Psychopharmacology Midterm: Understanding the Functions of the Brain and Neurotransmitters, Exams of Pharmacology

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Psychopharmacology Midterm Function of Cerebral Cortex - - Information Processing - Complex Cognition - Perception Function of the Subcortical Regions - - Basic Drives - Emotion - Memory - Fine Motor skills Function of the Brainstem - - Altertness - Vital Functions Function of the Cerebellum - - Coordination Lobes of Cerebral Cortex - - Temporal: (hearing/language comprehension) - Occipital: (vision) - Parietal: (visuospatial orientation, somatosensation) - Frontal: (Motivation, Planning, inhibition, motion, language expression) Subcortex Regions - - Basal Ganglia: fine motor control - Limbic System: emotional valence/memory - Thalamus: relay station - Hypothalamus: hormonal/vital sign/sleep regulation Brainstem Division - - Midbrain: (Pons, Medulla, Reticular Formation, Cerebellum) - Hindbrain: Tectum Roof (Colliculi)/Tectum Floor (Raphe Nucleus, Periadequatal, Substantia Nigra) - Diencephalon: (Thalamus/Hypothalamus) Somatic Nervous System - - voluntary control of skeletal muscle Autonomic Nervous System - - involuntary control of smooth muscle Sympathetic Division - - "Fight or Flight" - Norepeinphrine Parasympathetic Divsion - - "Rest and Digest" - Acetycholine Ligands - - Hormones, drugs, enzymes Second Messenger Systems - - G-proteins activate enzymes in the cell - Alter: Ion channel activation - Anti-Epileptic Drugs (AEDs) - Lithium - Atypical Antipsychotics Antipsychotic Classes - - First Generation Antipsychotic - Second Generation antipsychotic Cognitive Enhancers - - Stimulants - Non Stimulants for ADHD - Dementia Agents Pharmacodynamics - - Drus effect on the body Pharmacokinetics - - Body's effect on the drug 1. Pharmacokinetics: Absorption - - In stomach or small intestine - First Pass Effect - Bioavailability - Organ Specific Barriers (Blood Brain Barrier) First Pass Effect - - Metabolism of drug before it reaches the bloodstream Bioavailability - - Amount of drug reaching bloodstream 2. Pharmacokinetics: Distribution - - Two Phase Distribution - Equilibrium - Protein-Bound vs. Free Two Phase Distribution - - Organs with rich supply of blood flow - Areas with less extensive circulation (reservoirs, fat) Equilibrium - - Flow of drug between compartments is stable Protein Bound vs. Free - - Unbound molecules (ACTIVE) can cross cell membranes - Bound molecules (INACTIVE) 3. Pharmacokinetics: Biotransformation - - Transforming into compounds that are easily excreted by the kidney - Metabolites - Cytochrome P450 System - Drug/Drug Interactions Metabolites - - Chemical by products of biotransformation (Active vs. Inactive) Cytochrome P450 System - - Hepatic enzymes responsible for biotransformation - Inducers and Inhibitors Drug/Drug Interactions: Inhibitors - - Enzyme DECREASED - Result: More medication, Less metabolite Drug/Drug Interactions: Inducers - - Enzyme: INCREASED - Result: Less medication, More metabolite - SMOKING 4. Pharmacokinetics: Excretion - - Kidneys, Sweat, Saliva Half life - - Time required to reduce concentration by 50% Steady State - - Amount in = Amount out (4-5 lives) Serum Levels - - Trough levels (minimum) Therapeutic Index - - Toxic dose vs. Effective dose - Drugs with HIGHER TI are safer in excess/overdose Pharmacological Effects - - Desired Effects - Every morning/Night QHS - - Bed time XL - - Extended Release SR - - Sustained Release BID - - Twice Daily TID - - Thrice Daily QID - - Four times daily Q1HR - - Every 1 hr On which neurotransmitter do benzos anxiolytics and alcohol work to provide their principal effects? - - GABA Which organ system is responsible for the First Pass Effect? - - Liver In what routes of administration are medications subjected to first pass effects? - - PO Depression - - More than 2 Weeks - SIGECAPS (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide) MDD - - SIGECAPS + Distress - More than 2 weeks PDD (Dysthymia) - - 2 Years, no lapse greater than 2 months - ACHEWS (Appetite, Concentration, Hopelessness, Energy, Worthlessness, Sleep) Premenstrual Dysphoric Disorder - - Only during period Substance/Medication Induced Depression - - during or shortly after use or withdrawal - depression or anhedonia Mixed Features - - Mania Neuroanatomy in Depression - - Limbic System: Hippocampus Amygdala Hypothalamus - Prefrontal Cortex - Striatum/Basal Ganglia 5-HT in Depression - - regulation of mood, hunger, sleep, impulsivity, sexual fx NE in Depression - - regulation of mood, energy, interest, attention and pain DA in Depression - - regulation of mood, motivation, drive, pleasure/reward Hypothalamic-Pituitary Adrenal Axis - - HPA hyperactivity in severe Depression Psychotherapy Options - - CBT, Interpersonal, Motivational, Psychodynamic Medication Options - - SSRI - SNRI - TCA - NaSSA - NDRI - SARI - MAOI 5. Other therapies (ECT/Light therapy) Augmentation - - Lithium - Thyroxine - Atypical Antipsychotics - Stimulants - Dopamine Agonists Amygdala in Anxiety - - Assigns emotional valence - Alarm System - Removing amygdala --> lower anxiety Prefrontal Cortex in Anxiety - - Enables restored sense of control Medial Prefrontal - - Applies brakes to amygdala - Lights up when fear is evoked Chronic Anxiety - - Increased dendritic branching on amygdala - Reduced dendritic branching on mPFC in anxious people GABA in Anxiety - - Inhibitory NT - Decreased cellular excitability Serotonin in Anxiety - - Decreased 5-HT disinhibits LC signaling - More 5-HT --> Less NE --> Less Anxiety NE in Anxiety - Activates Hypothalamic Pituaitary Adrenal Axis --> Produces sympathetic response First Line Treatment for Anxiety - SSRI : BEST SNRI: 2nd BEST Exacerbating (Worsening) Agents - - Bupropion - Stimulant - Thyroid Supplementation Buproprion in Anxiety - - less effective - modest: social anxiety/PTSD Mirtazapine in Anxiety - - limited experience with anxiety - Nocturnal Anxiety Trazodone in Anxiety - - drowsy - less effective for panic disorder - Nocturnal anxiety Non Benzos - - Buspirone: (GAD) - Beta Blockers: (GAD/Specific Phobia) - Anticonvulsants (Panic disoder/PTSD) Benzo commonly used with SSRI when - - prominent anticipatory anxiety - phobic avoidance - initial treatment phase GAD - - Excessive worry - more days than not for 6 months - Restlessness - Fatigue - Concentration - Irritability - Muscle Tension - Sleep Disturbance Treatment of GAD - - SSRI - Buspirone - Benzo (short time) - Beta Blocker - Antihistamine Panic Disorder - - SSRI