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172 Cards in this Set
- Front
- Back
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Describe the functions of neurons.
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nerve cells that conduct electrical impulses, they respond to stimuli, and release neurotransmitters
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Identify four major neurotransmitters.
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Dopamine, Norepinephrine, Serotonin, and Acetylcholine
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Cholinergic relates to what part of the nervous system?
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PSNS
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Adrenergic relates to what part of the nervous system?
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ANS
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What is the PSNS?
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Rest and digest system
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What are symptoms of cholinergic drug overload?
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diarrhea, excessive urination, heart slower to respond, bronchi in resting state, drooling/lots of salivating
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What is the ANS?
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Fight or Flight response system
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What are symptoms of adrenergic drug overload or state of fear?
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heightened visual perception, increase HR, lot's of/deep breaths (more O2 sat), no poop or pee, convert glycogen to glucose- these are all survival mechanisms
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What are the adrenergic receptor sites?
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Alpha 1, Alpha 2, Beta 1, beta 2
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What are the cholinergic receptor sites?
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muscarinic and nicotinic
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What is the adrenergic neurotransmitter?
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norepinephrine
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What is the cholinergic neurotransmitter?
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Ach
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What receptor site is found in the heart?
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Beta 1
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Beta 1 ___, 2 _____
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1 heart, 2 lungs
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What receptor site is found in the heart?
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Beta 2
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What happens when Beta 1 in the heart has sympathetic stimulation?
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Increased HR and force on contraction, in creased conduction velocity
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What happens when Beta 1 in the heart has parasympathetic stimulation?
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Decreased rate, force of contraction, and velocity
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What happens when Beta 2 in the lungs has sympathetic stimulation?
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bronchial muscle relaxation
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What happens when Beta 2 in the lungs has parasympathetic stimulation?
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bronchial muscle contraction, increased secretions
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What receptor sites are found in the GI Tract?
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Beta 2 and Alpha
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What happens when receptor sites in the GI tract are stimulated by the SNS?
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Decreased motility and contraction of sphincters
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What happens when receptor sites in the GI tract are stimulated by the PSNS?
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Increased motility and relaxation of sphincters
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What receptor sites are found in the Bladder?
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Beta 2 and alpha
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What happens when receptor sites in the bladder are stimulated by the SNS?
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detrussor relaxation, contraction of sphincter
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What happens when receptor sites in the bladder are stimulated by the PSNS?
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detrussor contraction, relaxation of sphincter
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Acetylcholine
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A cholinergic neurotransmitter, works on muscrainic and nicotininc receptor sites
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Decrease in Ach can cause what diseases?
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Alzheimers, huntingtons, and parkinsons
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Increase in Ach can cause what disease?
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Depression
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Dopamine
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neurotransmitter, stimulates D1-D5 receptors
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Decrease in Dopamine can cause what diseases?
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Parkinson's and depression
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Increase in Dopamine can cause what disease?
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Schizophrenia and Mania
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Norepinephrine
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An adrenergic neurotransmitter that stimulates the alpha and beta receptor sites
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Decrease in Norepinephrine can cause what disease?
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Depression
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Increase in Norepinephrine can cause what disease?
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Mania, anxiety states, schizophrenia
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Serotonin
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stimulates 5-HT receptor sites (involved in sleep regulation)
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Decrease in Serotonin can cause what disease?
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Depression
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Increase in Serotonin can cause what disease?
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Anxiety States
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What are the monoamine neurotransmitters?
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Dopamine ,Norepinephrine, Serotonin, and histamine
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What are the amino Acid neurotransmitters?
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GABA and Glutamate
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GABA
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an neurotransmitter that is a natural inhibitor (tranquilizer), works at the GABA receptor sites
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Increase of GABA can cause what?
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Reduction of anxiety
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Decrease of GABA can cause what?
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Anxiety disorders, schizophrenia, mania, huntington's disease
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Glutamate
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an amino acid neurotransmitter, is excitatory
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Increase of Glutamate can cause what?
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a neurotoxic effect, neurodegeneration in alzheimers,
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Decrease of Glutamate can cause what?
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psychosis
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When a disease process is present there re 2 ways to approach the problem...
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an inhibitory (anti) drug or a stimulatory drug. Or can use both so less of one drug can be used.
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What effect would Cardura, an Alpha 1 blocker have?
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dilate arteries to decrease BP, used to relax urinary sphincter for men with enlarged prostate
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What is a s/e to look out for when using an alpha 1 blocking drug?
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orthostatic hypotension
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What would a Ditropan: inhibits acetylcholine be used for?
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Pts with bladder problems
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What would Detrol: muscarinic antagonist be used for?
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pts with bladder problems
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CNS:
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Brain
Spinal Cord |
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Overall goal of the Nervous system?
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MAINTAIN HOMESTASIS
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Soma
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body
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Dendrite
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receiving messages
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Axions
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sending messages; may connect with any other part of the of the neuron
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How is a response produced when a neuron is given stimuli?
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Response producdes an electrical impulse due to changes in the cell membrane’s permeability. Na+ and K+ move in and out of the cell causing an electrical charge.
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epinephrine
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the other primary neurotransmitter in the SNS
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Inderal: non-selective B blocker, used for?
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lower HR/BP (blocks CNS), bronchi constriction
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What is important to do before giving a drug like inderol?
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check apical pulse, just like digoxin
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Atropine: inhibits action of acetylcholine – anitmuscarinic... used for?
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Stops PSNS, lets SNS take action (would use to raise HR in ER)
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Albuterol: Stimulates B 2 receptors, used for?
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asthma
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Meclizine: Central anticholinergic activity- what is this used for?
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Turns off cholinergic system in brain-used for motion sickness
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Because there are a variety of neurotransmitters and they are present in more than one place in the brain &/or body....
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There is a Consequence, drugs meant to affect one part of the brain may affect another part.
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After a neurotransmitter is released and stimulates the post-synaptic cell, it must be _______.
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destroyed
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__________ is an enzyme in the synapse which destroys acetylcholine
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Acetylcholinesterase
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Reuptake
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Destruction within the pre-synaptic cell. An arm grabs the MA and brings them back into the pre-synaptic cell
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MA
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Monoamine
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_____ _______ breaks down monoamines within the cell. This allows the molecules to be recycled to make new monoamine neurotransmitters.This is very efficient.
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Monoamine Oxidase
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Besides breaking down neurotransmitters to maintain homeostasis, the amount of neurotransmitters secreted is regulated by a ____ ____ ____
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negative feedback system.
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negative feedback system
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Stimulate, then count, then reuptake
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Schizophrenia
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excess dopamine & serotonin
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Depression
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deficiency of serotonin & norepinephrine
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Anxiety is reduced when _____ in enhanced
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GABA
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Alzheimer's = deficiency of ________
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ACh
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most complex part of brain
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Cerebral Cortex
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2 hemispheres connected by the ___ _____
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corpus callosum
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Right hemisphere:
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creative
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Left hemisphere:
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analytical & verbal
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Frontal Lobe controls
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planning, & execution of movement
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most mental illnesses due to problems in ____ _____
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frontal lobes
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Limbic system
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EMOTIONAL brain involved with learning, memory, & olfactory center
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Key parts of limbic system:
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amygdala, hippocampus
LINKS EMOTIONS AND MEMORIES TOGETHER Because of this these areas are highly involved in schizophrenia |
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amygdala
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strong emotions
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hippocampus
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start having memories (50 first dates)
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Cerebellum
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balance and hand-eye coordination “Athletes brain”
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Reticular Activating System
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modulates awareness and consciousness. This means that it allows for both sleep (inattention) and attentiveness. If turned off you become inattentive and sleepy
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Extra Pyramidal System
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Movement system in the brain. It does not initiate movement but instead modulates movement, particularly walking, to make it smooth/rthymic
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CT scan
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seres of X-ray images of the brain- shows "slices" to make a computerized 3-d Image of the brain (SHOWS ANATOMY)
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MRI
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Magnetic field applied to the brain, nuclei of H atoms absorb and emit radio waves that are analyzed by the computer (SHOWS ANATOMY)
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PET Scan
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Radioactive substance injected, travels to brain, shows up as bright spots on the scan- shows brain activity, only test (along with SPET) that can show neurotransmitter/receptor interaction (doesn't show anatomy)
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SPECT Scan
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Similar to PET but uses radionuclides that emit gamma-radiation (protons); measures various aspects of brain functioning (doesn't show anatomy)
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Psychotic
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loss of contact with reality
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Antipsychotic
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oppose the loss of contact with reality
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Antipsychotic drugs
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Used with hallucinations and delusions, sometimes agitation as well. So strong it will put you to sleep and then when wake up will feel the happy effects. Usually used for those that are out of control.
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First group of drugs used effectively for mental illness
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Thorazine
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Hallucinations & delusions can accompany many diseases:
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Schizophrenia
Depression Mania Alzheimer’s Disease |
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Can Antipsychotic drugs be used for agitation?
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Yes
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Typical Antipsychotics
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Block dopamine receptor to prevent the stimulatory effects of dopamine. Therefore, decreases emotional/sensory stimulation (aggression, hallucinations, delusions).
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Why do Typical Antipsychotics cause stiff/jerky movement?
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They are strong and indiscriminatory, because of this they throw off the Dopamine/ACh balance- causing extrapyramidal symptoms
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Akathisia
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Side effect of Antipsychotic drugs: motor inner-driven restlessness (tapping foot incessantly, rocking forward and backward in chair)
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pseudoparkinson's
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Side effect of Antipsychotic drugs: mask like faces, stiff and stooped posture, shuffling gait, drooling, tremor, "pill-rolling" phenomenon
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Tardive Dyskinesia
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A Side effect of antipsychotic drugs: protruding and rolling tongue, blowing, smacking, irregular movements, slow complex serpentine movements, etc.
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How do we counter the extrapyramidal effects of antipsychotic drugs?
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Giving anticholinergic drugs such as COGENTIN. This restores the BALANCE between dopamine and ACh.
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What are negative symptoms from taking typical antipsychotic drugs?
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lack of motivation, insight.planning, judgement
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What can be taken to avoid the s/e from typical antipsychotic drugs?
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taking a-typical antipsychotic drugs
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Why do a-typical antipsychotic drugs produce fewer s/e?
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Because they work more specifically to the D2 receptor site
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Thorazine
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Typical Antipsychotic, LEAST potent
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Haldol
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Typical Antipsychotic, MOST potent
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Clozaril
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1st of the a-typical antipsychotics, last resort because it is hard to monitor
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major s/e of Clozaril
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Agranular cytosis (low WBC)
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Zyprexa
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a-typical antipsychotic (melt in your mouth pill)
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Metabolic Syndrome a problem for ____, _____ have the highest risk
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Zyprexa, Clozaril
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Geodon is contraindicated for patients with ____ _____
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cardiac problems
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_____ needs to be in balance with _____ to maintain smooth movement.
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acetylcholine, Dopamine
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If the body senses that there is less dopamine that acetylcholine, movement becomes ____
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stiff
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How does Cogentin work?
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blocking acetylcholine and restoring balance
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What are the possible s/e of a-typical antipsychotics?
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weight gain which leads to possibility of DMII- need to monitor weight!!, also increased blood glucose and triglycerides
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What is a rare s/e of typical anti-psychotics?
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Neuroleptic Malignant Syndrome, NMS = reduces consciousness, muscular rigidity, hyperpyrexia, hypertension, tachycardia
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Depression Related to deficiency of certain neurotransmitters =
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serotonin, norepinephrine, dopamine.
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Low levels of serotonin, norepinephrine, dopamine=
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Low mood
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Antidepressants _______ the level of neurotransmitters
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increase
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normal levels = normal mood
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normal mood
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Is the first antidepressant prescribed usually the best one?
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Most of the time the first drug tried does not work, so it is a trial and error
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Tricyclic antidepressants work by...
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Block the reuptake of norepinephrine.
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What are the s/e of Tricyclic antidepressants?
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anticholinergic effects- postural hypotension, dry mouth, urinary retention.
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Why should elderly or those that have cardiac disease not take Tricyclic antidepressants?
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It depresses cardiac conductivity & contractility
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Why are Tricyclic antidepressants not given during the day?
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very sedating- given at night
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What are Tricyclic antidepressants not prescribed very much any more?
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Toxic = can cause death with one month’s dose
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Selective serotonin re-uptake inhibitors work by
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Selectively blocking reuptake of serotonin :) causes gridlock in synapse
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What are possible s/e of SSRIs?
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May cause excessive stimulation & anorexia
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What is Serotonin Syndrome?
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Serotonin syndrome = fever, agitation, hypertension, hyperthermia, ridgity. Tends to happen with overstimulation of serotonin receptors as when two SSRI;s are used together. Just like how people die on ectasy
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Monoamine Oxidase Inhibitors (MAOIs) work by
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Work by inhibiting the enzyme monamine oxidase from breaking down neurotransmitter (norepi). It is reuptook but not broken down. The norepi can be reused- gives more norepinephrine for neurotransmission.
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What is a s/e of MAOIs?
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They also block the enzyme from working in the rest of the body. Thus the body is unable to breakdown monamines found in many foods. In particular THYRAMINE found in PRESERVED FOODS AND AGED CHEESES. When it is ingested it can cause a HYPERTENSIVE CRISIS.
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Give an example of a tricyclic antidepressant
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Elavil
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3 examples of SSRIs?
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Prozac, zoloft, Paxil
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2 Examples of MAOIs?
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Nardil, Parnate
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Lithium
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An ion similar to Na+ and K+ and a mood stabilizer.
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How does Lithium work?
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Seems to act by decreasing conductivity of neurons thus decreasing stimulation in manic states.
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What is the therapeutic range of Lithium?
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0.6 mEq/L-1.2 mEq/L
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Does lithium have a high or low therapeutic index?
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VERY LOW. Therapeutic level is very close to toxic level- needs to be monitored regularly and before given.
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Does lithium interact with other drugs?
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yes, interacts with many other drugs
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What is lithium sensitive to?
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electrolyte changes- need to be careful to keep fluid intake in balance
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What other drugs seem to work as mood stabilizers?
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Antiepileptic drugs
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Therapeutic index
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High= therapeutic level far from toxic level
low= therapeutic level close to toxic level |
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Depakote/Depakene
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Mood stabilizers that suppress electrical conduction
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anti-anxiety drugs
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most are benzos- work by promoting the activity of the receptor GABA- drug is sedating
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Benzodiazepines work how?
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These drugs bind to specific receptors next to the GABA receptors thereby enhancing the action of GABA.
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2 examples of mood stabilizer drugs?
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Lithium, Depakote/Depakene
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2 examples of anti-anxiety drugs?
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Ativan, Xanex
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What is a non addictive anti-anxiety drugs?
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Buspar
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How does Buspar work?
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decreases anxiety without sedation, blocks pre-synaptic counting receptor allowing more serotonin to be released = decreased anxiety. It does not let the neurotransmitter counting mechanism to work so more Seratonin is released
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What drug is most preferred for chronic anxiety?
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Buspar due to the high addictive effect of the other anti-anxiety drugs
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ADHD May relate to ...
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under stimulation of attention centers
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3 examples of ADHD meds?
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Ritalin, Adderal, and Concerta
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Seen in Alzheimers is a Decrease in levels of _____
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acetylcholine
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Alzheimers first kills off the ________ area
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hippocampus
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What med is used for Mild – Moderate Alzheimers?
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Aricept- a Cholinesterase Inhibitor
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What med is used for Moderate – Severe Alzheimers?
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Namenda- sits on glutamate receptor site and blocks it- prevents cell destruction
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Nothing stops Alz, all we can do is slow it down and prevent ____ _____
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cell destruction
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How does glutamate work in cell destruction?
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Glutamate is a highly stimulatory neurotransmitter, it will “bomb” and “bombard” the receptor site for so long the receptor site will be destroyed. Namenda blocks the receptor site to keep it from being destroyed which in turn slows down the Alz disease process.
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Cytochrome P450 enzymes in liver _______ many psychiatric drugs
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metabolize
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Genes inactivated = _____ metabolism of drugs
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poor
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Genes overactive =___ ___metabolism of drugs
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too fast
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Caucasians more likely to be poor metabolizers so need _____ dosage
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lower
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East African & Middle Eastern patients more likely ultra-rapid metabolizers, so need ____ drug
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more
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Name one Atypical Antipsychotic
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Zyprexa
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Major neurotransmitter that is affected with schizophrenia?
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dopamine
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Major neurotransmitter that is affected with depression?
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serotonin
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Depot injection
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an injection, usually subcutaneous or intramuscular, of a pharmacological agent which releases its active compound in a consistent way over a long period of time. Depot injections are usually either solid or oil-based.
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Anxiolytic
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is a drug used for the treatment of anxiety.
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Dystonia
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is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. extrapyramidal symptom
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Psychotropic drugs
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Antipsychotics, antidepressants, ADHD drugs, anti-anxiety medications and mood stabilizers
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