psychopharmacology exam 3

Dopamine

reward, motivation, pleasure (feel-good)

Norepinephrine

mood, attention, alertness, fight or flight (adrenaline)

Serotonin

(happiness hormone), appetite (GI), sleep

Histamine

alertness and awareness, inflammation

GABA

inhibitory to anxiety and stress (breaks), relaxation

Glutamate

excitatory (opposite of gaba), released in response to head injury or stroke

Acetylcholine

learning and memory, rest and digest (opposite of norepi)

Agonist

increases or mimics the effect of the neurotransmitter. Ex: anti-anxiety and GABA.

Antagonist

blocks a neurotransmitter.

Induction

Increasing synthesis causing faster drug breakdown.

Inhibition

Blocks enzyme activity slowing down drug metabolism.

Bipolar I

Episodes of MDD and at least one manic episode.

Bipolar II

Episodes of MDD with one hypomanic episode (good feeling, getting things done, energy).

Cyclothymia

Chronic, fluctuating hypomanic and depressive symptoms lasting at least 2 years.

Schizophrenia

A mental disorder characterized by altered cognition, perception, and impaired ability to distinguish reality.

Positive symptoms of Schizophrenia

Hallucinations, delusions, paranoia, bizarre thoughts, behavior, or speech.

Negative symptoms of Schizophrenia

Anhedonia, social discomfort, lack of goal-directed behavior.

Cognitive symptoms of Schizophrenia

Impaired judgement, poor impulse control, impairment in memory, attention or thinking.

Affective symptoms of Schizophrenia

Erratic or incongruent mood.

Lithium

Used for mania and maintenance, also helps with SI

not used often due to frequent labs

-must monitor renal, thyroid, and cardiac function

Valproate

Used for acute mania and prevention/stabilization;

-monitor liver, platelet, and coagulation

Carbamazepine

May cause bone marrow suppression, TEN, and SJS, monitor liver enzymes.

Lamotrigine

Risk of rare, life-threatening rash (Stevens-Johnson syndrome and toxic epidermal necrolysis).

Haloperidol

First generation antipsychotic; dopamine antagonist; treats positive symptoms of schizophrenia.

-high risk of NMS and EPS, especially in elders w/ dementia

Clozapine

Treatment of choice for treatment-resistant schizophrenia; highest risk of severe neutropenia, must monitor under REMS, high risk of metabolic syndrome

Akathisia

Motor restlessness; may decrease or may require medication change.

Pseudoparkinsonism

Masklike face; stooped/shuffling gait, pill rolling; may require medication change.

Tardive dyskinesia

Common with long-term use of antipsychotics; regular screening with AIMS, not relieved by discon., prevent worsen by early recognition, and switching to 2nd gen

Neuroleptic malignant syndrome

Rare, life-threatening emergency characterized by hyperpyrexia, muscle rigidity, and hypertension.

-hold meds, notify prover for emergency treatment

Acute dystonia

Acute, painful contractions of the muscles of the tongue, face, neck, and back(backward arching of head);

-treated with antiparkinsonian medications and diphenhydramine (Benadryl) IV.

Metabolic syndrome

Weight gain, increased abdominal circumference, dyslipidemia, increased blood glucose, insulin resistance.

-teach weight control strategies and regular checkups

liver dysfunction

Monitor for jaundice, dark urine, pale stool, easy bruising, itching, nausea, fatigue

Neutropenia

ANC below 999 uL- hold meds, below 500- reverse isolation.

-monitor for infection

-high risk w clozapine, requires monitoring

Cardiac arrhythmias

EKG prior to starting an antipsychotic; monitor for arrhythmias.

Anticholinergic effects

Decreased/absent peristalsis, urinary retention, hyperpyrexia, delirium, tachycardia.

-hold meds, notify provider, treat symptoms

1st generation (typical) antipsychotics

works on positive symptoms, dopamine antagonist, cheaper, can cause tardive dyskinesia (lip smacking, squinting) weight gain, sedation, hypotension, anticholinergic effects, sexual SE

2nd generation (atypical) antipsychotics

serotonin and dopamine antagonists, treats + and - symptoms, lower risk of SI like EPS and tardive dyskinesia, risk of weight gain and metabolic syndrome

3rd generation antipsychotics

subset of 2nd gen, stabilize dopamine, treat +, -, and cognitive symptoms, expensive

risperidone

highest risk of EPS

olanzapine

highest risk of metabolic syndrome

quitiepine

very sedating

ziprasidone

prolonged QT interval

aripiprazole and brexpiprazole

less risk of increased prolactin, less metabolic risk, may cause compulsive behavior

Caripraizine

most improvement for cognitive symptoms, higher rates of EPS