NU553 Unit 3 Seminar: Mental Health

A collection of 100 vocabulary flashcards covering mental health pathophysiology, pharmacology, and treatment guidelines for anxiety, depression, bipolar, ADHD, dementia, Parkinson’s, and seizures.

Patho Fizz….

The study of abnormal neurotransmitter release or decreased postsynaptic receptor sensitivity causing functional or absolute deficiencies.

5 HT-Serotonin

Influences feel-good mood, sleep, appetite, and learning; deficiency is associated with depression and anxiety.

Dopamine

Associated with motivation, movement, reward, and learning; deficiency is linked to Parkinsons.

Norepinephrine

Associated with being energizing, alert, attention, mood, and memory; deficiency linked to depression and anxiety.

GABA

Calms firing nerves; associated with anxiety when imbalanced.

Acetylcholine

Associated with thought, learning, and memory; deficiency linked to Dementia and Alzheimer’s.

Generalized Anxiety Disorder (GAD)

The most commonly occurring class of mental disorders characterized by persistent, excessive, overwhelming, and disabling stress.

GAD Physical Symptoms

Restlessness, easy fatigability, difficulty concentrating, irritability, muscle tension, and sleep disturbance.

Anxiolytics

Schedule IV DEA Controlled Substances with increased potential for tolerance and dependence used for antianxiety.

Benzodiazepines

Used for short-term treatment of anxiety, as abortive treatment, muscle relaxant, pre-anesthesia sedation, and prevention of panic attacks.

Diazepam

A Schedule IV Benzodiazepine sold under the brand name Valium.

Lorazepam

A Schedule IV Benzodiazepine sold under the brand name Ativan.

Buspirone

A serotonergic agent belonging to the azapirones group that exerts effects without CNS depression, sedation, or risk of dependence.

Buspirone (Onset of Action)

Requires slow onset of up to $6$ weeks and multiple daily dosing due to a short half-life of $1 \text{ to } 10$ hours.

First-line Anxiety Treatment

Cognitive-behavioral therapies should be considered first-line options in conjunction with medications or as monotherapy.

Insomnia Diagnostic Criteria

Dissatisfaction with sleep quality $3$ nights per week for $3$ months associated with difficulty falling/staying asleep.

Orexin

A neuropeptide that binds to receptors in the hypothalamus to promote arousal and regulates wakefulness.

Histamine (in sleep)

Activates neurons in the hypothalamus which maintain alertness.

Nonbenzodiazepine Hypnotics

Drugs that act at the GABA receptor but not the benzodiazepine site, including zolpidem, zaleplon, and eszopiclone.

Ramelteon

A melatonin receptor agonist with high affinity for melatonin $MT1$ and $MT2$ receptors.

Suvorexant

The first orexin receptor antagonist that blocks binding to orexin A and B receptors to promote sleep; brand name Belsomra.

Zaleplon

A Z-drug with a $1$ hour half-life, ideal for sleep initiation.

Zolpidem

A sleep agent with a $2.5$ hour half-life, safe and effective for up to $6$ months of usage; brand name Ambien.

Eszopiclone

A sleep agent with a $6$ hour half-life; brand name Lunesta.

Major Depressive Disorder patho fizz..

abnormal neurotransmitter release

Electroconvulsive Therapy (ECT)

A non-pharmacologic treatment for depression mentioned alongside CBT and psychodynamic therapy.

Antidepressant Treatment Order - EXAM QUESTION!

SSRIs, followed by atypical antidepressants, and then TSAs.

Bupropion (ATYPICAL)

A weak inhibitor of norepinephrine and dopamine uptake used for depression, weight loss, and smoking cessation; brand name Wellbutrin.

Mirtazapine

A selective $\text{alpha}_2$-adrenergic receptor antagonist that increases appetite and aids with sleep; brand name Remeron.

Trazodone

A weak serotonin receptor antagonist that is highly sedating due to antihistamine properties; used for insomnia.

Antidepressant Full Effect Time

Approximately $4 \text{ to } 6$ weeks, and potentially up to $12$ weeks, are needed to exert a full pharmacologic effect.1

Black Box Warning (Antidepressants)

Warning regarding suicidal ideation especially when starting treatment.

Amitriptyline

A Tricyclic Antidepressant (brand name Elavil) with highly potent effects on NE and $5$-HT.

Fluoxetine

An SSRI under the brand name Prozac with $0$ effect on NE and dopamine but highly potent on $5$-HT.

Venlafaxine

An SNRI under the brand name Effexor with highly potent effects on NE and serotonin.

Serotonin Syndrome Triggers

Interactions of SSRIs with Tramadol, meperidine, St. John’s wort, dextromethorphan, and decongestants.

Citalopram Dosage Limit

Should no longer be used at doses greater than $40 \text{ mg}$ per day due to risk of QT prolongation.

Discontinuation Syndrome Symptoms

Nausea, headache, chills, brain zaps, body aches, paresthesia, and insomnia occurring $1 \text{ to } 2$ days after stopping meds.

Bipolar I and II

Disorders characterized by variations in mood between extreme highs (mania) and lows (depression).

what medication do you NOT want to give to bipolar patients?

SNRI’s

DIGFAST

Mnemonic for mania symptoms: Distractibility, Irresponsible behavior, Grandiosity, Flight of ideas, Activity increase, Sleep decrease, Talkativeness.

Mood Stabilizers

Medications like Lithium, Lamotrigine, Divalproex, and Carbamazepine used to treat Bipolar disorder.

Duloxetine Additional Indications

An alternative option for treat neuropathic pain; brand name Cymbalta.

ADHD Neurotransmitter Basis

Dopamine (DA) deficiency causing an inhibition deficit; drugs act on DA and non-adrenergic synapses.

SNRI neurotransmitter and effect?

norepinephrine - energizing

what other effect does SNRI do to the body?

increase blood pressure and heart rate.

Methylphenidate in Pediatrics - what do we need to monitor?

weight - appetizer suppressant

Atomoxetine

A non-stimulant ADHD medication that does not promote the development of new tics; brand name Strattera.

Clonidine (ADHD)

An extended-release tablet ($Kapvay$) used as second-line monotherapy or adjunct to stimulants in children ages $6 \text{ to } 17$.

Methyldopa in Pregnancy

Considered safe in pregnancy for autonomic/blood pressure control, supported by more clinical trials than guanfacine.

Alzheimer’s Disease (AD) Hallmarks

Neurofibrillary tangles and neuritic or $\beta$-amyloid plaques within the brain.

Cholinesterase Inhibitors

First-line therapy for Alzheimer's that blocks the ACHe enzyme to prevent the breakdown of ACh.

Donepezil

A cholinesterase inhibitor indicated for mild to moderate cognitive impairment; brand name Aricept.

Memantine

A noncompetitive antagonist at NMDA receptors that is neuroprotective in Alzheimer’s treatment.

Parkinson’s Disease (PD)

A neurodegenerative disorder characterized by motor and nonmotor symptoms associated with findings in the substantia nigra pars compacta.

Cardinal Motor Symptoms of PD

Bradykinesia (slowing movement), resting/postural tremor, cogwheel rigidity, and postural instability.

Levodopa

A dopamine precursor that can cross the blood–brain barrier; converted to dopamine via decarboxylation.

Carbidopa

Administered with levodopa to limit the peripheral breakdown of levodopa.

Wearing-off Phenomenon

The return of motor and nonmotor symptoms prior to the next dose of levodopa after several years of treatment.

Levodopa Half-life

Relatively short, only $60 \text{ to } 90$ minutes, requiring $3 \text{ to } 6$ doses daily.

Amantadine

Indicated for mild PD and frequently used for patients experiencing dyskinesia.

Scopolamine

A transdermal disc applied postauricularly at least $4$ hours before antiemetic effect is desired for motion sickness.

Seizure Diagnosis

Confirmed using an electroencephalogram (EEG).

Phenytoin

A Hydantoin (brand name Dilantin) used for tonic-clonic and focal seizures; inhibits sodium ion influx.

Phenytoin Therapeutic Level

The therapeutic plasma level range is $10 \text{ to } 20 \text{ mcg/mL}$.

Phenytoin IV Infusion Rate

Boxed warning: should not exceed $50 \text{ mg/min}$ in adults and $1 \text{ to } 3 \text{ mg/kg/min}$ in pediatric patients.

Carbamazepine

Used for epilepsy and bipolar disorder; slows sodium influx in cortical neurons; brand name Tegretol.

Levetiracetam

Unique AED class indicated as adjunct for partial-onset seizures; brand name Keppra.

Guanfacine First-Pass Effect

Has a significant effect where about 75 \text{ %} of the related guanabenz is metabolized.

Dementia (AD) Diagnosis

Can be confirmed only by autopsy.

Rivastigmine

A cholinesterase inhibitor prescribed for Alzheimer disease; brand name Exelon.

Pyridostigmine

A cholinesterase inhibitor used for the treatment of myasthenia gravis; brand name Mestinon.

Oxybutynin

Used to treat overactive bladder and urinary incontinence by inhibiting action on smooth muscle.

LGS (Lennox-Gastaut Syndrome)

Condition associated with seizures treated using medications like Topiramate.

Pregabalin and Gabapentin

Drugs that affect GABA used for partial-onset seizures and neuropathic pain.

Stevens–Johnson syndrome (SJS)

A serious dermatological reaction associated as a side effect of some anticonvulsants.

ADHD Inattentive Symptoms

Includes making careless mistakes, losing things like books/pencils, and avoiding tasks requiring mental effort.

ADHD Adult Symptoms

Includes internal restlessness, inefficient work, and poor time or money management.

Methylphenidate Caudate Link

Drug induces dopamine changes specifically in the caudate area of the brain.

Lithium

A classic mood stabilizer used in the management of Bipolar disorder.

Alpha2-adrenergic receptor antagonist

Mechanism of action for Mirtazapine affecting norepinephrine and serotonin.

Black Box Warning (Suicidal ideation)

Associated with all antidepressants to track risk in patients.

Gingival Hyperplasia

A specific potential GI/oral side effect associated with Hydantoins.

Trihexyphenidyl

Used for the management of Extrapyramidal Symptoms secondary to drug therapy.

Donepezil Half-life

Relatively long at approximately $70$ hours.

Protein and Levodopa

High protein consumption may reduce the absorption of levodopa from the intestine.

Bradycardia in Dementia drugs

A cardiac conduction risk when prescribing donepezil, galantamine, or rivastigmine.

Pramipexole

A dopamine agonist used to treat moderate symptoms of Parkinson’s disease.

Fosphenytoin

A Hydantoin anticonvulsant used for the treatment of grand mal seizures.

Vitamin K and Phenytoin

Newborns exposed in utero may have decreased clotting factors and must receive Vitamin K at birth.

Grapefruit juice and Carbamazepine

Increases serum levels and effects of the medication.

Levetiracetam Mood Warning

Increased risk for suicidal thoughts, depression, and unusual changes in behavior.

Nystagmus

An eye movement side effect associated with the side effect profile of Hydantoins.

Phenelzine

A Monoamine Oxidase Inhibitor (MAOI) indicated for treating anxiety and depression; brand name Nardil.

Escitalopram

A Selective Serotonin Reuptake Inhibitor brand named Lexapro.

Duloxetine

An SNRI also indicated for the management of menopausal symptoms; brand name Cymbalta.

Methylphenidate Dosage Limit

Standard maximum dose for various formulations is typically $60 \text{ mg/d}$.

Narcolepsy Pathophysiology

Thought to be caused by an orexin receptor mutation.

Somnolence

The most common adverse drug reaction reported for Levetiracetam at 12 \text{ %}.

Dopamine and PD Treatment

Dopamine itself is not used because it cannot cross the blood–brain barrier.