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52 Cards in this Set
- Front
- Back
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Classes of Neurotransmitters |
Monoamines Amino Acids Other |
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Monoamines |
Norepinephrine: Depression and anxiety Epinephrine: Anxiety Dopamine: Pakrinson's and Schizophrenia Serotonin: Depression and anxiety |
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Amino Acids |
Glutamate and aspartate: Alzheimers GABA and glycine: Anxiety |
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Other |
Acetylcholine: Alzheimer's and Parkinson's |
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Parkinson's |
progressive loss of dopaminergic neurons in the substantia nigra |
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Symptoms of Parkinson's |
Tremor Rigidity Bradykinesia (slowness of movement) |
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Pathophysiology of Parkinson's |
imbalance between acetylcholine and dopamine decreased dopamine release resulting in increased GABA release excess acetylcholine resulting in increased GABA release GABA causes the movement problems |
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Etiology |
Drugs may contain MPTP which causes irreversible death of dopaminergic neurons Genetics- mutation in alpha synuclein, parkin, UCHL1, DJ-1 Environmental toxins- pesticides Brain Trauma Oxidative Stress: reactive oxygen species may cause degeneration of dopaminergic neurons |
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L-Dopa |
Dopamine replacement Crosses the BBB by an active transport protein where it is converted to dopamine in dopaminergic nerve terminals |
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What is the conversion of L-Dopa to dopamine mediated by and what speeds it up |
decarboxylase enzymes cofactor pyridoxine (vitamin B12) |
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adverse effects of L-dopa |
Nausea and vomiting due to dopamine mediated activation of the chemoreceptor in the medulla Dyskinesias Cardia dysrhythmias (can activate beta 1) Orthostatic hypotension Psychosis |
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Carbidopa |
A decarboxylase inhibitor allowing more L-dopa to reach the brain at less of a dose given |
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Wearing off of L-dopa |
Occurs at the end of a dosing interval minimized by shortening interval, giving a drug that inhibits metabolism of L-Dopa (COMT inhibitor), or add a dopamine agonist to the therapy |
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On-Off of L-dopa |
Can be minimized by dividing the medication into 3-6 doses/day, using controlled release formulation, or moving protein containing meals to the evening |
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Dopamine Agonist |
Directly activate dopamine receptors on the post-synaptic cell membrane Not as effective as L-dopa |
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Adverse effects of Dopamine agonists |
hallucinations daytime drowsiness orthostatic hypotension |
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Dopamine releaser |
stimulated release of dopamine from dopaminergic neurons blocks dopamine reuptake blocks NDMA receptors (decreases dyskinesia side effect of L-dopa) Not as effective as L-dopa, used in combination |
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Adverse effects of Dopamine releasers |
dizziness, nausea, vomiting, lethargy, and anticholinergic side effects |
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COMT |
inhibits the enzyme that adds a methyl group to dopamine and L-dopa making them inactive often used with L-dopa as this drug results in a greater fraction of L-dopa used |
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Adverse effects of COMT |
nausea orthostatic hypotension vivid dreams hallucinations |
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MAO-B inhibitor |
inhibits the enzyme that metabolized dopamine and L-dopa through oxidation often combined with L-dopa
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Adverse effects of MAO-B inhibitors |
insomnia orthostatic hypotension dizziness |
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Effects of excess acetylcholine |
diaphoresis salivation urinary incontinence |
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Anticholinergic drugs |
block the binding of acetylcholine may increase the effectiveness of L-dopa decreased excess acetlycholine effects |
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Adverse effects of anticholinergic drugs |
dry mouth blurred vision urinary retention constipation elderly may experience severe CNS side effects |
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Alzheimers |
degeneration of cholinergic neurons in the hippocampus, followed by degeneration of neurons in the cerebral cortex |
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Neurofibrillary tangles |
form inside neurons when microtubule arrangement is disrupted microtubule arrangement is disrupted when there is an abnormal production of Tau (responsible for forming cross-bridges between microtubules) |
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Neuritic plaques |
Found outside neurons Composed of beta amyloid which kills hippocampal cells |
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Etiology |
Mutations in DNA: pts with two copies of apolipoprotein E4 are at increased risk as it promotes the formation of neuritic plaques by binding to beta amyloid therefore promoting deposition Mutations in the amyloid precursor protein gene which is involved in the production of beta-amyloid Head injury Hereditary |
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Cholinesterase inhibitors |
inhibit acetylcholinesterase, which metabolizes acetylcholine thus allowing more acetylcholine to remain in the synaptic cleft |
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Adverse effects |
nausea and vomiting diarrhea insomnia |
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NMDA receptor |
calcium channel blocked at rest by magnesium when glutamate binds to the NMDA receptor the Mg dissociates so Ca can enter the cell Important as normal Ca influx is important for memory, too much can cause degradation of neurons
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NMDA receptor problem in Alzheimers |
Excess glutamate release so the receptor remains open |
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Positive symptoms of schizophernia |
delusions hallucinations agitation paranoia combativeness disorganized speech disorganized thinking |
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Negative symptoms of schizophrenia |
social withdrawl poverty of speech poor self care poor insight poor judgement emotional withdrawal blunted effect lack of motivation |
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Etiology of schizophrenia |
Fam hx Drug abuse Low birth weight Low IQ |
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Basal Ganglia |
Movement and emotions Schizophrenia: paranoia and hallucination |
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Frontal Lobe |
Problem solving In Schizophrenia: involved with difficulty planning actions and organizing thoughts |
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Limbic System |
Emotions Schizophrenia: Agitation |
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Auditory System |
Schizophrenia: hallucinations |
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Occipital Lobe |
Visual information Schizophrenia: interpreting images, reading emotion, recognizing motion
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Hippocampus |
Mediates learning and memory Decreased in schizophrenia |
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Pathophysiology of schizophrenia |
disorder with increased dopaminergic nerve transmission 5-HT (serotonin): decreased number of 5-HT2A and increased number of 5-HT1A in the frontal cortex Glutamate: decreased NMDA receptors in some regions of their brain |
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Conventional Antipsychotics |
Block Dopamine 2 receptors in the mesolimbic area so Dopamine cannot bind Also block receptors for acetylcholine, histamine and norepinephrine Effective for postitive symptoms |
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Adverse effects of conventional antipsychotics |
extrapyramidal Symptoms sudden high fever anticholinergic effects orthostatic hypotension Sedation skin reactions |
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Extrapyramidal Symptoms |
Movement disorderst that resemble the symptoms of Parkinson's related to the blocking of D2 receptors
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Acute dystonia |
involuntary muscle spasms in face, tongue, neck and back |
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Parkinsonism |
bradykinesia, mask-like face, rigidity and stooped posture (treat with anticholinergic drug) |
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Akathesia |
pacing, squirming |
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Tardive Dyskinesia |
involuntary twisting and writhing of the face and tongue, lip smaking |
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Atypical Antipsychotics |
block D2 (low affinity) and 5-HT receptors(high affinity) Much better at treating negative symptoms with the same effect for positive Lower risk for developing negative side effects |
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Adverse effects of atypical antipsychotics |
sedation ortho Hypotension weight gain risk of developing type II diabetes anticholinergic effects |
