsonism

EPS characterized by bradykinesia, rigidity, shuffling gait, drooling, and tremors

Treatment of pseudo-parkinsonism

anticholinergic agents- benztropine or diphenhydramine

Onset of pseudo-parkinsonism

within 1 month of beginning meds

Acute dystonia

EPS characterized by severe, painful spasms of the tongue, neck, face, and back

"candy cane" arched position

Onset of acute dystonia

almost immediate

Treatment of acute dystonia

benztropine or diphenhydramine

Tardive dyskinesia

EPS characterized by involuntary movements of the face and tongue

protrusion and rolling tongue, chewing motion, sucking and smacking of lips

Onset of tardive dyskinesia

months to years after

Treatment of tardive dyskinesia

stop taking medication

Neuroleptic Malignant Syndrome

Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes

Treatment for neuroleptic malignant syndrome

stop medication, change to atypical antipsychotics

Atypical antipsychotics can be better because

they have less side effects than conventional antipsychotics

2nd generation antipsychotic used for schizophrenia, bipolar disorder, and irritability

risperidone (Risperdal)

Action of risperidone

block dopamine and serotonin receptors

Adverse effects of atypical antipsychotics

diabetes, elevated cholesterol, orthostatic hypotension, anticholinergic effects, elevated prolactin, sexual dysfunction

Closed angle glaucoma

block at the entrance of the eye

sudden, acute painful onset

Open angle glaucoma

blockage somewhere back in the eye

gradual loss of vision

Glaucoma

increased intraocular pressure results in damage to the retina and optic nerve with loss of vision

2 beta adrenergic blockers used to treat glaucoma

betaxolol (Betoptic)

timolol (Timpotic)

Action of timolol

decrease aqueous humor production, decreasing intraocular pressure

Systemic effects of beta blockers

bradycardia, hypotension, bronchospasm

Administration of glaucoma treatment

contact lenses are out, gentle pressure to the inner corner of the eye

DO NOT WIPE OUT