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88 Cards in this Set
- Front
- Back
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3 types of partial or focal seizures
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simple: seizures with symptoms in a single domain
complex: aka temporal lobe seizures, temporal lobe epilepsy (tle) or psychomotor seizures secondary generalized seizures: starts in as simple or complex and then develops into generalized |
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4 types of simple partial or simple focal seizures
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focal motor seizures
focal sensory seizures focal autonomic seizures psychic focal seizures |
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ion channels involved in seizures
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na, k, ca
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gaba's role in seizures
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concentrations of GABA are reduced in the brains of persons with seizure disorders
treatment drugs (anticonvulsants) act to increase GABA in the brain drugs that reduce GABA in the brain tend to cause seizures |
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Other uses of Short-chain Fatty acids
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other than being anticonvulsants these can be used as mood stabilizers for mania or bipolar disorders
for example: sodium valproate (depakote, depakene): most commonly used mood stabilizer in bipolar patients |
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First line drug recommendation for: simple partial or simple focal seizure
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phenytoin, carbamazepine, gabapentin, lamotrigine
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first line drug for: complex partial seizures
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valproate, carbamazepine, phenytoin
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first line drug for: generalized absence or petit mal seizures
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valproate, ethosuximide
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first line drug for: generalized tonic seizures, generalized clonic seizures, and atypical absence seizures
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valproate
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first line drug for: juvenile myoclonic seizures
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valproate, clonazepam
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first line drug for: generalized tonic-clonic (grand-mal) seizures
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phenytoin, phenobarbital, carbamzepine, valproate
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List of endocrine disorders
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addisons, cushings, hyperthyroidism (aka thyrotoxicosis, graves disease), hypothyroidism (aka myxedema,
biologi |
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addisons disease
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reduced production of adreno coricosteroid hormones
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cushings disease
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increased production of teh adreno corticosteroid hormones
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hyperthyroidism or thyrotoxicosis or graves disorder
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excessive thyroid hormone
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hypothyroidism or myxedema
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too little thyroid hormone, most common medical disorders to result in depressive illness
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biological or physiological symptoms of depression
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sleep disturbance, appetitite disturbance, fatigue and low energy level, decreased libido, agitation and restlessness or psychomotor retardation, impaired concentration and forgetfulness, pronounced anhedonia, diurnal variaiton in mood,
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common side effects of cyclics
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anticholinergic effects
adrenergic effects antihistaminic other: cardiac arrythmias |
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side effects of ssris
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gastointestinal symptoms
sexual dysfunction nervous system symptoms |
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drug treatment for depression with: family history of bipolar
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should NOT treat with antidepressant simultaneous administration of both a mood stabilizer and an antidepressant
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drug treatment for depression with: anxiety, agitation, obsessional symptoms, rumination, irritiability, and or aggression
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ssris
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drug for depression accompanied by apathy, low energy, anhedonia, and or low motivation
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DNRIs (bupropion), RNIs (atomoxepine or reboxetine)
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depression with psychotic features drug treatment
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combo of an antidepressant (SSRI) and an atypical antipsychotic, DO NOT USE bupropion
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clinical depression with high suicidality
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ssris, trazodone, venlafaxine or bupropion
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seasonal affective disorder drug treatment
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ssris and bright light exposure therapy
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pmdd drug treatment
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ssris, some women only have to take these during the days of their cycle when symptoms are experienced
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depression concurrent with ocd drug treatment
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ssris or clomipramine
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depression and panic disorder drug treatment
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ssris or cyclic antidepressants
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clinical depression and seizure disorder
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do not use bupropion or the cyclic antidepressants
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deprssion + parkinsons drug treatment
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bupropion
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depression accompanied by sexual dysfunction
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bupropion, nefazodone, citalopram, or mirtazapine
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depression accompanied by chronic pain
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amitriptyline, doxepine, venlafaxine
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depression with weight gain
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bupropion
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4 ways anxiety and painic symptoms can be differentiated
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onset of symptoms, precipitating stress, duration of symptoms, intensity of symptoms
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medical disorders that can result in anxiety symptoms
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endocrine disorders
metabolic disorders cardiac disorders CNS disorders Meniere's disease |
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Prescribed and over the counter medications and drugs of abuse that can cause anxiety symptoms
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stimulants
appetite suppressants asthma medications nasal decongestants steroids withdrawal from CNS depressant |
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3 nt systems that are invovled in anxiety
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NE, 5ht, GABA
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anxiolytics
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drugs specifically developed to reduce anxiety
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medications for anxiety
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benzos
barbituates carbamates noradrenergic agents antihistamines buspirone |
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commonly used benzos
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cholordiazepoxide (librium)
diazepam (valium) clorazepate (tranzene) lorazepam (ativan) oxazepam (serax) alprazolam (xanax) halazepam (paxipam) przepam (centrax) clonazepam (klonopin) |
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primary side effects of benzos
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sedation and lethargy (sleepy or drowsy)
dizziness Weakness Motor Incoordination Slowed motor response latency Older adults may have memory and cognitive impairments |
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drug treatment for GAD
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buspirone, venlafaxine, ssris
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ocd drug treatment
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ssris are first line
sometime clomipramine (anafranil- a tricyclic antidepressant) |
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performance anxiety treatment
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noradrenergic agents: beta blockers and alpha 2 agonist
occassionaly benzos |
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social anxiety or social phobia drug treatment
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ssri, others include: busprirone, venlafaxine, propranolol, and benzos
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PTSD drug treatment
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ssri (could be treating the comorbid depression as well)
dont use benzos (substance abuse likely) atypical psychotic could help if acute psychotic symptoms manifest |
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panic disorder drug treatment
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ssri, often start with benzos (faster acting) then taper off as ssris take effect
sometimes tricyclic antidep used as second line |
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sleep stages
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first 30 minutes: descend from wake through stage 1-4
30 to 45 min in stage 4 then 3,2,1 1st REM (brief) 123 to 4 for 30 minutes of deep sleep 2nd REM: slightly longer than first 3rd stage sleep 3rd REM phase: longer than last stage 2 longest REM (20 to 30 min) may go to stage 2 then awake I GUESS YOU REALLY JUST NEED TO KNOW THAT BENZOS REDUCE SLOW WAVE SLEEP |
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four nts associated with sleep
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ACh, DA, NE, 5HT
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medical disorders related to insomnia
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hyperthyroidism, chronic obstructive pulmonary disease (emphysema)
chronic pain syndromes |
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two uses of stimulant medications in psychopharm
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adhd (most common)
narcolepsy |
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adhd treatment involves what 4 types of psychotropic agents
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stimulants
anticonvulsants antidepressants alhpa 2 adrenergic agonists |
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stimulants used for ADHD
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Methylphenidate Daytrana (ritalin, concerta, methylin, metadate, transdermal patch)
Dexmethylphenidate (focaline) Dextroamphetamine (dexedrine, adderall) levoamphetamine Methamphetamine? (desoxyn) |
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anticonvulsants used for ADHD
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divalproex (depakote)
valproic acid (depakene) |
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antidepressants used to treat ADHD
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atomoxetine (NRI) (strattera)
bupropion (DNRI) (wellbutrin) |
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what is tissue tolerance
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substance induced insensitivity of receptors at sites where the substance acts in the brain
happens in both pre and post synaptic receptors most likely to occur with sedating substances (opiates, benzos, alcohol! |
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what is the brains reward center
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nucleus accumbens
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where is the dopamine pathway (what is included in it etc)
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limbic system:
extends to prefrontal cortex and basal ganglia |
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opiates, heroin, morphine all act as agonist on what nt system(s)
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endorphins, enkephalins
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alcohol acts on an agonist on what nt system(s)
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GABA, endorphins
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Benzos act on what nt system(s)
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GABA
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Nicotine acts on what nt system(s)
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acetylcholine (ACh)
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Cannabis
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Anadaminde
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LSD, hallucinogens
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Seratonin (5ht)
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In what ways does alcohol act on nt systems
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antagonist for glutamate receptors
enhances GABA when I learned about these nts I was always taught to think of glutamate (excitatory) as the gas pedal and GABA (inhibitory) as the brakes |
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what happens when someone prescribed to disulfiram (antabuse) ingests alcohol
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dilation of the peripheral blood bessels and flushing
nausea, vomiting, and gastrointestinal distress hypotension (reduced blood pressure) tachycardia (increased heart rate) |
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most commonly used benzos for alcohol withdrawl symptoms (cross-tolerance)
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diazepam (valium)
chlordiazepoxide (librium) lorazepam (ativan) |
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symptoms of opiate intoxication
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euphoria, sedation, slurred speech, apathy, dysphoria, psychomotor retardation or agitation, impaired judgement, constriction of the pupils (miosis), decreased rate of respiration
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treating opiate withdrawl with drugs
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benzos used briefly >
alpha 2 adrenergic agonists (help calm agitation) clonidine (catapres) is most common one > Long acting synthetic opiate with minimal euphoric properties: methadone (dolophrine) or propoxyphene (Darvon) |
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what nt systems do stimulants typically act on
how do they act on the receptors? |
dopamine (DA) and norepinephine (NE) systems
increase release into synapse (amphetamine), or block reuptake (cocaine) thus leaving more in the synapse |
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effects of dissociative anesthetics
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alteration in level of conciousness (anesthesia)
pain killing effects (analgesia) impairments in explicit memory (amnesia) |
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drugs in dissociative anesthetic class
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phenylcyclidine (PCP) or angel dust
ketamine |
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syndromes associated with dissociative anesthetics
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intoxication
substance induced psychotic disorder withdrawal syndromes are not usually associated chronic organic mental disorder |
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pharmalogical treatment of dissociative anesthetic intoxication
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benzos when person's main presentation invovles anxiety and agitation
antipsychotics may be used if person manifests psychotic symptoms |
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cannabis withdrawal pharmalogical treatment
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smoke a bowl
while withdrawal is rare the symptoms include: insomnia, irritability, tremor and nausea, |
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4 main features of parkinson syndromes
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bradykinesia, muscular rigidity, resting tremor, abnormalities in posture and gait
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drug treatment of parkinsons
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l-dopa (levo dopa): DA precursor
often a decarboxylase inhibitor (carbidopa, benserazide) is also administered to allow more l-dopa to reach the brain |
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what is the biggest risk fact for alzheimers
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age
5% of 65+, 15-20% of 80+ |
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how can you confirm a diagnosis of Alzheimers
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only through autopsy (otherwise it is used as a rule out diagnosis)
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nt's in alzheimers
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ACh (reduction)- this is the main one
NE, 5ht, and DA also reduced |
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Drug treatment of Alzheimers
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many have been tried:
anticholinesterases or cholinesterase inhibitors, cholinommetics, antiinflammatory drugs, antioxidants, chelating agents, estrogens, cognitive enhancers or nootropic agents, ginkgo biloba, memantine |
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drug treatment of early or mild stage alzhemers
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newer cholinesterase inhibitor (donepezil, galantamine, rivastigmine)
sometimes augmented with vitamin E supp |
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drug treatments of moderate or severe Alzheimers
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memantine
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what is an occlusive stroke
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stroke where there is no evidence of a hemmorrhage
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what drug will be administered for occlusion stroke
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tissue plasminogen activator (tpa)
- needs to be administered within three hours of the stroke |
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how do pharmodynamics differ in children
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cns are immature consequently their second messengers systems and receptors take longer to respond
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issues to consider when treating older adults
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presence of medical disorders can complicate diagnosis
medications for medical disorders can induce psychotic symptoms pharmokinetics and pharmodynamics may be altered more likely to be taking multiple medications maybe more sensitive to side effects lack of drug compliance (memory problems, confusing which drug to take when) |
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genetic factors that differ btwn racial and etnic groups and that influence responses to psychotropic drgs
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cytochrome P450 liver enzymes
other drug metabolizing enzymes plasma protiens genes that encode nt receptors |
