psychopharmacology

dopamine

dopamine

excitatory, product of tryosine

emotional response, complex movements, cognitive function

-key neurotransmitter regulated with anti-psychotic meds for schizo

serotonin

inhibitory, 2x receptors in the body

-emotional regulation, sex, temp regulation, pain management

norepinephrine

excitatory, most common neurotransmitters in system

learning, sleep, mood, memory, attention

histamine

neuromodulation- regulates histamine, glutamate, S, D, GABA

-sleep wake (alertness and wakefulness), GI, allergic response, cardiac stimulation

GABA

inhibitory neurotransmitter, amino acid

-neural development, improves sleeplessness, minimizes depression

-benzos

glutamate

excitatory amino acid and neurotransmitter, work with dopamine

-motor function, affect, cognition and function

-high levels can serve as precursor to manifestations of psychosis

acetylcholine

Excitatory and inhibitory, receptors mostly found in skeletal muscle

-sleep wake and primary neurotransmitter in muscle function

-alzheimer’s meds are used to increase the concentration of acetylcholine

Benzodiazepines

most prescribed meds to treat anxiety. regulates GABA by creating a major inhibitory effect causing large amounts of dopamine to be released

-can lead to addiction and CNS sedation

-can be reversed using fluzamenil

buspirone

partial serotonin receptor agonist and weak dopamine antagonist and used to treat chronic anxiety.

nurse education for anxiolytics

used to treat symptoms of anxiety not the cause, plan days when one will be on a benzo and risk of addiction

MAOIs

monoamine oxidase inhibitors, increasing the amount of time MA transmitter (S and D) can function before being degraded

side effects: weight gain, sedation, sexual dysfunction, and insomnia

avoid foods with tryamine (in aged and fermented food)

TCA

blocking reuptake of serotonin and norepinephrine in presynaptic receptors

-dry mouth and constipation and ortho hypo

-takes a few weeks to take effect

SSRIs

block serotonin reuptake selectively in the presynaptic receptors

side effects: nausea, agitation, sexual dysfunction

SNRIs

serotonin and norepinephrine reuptake are selectively blocked in the presynaptic gap

-appetite suppresion

antidepressant education

can lead to worsening depression, and exhibition of unusal behaviors and most antidepressants take a few weeks to work

serotonin syndrome

causes: intentional OD, LSD, ST. johns wort

restlessness, tachycardia, high BP, muscle rigidity, sweating, loss of muscle control

care: stabilize vitals, benzos for sedation, serotonin agonst like cyproheptadine

activation syndrome

impulsivity, and suicidal ideation that may present after stating an SSRI

lithium toxcity early

confusion, poor coordination, GI upset, coarse tremorl

lithium toxicity advanced

2.0-2.5; seizures and stupor, diluted urine, resp complications tinnitus, jerking movements

lithium severe toxcity

2.5+ resp issues leading to death, cure is hemodialysis

neuroleptic malignant syndrome

fever, encephalopathy, vital sign instability, elevated creatine and kinase, rigidity

-discontinue meds, cooling measures, fluids

relief agent for antipsychotic eps symtpoms

dephenhydramine

acute dystonia

muscle rigity and spasms

akathisia

severe feelings of restlessness

pseudo parkinsons

slumped posture, shuffling gait, drooling, tremors

tardive dyskinesia

permanent involuntary movement of face, tongue, neck, and upper and lower extremities, smack their lips, tilt head

alc withdraw symtpoms and what medication to balance symtpoms

CNS excitement, like high HR BP, nausea, vomiting, increased seizure risk, hallucinations

benzos

opiates withdraw symptoms and medication to balance symtpoms

muscle aches, goose flesh, GI discomfort, sweating

methadone or buprenorphine

reuptake

a process in which neurotransmitters are reabsorbed by the synapse that secreted it

neuroplasticity

brain’s ability to adapt synaptic connections, particularly in response to stress or learning or after experiencing an injury

-adaptive process can take weeks to months

what does neuroplasticity help explain in relation to mental illness

how manifestations can increase over time like major depressive disorder and cannot be cured through a single dose of medication

-important to educate patients their medication will not immediately work

antipsychotics (neuroleptics) use

to treat manifestations present in shizophrenia spectrum

first gen

“conventional meds” that work by blocking dopamine receptors. incredibly potent and can be effective with treating severe manifestations

ex: haloperidol, loxapine, chlorpromazine

2nd gen antipsychotics

unconventional/atypical; block dopamine to a lesser degree and inhibit reuptake of serotonin

side effects of neuroleptics

anticholinergic, ortho hypo, photosensitivity, decrease sex drive, menstrual irregularities, and weight gain

neuroleptic education

continue meds even when they feel better, importance of routine lab testing, more likely to be successful with a support person.

mood stabilizers

lithium and anticonvulsants

lithium

unknown why it calms people down but it regulates reuptake of MA (serotonin and dopamine) transmitters preventing manic or depressive episodes

BLOOD TESTS WEEKLY UNTIL THERAPEUTIC LEVEL REACHED (05-1.5)

anticonvulsants

inhibit kindling process (cascading effect that causes seizures) which is linked with production of manic or bipolar episodes. also increases levels of GABA, causing an increase neurological effects

adverse effects for lithium

diarrhea, nausea, increased thirst, fine hand tremors, weight gain

sedatives/hypnotics

treats insomnia and sleep wake disorders

ex: benzos, melatonin receptor agonist, nonbenzo hypnotics

acts on gaba receptor sites (nonbenzo hypnotics)

side effects: headache, fatigue, dizziness, nausea

never use prior to operating vehicles or while consuming alc or any CNS depressants

stimulants

treat ADHD and narcolepsy; can become addicitive

cause release of dopamine, serotonin and norepinephrine and also blocks their reuptake

decrease hyperactivity, impulsivity, and inattentiveness

side effects: anticholingeric, heart palpatations, decreased appetite leading to weight loss

teaching: support person for decreased appetite and avoid stimulants