Glutamate
Glutamate is created from?
Glutamine
Glutamine is taken up by what transporter and converted back into glutamate.
SNAT
Specific Neutral amnio acid transporter
Name the pharmalogical class of drugs to treat psychosis.
Antipsychotics
Conv Antipsych cause massive d2 blockage which disrupts in which pathway
Reward pathway
making it hard for patients to experience pleasue
D2 blockage in the nigrostriatal pathway may also cause this fatal situation.
Neuroleptic Malignant Syndrome (NMS)
Glutamate binds to this receptor?
NMDA
Schizophrenia is caused by the _________ of glutamate actvity at the NMDA receptors.
HYPOfunctioning
Antipsychotics can also be used for
agitation/aggression
mood stability (atypical antipsychotics)
improve depression.
off label for sever anxiety
Conv Antipsch Blocks D2 = blocking in DA in the mesocortical pathway causes worsening _________
sxs?
worsening cognitve sx
Sx of Neuroleptic Malignant Syndrome (NMS)
muscle rigidity, fever, autonomic instability (increased HR, B/P, sweating), coma, and death
more common in MEN than women
What type of receptor is NMDA
ion gated receptor
When is glutamine not functioning what type of Schizophrenic Sxs does one experience?
positive and negative Sxs
2 classses of antipsychotics?
Conventional (typical or 1st generation
Atypical (2nd generation)
Chronic and prolonged D2 blockade in the nigrostriatal pathway caues?
Tardive Dyskinesia
Blocking D2 in the tuberoinfundibular pathways causes
elevated prolactin level
(d/t DA inhibits prolactin release)
Glutamate requires the presence of a _________ that must also be bound at the same time to the receptor to have its effect.
Co transmitter or another neuron
DA theory explains what type of Schizophrenia sxs
Positive Sx
The difference between the 2 classes of antipsychotics
Conventional older and have been around longer. Primarlay differ in side effect profiles.
Emergency situation caused by antipsychotics?
Hyperkinetic movement disorder & oralfacial disorder=emergency=Benadryl
may also cause choreiform movements.
when testing prolactin levels instruct pt to
test 1st thing in the am and minimize breast stimulation.(don't shower)
Name the cotransmitters required for glutamate to be effective.
Glycine or D- Serine
NMDA receptors not functioning mimics these street drugs?
PCP & Ketamine
Where do conventional antipsychotics do most of the blocking?
D2 receptors across DA tracks causing MORE side effects.
FDA approved medication to help Tardive dyskinesia
Valbenazine (Ingrezza)
Tx for NMS (5 steps)
1. take-off of medication
2. fluids
3. give dantrolene(dantrium) to relax musles
4. ECT may help
5. resume antipsychotic cautiously, wait as long as possible to restart