Comprehensive Neuropharmacology and Endocrine System Review for JSU Pharmacology

CNS

Brain + spinal cord; integration and response center.

PNS

Nerves outside CNS; links CNS to body.

Somatic system

Voluntary movement (skeletal muscle).

Autonomic system

Involuntary control (smooth muscle, glands, heart).

Sympathetic (Adrenergic)

"Fight or flight"

Neurotransmitters

Chemical messengers that transmit signals across a chemical synapse.

ACh

Muscle activation, memory; affected by anticholinergics.

Norepinephrine/Epinephrine

Alertness, fight-or-flight; adrenergic drugs.

Dopamine

Coordination, emotion, reward; low in Parkinson's.

GABA

Inhibitory; prevents overexcitation; benzodiazepines enhance.

Serotonin

Mood, sleep, arousal; SSRIs increase levels.

Blood-Brain Barrier (BBB)

Protects CNS from toxins/pathogens; makes drug delivery difficult.

Parkinson's Disease (PD)

Progressive loss of dopamine-producing neurons in basal ganglia.

Symptoms of PD

Tremor ("pill rolling"), bradykinesia, rigidity, postural instability, masklike face, drooling, shuffling gait, depression, sleep issues, cognitive decline.

Therapeutic Goal of PD

Improve ADLs by restoring dopamine-ACh balance.

Dopaminergic Agents

Increase dopamine activity.

Anticholinergic Agents

Block ACh to restore balance.

Drug Adaptation in CNS

Long-term use → tolerance, dependence.

Withdrawal Symptoms

Depression, insomnia, anxiety; some drugs may cause psychiatric side effects after prolonged exposure.

Levodopa (Dopar, Inbrija)

Converted to dopamine in CNS

Carbidopa-Levodopa (Duopa)

Enhances CNS delivery; fewer side effects

Amantadine (Symmetrel)

Promotes dopamine release

COMT Inhibitors (Entacapone, Tolcapone)

Prevent levodopa breakdown

MAO-B Inhibitors (Selegiline, Rasagiline)

Inhibit dopamine breakdown

Dopamine Receptor Agonists (Pramipexole, Ropinirole, Apomorphine)

Stimulate dopamine receptors

Anticholinergic Agents (Benztropine, Trihexyphenidyl)

Block ACh in CNS → ↓ tremors & rigidity

Alzheimer's Disease (AD)

Neuronal degeneration (hippocampus → cortex) - ↓ ACh, β-amyloid plaques, neurofibrillary tangles.

Cholinesterase Inhibitors

Prevent ACh breakdown → ↑ communication between neurons

NMDA Antagonist

Regulates glutamate to prevent excitotoxicity

Combo Drug (Donepezil + Memantine)

Dual action - Improved cognition in advanced AD

Growth Hormone (GH)

Stimulates growth, protein synthesis, fat metabolism.

Somatropin

Synthetic GH replacement (SQ/IM at bedtime).

Octreotide (Sandostatin)

GH antagonist used for acromegaly.

Adverse Effects of Levodopa

N/V, dyskinesia, hypotension

Adverse Effects of Carbidopa-Levodopa

Orthostatic hypotension, hallucinations, melanoma risk

Adverse Effects of Amantadine

Confusion, mottled skin

Adverse Effects of COMT Inhibitors

Dyskinesia, liver toxicity

Adverse Effects of MAO-B Inhibitors

Avoid tyramine foods; insomnia, headache

Adverse Effects of Dopamine Receptor Agonists

Hallucinations, compulsive behavior

Adverse Effects of Anticholinergic Agents

Dry mouth, constipation, blurred vision, urinary retention, confusion (elderly)

Hypothyroidism

A condition characterized by cold intolerance, weight gain, bradycardia, lethargy, and constipation.

Levothyroxine (Synthroid)

A synthetic T4 medication taken on an empty stomach in the morning, 30-60 minutes before food.

Liothyronine (Cytomel)

A synthetic T3 medication with a shorter half-life.

Hyperthyroidism

A condition characterized by heat intolerance, tachycardia, weight loss, tremors, and insomnia.

Methimazole (Tapazole)

A thioamide that inhibits thyroid hormone synthesis and is taken once daily.

PTU (Propylthiouracil)

A medication that blocks the conversion of T4 to T3 and is preferred during pregnancy.

Iodine preparations

Medications like Lugol's and Potassium Iodide that decrease gland vascularity pre-surgery.

Radioactive Iodine

A treatment that destroys thyroid tissue.

Diabetes Mellitus (DM)

A metabolic disorder characterized by high blood sugar levels due to insulin issues.

Type 1 Diabetes

An autoimmune condition leading to the destruction of β-cells, resulting in no insulin production.

Type 2 Diabetes

A condition marked by insulin resistance and decreased insulin secretion.

Normal Blood Glucose (BG)

The normal range for blood glucose levels is 70-100 mg/dL.

A1C goal

The target A1C level for diabetes management is less than 5.7%.

Insulin Therapy

The use of insulin to replace or supplement endogenous insulin to regulate glucose.

Rapid Insulin

Insulin types like Lispro, Aspart, and Glulisine that have an onset of 10-30 minutes.

Short Insulin

Regular insulin (Humulin R, Novolin R) with an onset of 30-60 minutes.

Intermediate Insulin

NPH (Humulin N) insulin that is cloudy and should be mixed clear to cloudy.

Long Insulin

Insulin types like Glargine, Detemir, and Degludec that have a duration of 24+ hours.

Mixing Rule

The rule for mixing insulins is to mix clear (Regular) insulin before cloudy (NPH) insulin.

Hypoglycemia

A condition characterized by low blood sugar, often described as 'cold and clammy - need some candy.'

Lipodystrophy

A complication of insulin therapy that requires rotating injection sites.

Glucagon

A rescue medication for severe hypoglycemia that can be administered IM, SQ, or IV.

Biguanides

Metformin (Glucophage) - 1st line; GI upset; hold before contrast dye; BBW lactic acidosis; ↓ hepatic glucose production, ↑ insulin sensitivity.

Sulfonylureas

Glipizide, Glyburide - Stimulate insulin release from β-cells; Risk hypoglycemia; avoid alcohol; take 30 min before meal.

Alpha-Glucosidase Inhibitors

Acarbose, Miglitol - Delay carb absorption in GI tract; Flatulence, diarrhea; take with first bite.

Meglitinides

Repaglinide, Nateglinide - Stimulate insulin release (short acting); Take with meals; skip if skipping meal; BBW heart failure; monitor LFTs.

Thiazolidinediones (TZDs)

Pioglitazone, Rosiglitazone - ↓ insulin resistance in muscle/fat.

DPP-4 Inhibitors

Sitagliptin, Saxagliptin - ↑ incretin → ↑ insulin release; URI, pancreatitis risk.

SGLT2 Inhibitors

Canagliflozin, Dapagliflozin - Promote glucose excretion via urine; Risk UTI, dehydration.

GLP-1 Agonists

Exenatide, Liraglutide - Mimic incretin, ↑ insulin, ↓ appetite; Weight loss, GI upset, pancreatitis.

DKA (Diabetic Ketoacidosis)

Common in Type 1; caused by insulin deficiency. S/S: Fruity breath, Kussmaul respirations, dehydration, acidosis. Tx: IV insulin, fluids, electrolyte replacement.

Endocrine Feedback Loops

Low hormone → hypothalamus → releasing hormone → pituitary → stimulating hormone → target gland.

Thyroid

T3/T4 regulate metabolism; calcitonin regulates calcium.

Insulin Administration

Always clear before cloudy; rotate injection sites.

Parkinson's Disease

Dopamine ↓, ACh ↑; treat with dopaminergics or anticholinergics.

Alzheimer's Disease

ACh ↓; treat with cholinesterase inhibitors.

Hypoglycemia Mnemonic

Cold and clammy, need some candy.

Hyperglycemia Mnemonic

Hot and dry, sugar high.

Thyroid Medications Mnemonic

Too much = tachy, too little = tired.

Anticholinergic Effects Mnemonic

Can't see, can't pee, can't spit, can't poop.