Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/98

Click to flip

98 Cards in this Set

  • Front
  • Back
Psychotropic medications affect what three domains of human funcitoning?
Perception, behaviour and mood.
Antidepressants are all __________ _______.
Antidepressants are all EQUALLY EFFECTIVE (50-60%
improvement as compared to 30-40% on placebo) and have similar drop-out rates.

As a result, drug choice should be tailored to the individual patient, based on patient choice, side effect profile, previous response, co-morbidity, suicide risk and cost.
Most antidepressants block ______________ reuptake (i.e. E, NE, 5HT and DA)
Most antidepressants block MONOAMINE reuptake (i.e. E, NE, 5HT and DA)
Fewer than __% of all patients with
depression show full remission with
optimised treatment, including trials on
numerous medications with and without
concurrent psychotherapy
Fewer than 50% of all patients with
depression show full remission with
optimised treatment, including trials on
numerous medications with and without
concurrent psychotherapy
Antidepressants ___ ____elevate mood in
healthy humans.
Antidepressants do not elevate mood in
healthy humans.
WHAT % of patients will have treatment failure with their first tried antidepressant?
40%
What are the 3 “generations” of drugs to treat
depression and related affective disorders
(anti-depressants)?
1st generation: monoamine oxidase inhibitors
(MAOI’s) and tricyclic anti-depressants

2nd generation: selective serotonin reuptake
inhibitors (SSRI’s)

3rd generation: tricyclic anti-depressants with a
twist
Tricyclic antidepressants (TCAs):

Main mode of action?


Block the re-uptake of both norepinephrine and
serotonin and thus elevate neurotransmitter levels
in the synapse


In TCAs

Blocking of muscarinic cholinergic receptors will produce what side effects?
Dry mouth
Blurred vision
Urinary retention
Constipation,
Confusion,
Memory problems
In TCAs

Blocking of H1 histamine receptors causes
Sedation and weight gain
In TCAs

Blocking of alpha1 adrenergic receptors causes
Postural hypotension and dizziness
How much medication is required for a lethal TCA overdose?
A 8-10 day supply can be a lethal dose; hence shift to SSRIs
Venlafaxine =

What generation anti-depressant is it?

Therefore?
Effexor

3rd

Both a TCA and an SSRI therefore both the
effects and the attenuated side effects of both
What are the three advantages of venlafaxine?
1 Clinically meaningful more rapid onset of action (within 1 week)
2 Safety in over dosage is high
3 Probably less interactions with other drugs
What are the disadvantages of venlafaxine relative to SSRIs? (2)
1. Potential for blood pressure elevation at higher doses - requires BP to be monitored closely during first 2 months of being stabilised on any dose above 225 mg/day

2. Dose needs to be titrated
Four most common side effects of Effexor (venlafaxine)? (4)
1. slightly anticholinergic
2. nausea
3. dizziness
4. sedation
Two uncommon side effects of Effexor?
1. SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion)
2. Serotonin syndrome
In effexor:

At higher doses (i.e. TCA), dose-dependent
increases in what three things?
1. blood pressure (rarely observed below 225 mg/day)
2. sweating
3. tremors
What are some of the common side effects of Zyban (bupropion). (10)
Less if taken?
Dry mouth, tremors, anxiety, loss of appetite,
agitation, dizziness, headache, excessive sweating, increased risk of seizure, and insomnia.



Bupropion causes less insomnia if it is taken just before going to bed.

Bupropion (Zyban) and sexual side effects relative to other SSRI's?
Sexual side effects normally accompanying SSRI's do not accompany bupropion. Interestingly, patients commonly report increased libido, perhaps evidence of its dopaminergic properties.
What are some of the contraindications of Bupropion (Zyban)? (5)
1. Seizure disorder
2. current use of other form;
3. bulimia/anorexia;
4. MAOI in last 14 days;
5. heavy alcohol use
Bupropion is what class of antidepressant ?
Norepinephrine-dopamine reuptake inhibitor
Citalopram
Fluoxetine
Paroxetine

Class of drugs?
SSRI
Amitriptyline
Maprotiline
TCAs

Amitriptyline = tricyclic
Maprotiline = tetracyclic
which is the most studied drug with regard to antidepressant action and cognitive effect?
Amitriptyline
Which antidepressant has the greatest sedative and anticholinergic property?
Amitriptyline
Performance impairment is always significant with regard to which antidepressant?
Amitriptyline
Describe the effect of a single dose of Amitriptyline?
The effect starts 30 minutes following a single
administration and is maximal by 2 to 4 hours
Which drug should be carefully applied in individuals with recent memory problems or in Alzheimer’s disease?
Amitriptyline
Patients with depression are subject to neuropsychological deficits in (5)
1. attention
2. memory
3. psychomotor speed
4. processing speed
5. executive function.
When depressed patients are treated, what happens to their cognitive function relative to controls?
They perform better, but they do not perform as well as normal controls.

As such, they improve, at least to a degree, but do not “normalize.”
How well will depressed patients on bupropion perform on a battery of cognitive tests relative to controls?
Depressed patients on bupropion perform AS WELL as
normals do on a battery of neurocognitive tests.
How well will depressed patients on venlafaxine and SSRIs perform on a battery of cognitive tests relative to controls?
They will not perform as well.
The cognitive benefit of some antidepressants may occur relative to an antidepressant's _________________ activity.

A lack of benefit may relate to its ___________ activity.
The cognitive benefit of some antidepressants may occur relative to an antidepressant's norepinephrine activity.

A lack of benefit may relate to its serontenergic activity.
In single-dose studies, the main impairment in
cognitive function occurs in the agents with strong
____________ or ____________ effects.
In single-dose studies, the main impairment in
cognitive function occurs in the agents with strong
anticholinergic or sedative effects
In single-dose studies, the main impairment in
cognitive function occurs in the agents with strong
anticholinergic or sedative effects
Sedative qualities of the TCAs have their
greatest effect of ________________ functioning while
both the sedative and the anticholinergic effect
contribute to _____________compromise.
Sedative qualities of the TCAs have their
greatest effect of PSYCHO-MOTOR functioning while
both the sedative and the anticholinergic effect
contribute to MEMORY compromise
What potentiates the effect of the sedative
antidepressants?
alcohol
1st line treatments for GAD, Panic, SAD, OCD & PTSD?
SSRIs

What replaced barbiturates?
BZD
What was originally touted as the cure for living in our highly pressured, technological society?
BZD.
Fives uses for BZD?
Anxiolytic
Sedative and hypnotic
Anticonvulsant
Muscle relaxant
Alcohol withdrawal
Risks of BZD (8)
1. Cognitive impairment, decreased motor skills,
2. daytime sedation; often used as “date rape” drugs
3. Additive CNS depression (ethanol,antihistamines,
opioids)
4. Dependence
5. Behavioural disinhibition (paradoxical)
6. Anterograde amnesia
7. Abrupt withdrawal can result in panic attacks,
8. rebound anxiety
Risk of foetal deformation (1st trimester)
“Doctor shopping
BZDs are one of the _______ _________ ______ drugs (4% of all prescriptions from General Practitioners)
BZDs are one of the most prescribed drugs (4% of all
prescriptions from General Practitioners)
Long term benzodiazepine users are significantly impaired in comparison to controls in which areas of cognition?
Moderate to large effect sizes were found for all cognitive domains, indicating that long term benzodiazepine users were significantly impaired in comparison to controls in all the areas assessed.
In BZD use, which cognitive domains seem to be more severely affected than are others? (4)
1. Sensory processing
2. Psychomotor speed
3. non-verbal memory
4. Visuospatial processing
The results of the three meta-analyses support __________ __________in the use of long-term benzodiazepine therapy.
The results of the three meta-analyses support EXTRENE CAUTION in the use of long-term benzodiazepine therapy.
The effect of long term benzodiazepine use is comparable to the deficits noted in what?
The effect of long term benzodiazepine use is comparable to the levels of deficits noted with moderate to severe closed head injury.
Is there a justifiable clinical application for the
benzodiazepines for any presentation on a long-term basis?
No.
Where do z-class drugs bind?
Bind to a subset of GABAA receptors with alpha 1
subunits
What effects do z-class drugs have?
They produce pure sedation (without anxiolytic,
anticonvulsant or muscle relaxing effects)
What is the effect of Z-class drugs on REM sleep?
Minimal.
What is the indication of Z-class drugs?
Insomnia
What is the main advantage of z-class drugs relative to BZD and barbituates?
Less daytime impairment compared to the benzodiazepines and the barbiturates.
What appears to be better preserved in people by non-benzodiazepine agents than by benzodiazepines. (2)
Psychomotor tasks and memory capacities
On-the-road studies involving benzodiazepine hypnotics reveal what?
On-the-road studies revealed that benzodiazepine hypnotics significantly impaired driving ability the morning following bedtime administration.
On-the-road studies involving benzodiazepine hypnotics reveal what regarding afternoon performance the following day?
Impairment was sometimes also significant in the afternoon (16–17 h after administration).
Long-term efficacy of BZD use?
limited.
Which benzodiazepines exhibit negative effects on psychomotor and memory function
All.
In terms of recent BZD use, the neuropsychologist should be aware of.....
Thus the neuropsychologist should be aware of all
benzodiazepine use in the last month but particularly
within the last week.
BZD:

It is clear that the long-term residual effects persist
for at least ___ ________ post cessation.
Also it is clear that the long-term residual effects persist for at least 6 mths post cessation.
In terms of neuropsychological assessment, Z drugs only really a problem in ____ _____ _____after use.
Z drugs only really a problem in first few hours after use
There are 3 “generations” of drugs which are used to treat schizophrenia and related psychotic disorders (anti-psychotics).

What are they?
1st generation: neuroleptics or typical antipsychotics
2nd generation: atypical anti-psychotics
3rd generation: Aripiprazole (Abilify)
Typical anti-psychotics are _______ _____ ______ antagonists.
Typical anti-psychotics are dopamine D2
receptor antagonists
The ___________ of a typical anti-psychotic for the
D2 receptor is positively associated with
treatment outcome
The affinity of a typical anti-psychotic for the D2 receptor is positively associated with treatment outcome (higher affinity better treatment outcome.

Higher affinity better treatment outcome.
1st generation anti-psychotics are effective at treatment what symptoms?
Only effective at treating positive symptoms
What are the side effects of 1st generation anti-psychotics and what?
Parkinson-like syndrome (because you’re blocking dopamine in the basal ganglia too)
What is tardive dyskinesia and why does it occur?
Abnormal facial and limb movements due to sensitization of D2 receptors.
Most anti-psychotics affect other
neurotransmitter systems including (4)

What does this explain?
1. Histamine,
2. Acetylcholine,
3. Adrenaline
4. Serotonin

Additional side effects
Why were atypical anti-psychotics developed?
Atypical anti-psychotics have been developed because of their more selective action on the dopamine system and/or action on other neurotransmitter systems.
What do all effective antipsychotic drugs block?
D2 receptors.
Which receptors does Haloperidol mainly act on?
D2 receptors.
Haloperidol has some effect on which other two receptors?
Serotonin 5-HT2 and a 1 receptors
Clozapine binds more to ___, ____, ___, and ________ H1 receptors than to either D2 or D1 receptors.
Clozapine binds more to D4, 5-HT2, 61, and histamine H1 receptors than to either D2 or D1 receptors.
Risperidone is about equally potent in blocking ___ and _________ receptors
Risperidone about equally potent in blocking D2 and 5-HT2 receptors.
Side effects of anti-psychotic medication:

Dopaminergic effects on the striatum (EPSE)? (4)
Dystonia/oculogyric crisis
Parkinsonism
Akathisia
Tardive dyskinesia and BLMs
Side effects of anti-psychotic medication:

Anti-cholinergic (muscarinic)? (3)
Dry mouth
Blurred vision
Constipation and difficulty in passing urine
Side effects of anti-psychotic medication:

Anti-adrenergic (adrenaline): (5)
1. Drop in blood pressure on standing (postural hypertension)
2. Sedation
3. Failure of ejaculation (especially Thioridazine)
4. Skin rashes, e.g., photosensitivity
5. Weight gain (possibly due to blockade of H1 and 5HT2
Side effects of anti-psychotic medication:

Anti-histaminergic: (1)
sedation
Phenothiazenes and halperidol, which
have little anticholinergic activity, do not
seem to impair __________ ________.
Phenothiazenes and halperidol, which
have little anticholinergic activity, do not
seem to impair MOTOR SPEED.
However, Phenothiazenes and halperido are more likely to produce _______ and may thereby cause
decreases in motor speed and coordination.
However, these agents are more likely to
produce extrapyramidal symptoms (EPS) and may thereby cause decreases in motor speed and
coordination.
In terms of anti-epileptic drugs, ___________produced the worst performance in terms of cognitive function.
In terms of anti-epileptic drugs, phenobarbital produced the worst performance in terms of cognitive function.
The cognitive effects of antiepileptic agents:

Seizure patients administered antiepileptics
appear to _____________ from seizure control, but
______________ typically overcomes any potential
benefit with heavy sedation and negative
effects on a wide range of functioning.
Seizure patients administered antiepileptics
appear to BENEFIT from seizure control, but
PHENOBARBITAL typically overcomes any potential
benefit with heavy sedation and negative
effects on a wide range of functioning.
Carbamazepine and valproate are both agents are considered to be ____ __________ and therefore less neuropsychologically _____ ;


Carbamazepine and valproate are both agents are considered to be LESS SEDATING sedating and
therefore less neuropsychologically TOXIC ;


Which AED productes the greatest negative neuropsychological effects?
Phenobarbital.
Mechanism of action in lithium?
Mechanism of action not fully understood.
Early dose related adverse effects of lithium?
1. GI distress
2. Sedation, weight gain
3. Muscle weakness
4. Polyuria, polydipsia
5. Impaired cognitive function
6. Tremor

Tolerance may develop
Adverse effects of L Dopa? (2)
1. Cardiac arrhythmia from stimulation of adrenergic
receptors in heart. Dose needs to be adjusted for
people with cardiac problems

2. Abnormal involuntary movements (50%) - i.e.. grimacing of face and tongue movements; slow writhing type of movements (not jerky movements) in arm and face)
What occurs in 20 - 25% of the population on L Dopa?
Behavioral disturbances.
L Dopa can induce: (5)
Psychosis
Confusion
Hallucination
Anxiety
Delusion
What are the 7 red flags in clinical situations?
1. Recent change in medical condition that has not been assessed by their Primary Care Physician (PCP)
2. Symptoms of withdrawal from drugs or alcohol
(sweating, shaking, pale pasty skin, lethargy)
3. Acute change in mental status
4. Evidence of inability to care for self (malnourished, dehydrated, dirty, malodorous, risk of exposure to elements)
5. Evidence of recent sexual or physical abuse that has not been evaluated
6. Suggestions of serious side effects to medications
7. Acknowledged or observed suggestions of suicidality or homicidality factors.
What are the five Factors that should be integrated more fully into the typical neuropsychological
assessment of patients taking psychotropic medications?
1. chronicity of drug administration
2. metabolic capacity
3. the positive neuropsychological effects of
disease management
4. a direct comparison of speeded versus nonspeeded tasks within cognitive domains
5. the temporal onset of patient/significant other cognitive complaints with respect to drug initiation/cessation and
increase/reduction
Summary and conclusions (1)

Within the antidepressant class, which drug is the most concern and for what three reasons?

Acute (2) effects

and persisting impairment in (1) due to....
TCAs are of most concern (particularly
amitriptyline) within the antidepressant class
with acute psychomotor and concentration
effects and persisting anti-cholinergic associated
memory impairment.
Which two classes of antidepressant drugs are in need of more definitive study but are largely safe?
SSRIs and MAOIs.
Among the anxiolytics, benzodiazepines all
produce compromise in which four cognitive domains?


1. Sedative
2. Psychomotor
3. Concentration
4. memory compromise
Atypical vs typical antipsychotics: Which is better in terms of cognitive benefit?
Now seems clear that there is no substantive
cognitive benefit of atypical versus typical
antipsychotics
Seizure patients administered antiepileptics
appear to benefit from seizure control, but
__________________ typically overcomes any potential
benefit due to _________ __________ and negative
effects on a wide range of functioning.
Seizure patients administered antiepileptics
appear to benefit from seizure control, but
phenobarbital typically overcomes any potential
benefit with HEAVY SEDATION and negative
effects on a wide range of functioning.
Which AEDS produce mild effects on cognition?
Carbamazepine, valproic acid and, to a lesser
extent, phenytoin, produce more mild effects.
Generally you are unlikely to make a false
positive diagnosis with the principal exception of
the effects of which two psychotropic classes?
Benzodiazepines and TCAs