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Key components of the Brain
  • Cerebellum
  • cerebrum
  • brain stem
  • limbic system
  • Two hemispheres
  • Four lobes
  • Frontal lobe: thought, body movement, memories, emotions, moral behavior
  • Parietal lobe: taste, touch, spatial orientation
  • Temporal lobe: smell, hearing, memory, smotional expression
  • Below the cerebrum
  • Center for coordination of movements, postural adjustments
  • Reception, integration of information from all body areas to coordinate movement, posture
Brain Stem
  • Midbrain: RAS (motor activity, sleep, conciousness, awareness) and extrapyramidal system
  • Locus Ceruleus: norepinephrine producing neurons (stress, anxiety
Limbic System
  • Above the brain stem
  • Thalamus: (activity, sensation, emotion)
  • Hypothalamus: (temperature regulation, appetite control, endocrine function, sexual drive, impulsive behavior)
  • Hippocampus: (emotional arousal, memory)
  • Amygdala: (emotional arousal, memory)
  • May be involved with Kindling (acceleration and magnification of symptoms)
  • chemical substances to facilitate neurotransmission
  • important in the right proportions to relay messages
  • play a role in psychiatric illness, actions and side effects of psych drugs
Excitatory Neurotransmitters
  • Dopamine: complex movements, motivation, cognition, regulation of emotional response
  • Norepinephrine: attention, learning, memory, sleep, wakefulness, mood regulation
  • Epinephrine: fight or flight response
  • Glutamate: major neurotoxic effects at high levels
Inhibitory Neurotransmitters
  • Serotonin: food intake, sleep, wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotions
  • GABA: modulation of other neurotransmitters
Inhibitory or Excitatory
  • Acetylcholine: sleep and wakefullness cycle, signals to muscles to become alert
  • Histamine: neuromodulator
Neurobiologic Causes of illness
  • genetics and heredity play role, but not solely genetic
  • twin, adoption, and family studies used
Psychopharmacology Definitions
  • Efficacy: maximum therapeutic effect
  • Potency: amont of drug needed for maximum effect
  • Half-Life: time period in which 1/2 of drug is left
  • Approved use: researched and tested uses
  • Off label use: effective for diseases different from original testing
Black Box Warnings
  • serious or life threatening side effects
  • May psych meds have black box warnings
  • Eg. elongated QT interval, DM, death, suicidality
Principles of psychopharmacology
  • Effect on target symptom (specific rather than general)
  • adequate dosage for sufficient time (frequency)
  • lowest effective dose (potency)
  • lower doses for older adults
  • tapering rather than abrupt cessation to avoid rebound or withdrawal
  • follow-up care (blood draws, clozaril/lithium)
  • simple regimen to increase compliance
Antipsychotic Drugs
  • Neuroleptics
  • Used to treat psychotic symptoms
  • Work by blocking dopamine receptors
  • Conventional: Thorazine, Prolixin, Navene, Haldol, Loxitane
  • Atypical: Clozaril, Risperdal, Zyprexa
  • New generation (dopamine system stabilizers): Abilify
Route of delivery
  • Oral
  • IM: used to be just haldol which is now overused.
Differences in types of neuroleptics
  • Conventional: treats positive symptoms, more EPS
  • Atypical: works on negative symptoms, fewer EPS
  • New generation: manages both ↑ and ↓ dopamine, much fewer side effects
Side effects of neuroleptics (EPS)
  • Extrapyramidal Syndrome
  • Acute dystonia (can be fatal): twisted head/neck, arched back, eyes roll back, laryngospasm
  • Acute dystonia treated with anticholinergics or benadryl
  • Pseudoparkinsonism (stooped posture, masked-like face, shuffling gait)
  • Akathisia: acute restlessness, anxiety, agitation
Neuroleptic side effects cont.
  • Neuroleptic Malignant Syndrome (NMS)
  • Tardive dyskinesia (irreversible involuntary movements)
  • Anticholinergic effects (dry mouth, constipation, urinary hesitancy or retention)
Neuroleptic side effects cont.
  • Increased prolactin levels (sexual dysfunction, contributes to noncompliance)
  • Weight gain (atypical agents, except geodon)
  • Prolonged QT interval (Thorazine, Inapsine, Serentil)
  • Agranulocytosis (Clozaril): draw CBC, ANC levels
  • Sudden death from torsade de pointes
Antidepressant uses
  • Major depressive illness
  • anxiety disorders
  • depressed phase of bipolar
  • psychotic depression
Types of antidepressants
  • Tricyclic and related cycle antidepressants TCAs (older, longer half life, elavil is a suicide risk, effect heart)
  • SSRIs: used for moderate depression
  • MAOIs: nardil, marplan, parnate, react with foods, demerol, anesthesia
  • Other: Effexor, Wellbutrin, Desyril, Serzone (sometimes for
Antidepressants: mechanisim of action
  • interact with monamine neurotransmitter symptoms, especially norepinephrine and serotonin
SSRI side effects
  • anxiety, agitation, akathisia, nauea, insomnia, sexual dysfunction, weight gain
TCA side effects
  • anticholinergic effects
  • orthostatic hypotension, sedation, weight gain, tachycardia
  • sexual dysfunction
  • Cardiac dysfunction: death from overdose (Elavil)
MAOI side effects
  • daytime sedation, insomnia, weight gain, dry mouth, orthostatic hypotension, seual dysfunction
  • hypertensive crisis (from food containing tyramine, demerol, anesthesia)
Other antidepressant side effects
  • sedation, headache (nefazodone, trazodone)
  • loss of appetite, nausea, agitation, insomnia (bupropion, venlafaxine)
  • Priapism (trazodone)
Antidepressant drug interactions
  • Serotonin syndrome
  • agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia
  • coma, death (extreme reactions)
Antidepressants (client teaching)
  • Time of dosage: SSRI in morning, TCAs at night
  • Actions for missed dose: SSRI up to 8 hours, TCA within 3 hours
  • dietary restrictions for MAOIs
Mood-stabilizing Drugs
  • Used for impulse control
  • Lithium
  • some anticonvulsants (carbamazepine, valproic acid, gabapentin, topiramate, oxcarbazepine, lamotrigine)
  • used to treat bipolar
Mood-Stabilizing Drugs Mechanisim of Action
  • Normalize reuptake of certain neurotransmitters (lithium)
  • Increase levels of GABA (valproic acid, topiramate)
  • Kindling process (valproic acid, carbamazepine)
  • Naturally occuring salt
  • works through the kidneys
  • Normal level 1 mEQ/L
  • Works for about 80% of pts
  • helps with suicidality
  • therapeutic range is very narrow
Side effects of Lithum
  • Nausea, diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, metallic taste, fatigue, lethargy, weight gain, ane (late therapy)
  • Toxicity: severe diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination, (can lead to coma and require dialysis
  • kidney damage
Mood stabilizers: other side effects
  • Carbamazepine: rash, orthostatic hypotension blackbox (aplastic anemia, agranulocytosis)
  • Valporic acid: weight gain, alopecia, handj tremor, black box (hepatic failure)
  • Topiramate: diziness, sedation, weight loss
Mood stabilizers: client teaching
  • periodic monitoring of blood levels (12 hrs after last dose)
  • take drugs with meals
  • safety measures
Cultural considerations
  • African Americans: more rapid response to antipsychotics and TAs, greater risk of side effects
  • Asians: slower metabolism of antipsychotics and TCAs, lower doses needed for same effects
  • Hispanics: lower doses of antidepressants needed for desired effects
  • Lithum: lower doses needed for hispanics and asians
Cultural considerations cont.
  • Increased frequency of herbal medicine use: st john's wort, kava, velarian, gingko biloba
  • increased risk for interactions
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