HPA Axis
Fear triggers the amygdala that activates the sympathetic nervous system and the Blank.
What is the hypothalamic pituitary adrenal axis (HPA Axis). Board Vitals PMHNP Review Questions
This blank enzyme system mediates how the body metabolizes many drugs, including antipsychotics.
What is the Cytochrome P450. Stahl p. 47
Cytochrome P450 1A2 enzyme can be induced, or increased in activity, by what legal substance? Often requiring a higher antipsychotic drug dose outpatient then what they would need inpatient.
What is Cigarettes. Stahl p. 48.
Excitatory neurotransmitter that is being implicated more and more in schizophrenia. In excess, may be responsible for kindling and apoptosis.
Glutamate
All antagonize H1 receptors. Often used to treat movement disorders associated with neuroleptics. Also used for sleep and anxiety.
Antihistamines
"One sick _______ in a neuronal circuit can affect the whole circuit, from the GABA interneuron and the glutamate neurons it innervates, to downstream dopamine neurons and beyond."
What is a synapse?
This can be the outcome when an exogenous substance is introduced to the mesolimbic dopamine pathway.
What is addiction?
Blocking the action of the natural neurotransmitter agonist. The substance is by itself inactive.
What is an antagonist?
Antacids reduce bioavailability of this anticonvulsant/CNS depressant
What is gabapentin (Neurotin)?
The HPA axis releases Blank, activating secretion of Blank, causing secretion of cortisol.
What is the Corticotropin releasing factor (CRF) and Adrenocorticotropic hormone (ACTH). Board Vitals PMHNP Review Questions
P450 enzyme pathways inhibited will raise or lower substrates (medications)?
What is raises. Stahl, p. 49.
This anticonvulsant/mood stabilizer’s induction and autoinduction by the hepatic enzyme CYP450 (3A4) pathway occurs in 2 to 3 weeks; slightly higher doses may be needed or tolerated at that time.
What is Carbamazepine p.962 Sadock & Sadock.
The brain releases this neurotransmitter during pleasurable activities. Too much is associated with schizophrenia. Too little is associate with depression, muscular rigidity and Parkinson's disease.
Dopamine
Dopamine and serotonin antagonist used to treat both positive & negative symptoms in schizophrenia. Associated with lower risk of EPS and higher risk of metabolic side effects.
Atypical, Second Generation Antipsychotics
I am the circuit considered to be the "final common pathway of reward."
What is the mesolimbic dopamine circuit?
These two pathways are considered as the cause of schizophrenic symptoms.
What are the dopamine pathways and the glutamate pathways?
These are found at opposite ends of the agonist spectrum
What are agonists and inverse agonists?
Drugs that should be given with caution when a patient is on lithium
What are NSAID's, ACEI's, and ARB's?
In situations of chronic stress, excessive blank release may eventually cause hippocampal atrophy. The hippocampus inhibits the HPA axis, atrophy in this region may lead to chronic activation of the HPA axis, likely increasing risk of developing psychiatric illnesses
What is Glucocorticoid/Cortisol Release. Stahl P. 272
Why do we and other animals have Cytochrome P450 metabolizing enzyme systems?
Original purpose was for metabolizing plants and the toxins the plants have produced to keep creatures from eating them. Dr. David Puder Psychiatry and Psychotherapy podcast
This Cytochrome enzyme pathway metabolizes several psychotropic drugs as well as several of the statins for treating high cholesterol. Potentially increasing risk of muscle damage and rhabdomyolysis.
What is CYP 3A4, Stahl p. 49.
Excitatory neurotransmitter that elevates mood, modulates attention and fatigue. Too much is linked to anxiety and hyperactivity. Too little is linked to depression, low energy, and fatigue.
Norepinephrine
Used to treat depression. Also used for anxiety disorders, PMDD, and eating disorders.
Selective Serotonin Reuptake Inhibitors (SSRIs)
This circuit can create fear and panic leading to phobias.
What is the amygdala-centered circuit?
There are 4 main circuits which are "out of tune." These include the ACC, dorsolateral PFC, the prefrontal motor cortex, and the orbital prefrontal cortex. I am the mental illness caused by abnormal firing in these areas.
What is ADHD?
This causes partially enhanced signal transduction
What is a partial agonist?
These herbal supplements can cause serotonin syndrome if taken with SSRI's
What are St. John's wort, ginseng, and nutmeg?
Neurons from what two areas of the brain normally suppress the hypothalamic-pituitary-adrenal axis?
What is the hippocampal area and amygdala. Stahl p. 268
P450 enzymes pathways induced by medications will raise or lower other substrates (medications)?
What is lower. Stahl, p. 50.
Fluvoxamine (SSRI, FDA approved for OCD) is an inhibitor for these two common Cytochrome P450 enzyme pathways (1A2, 2D6, 2C9, 2C19, or 3A4)?
What is 1A2 and 3A4 Stahl p48, 50.
Projections from this neurotransmitter affect mood, depression, movement, obsessions, compulsions, appetite, sleep, and sexual response. Too little is linked to depression. Too much can be potentially fatal.
Serotonin
Used to speed up the central nervous system to increase neural activity in the brain. Acts by increasing NE and DA in the prefrontal cortex. Balances tonic versus phasic firing. Used for ADHD and Narcolepsy. Used as an adjunct for depression, obesity, chronic fatigue.
Stimulants
Ascending serotonergic projections in the brain regulate these 3 things.
What are mood, anxiety, & sleep?
Underactivity of this system leads to negative, cognitive, and affective symptoms of schizophrenia.
What is the mesocortical dopamine system?
A conformational change in the G-protein linked receptor that turns on the synthesis of a second messenger to the greatest extent possible
What is the action of a full agonist?
Constipation caused by this atypical antipsychotic may cause reduced if administered at the same time as these
What is clozapine and: bulk laxatives, magnesium-based antacids, lactulose
While proper functioning of the HPA axis is essential for dealing with stress, when the HPA axis is stimulated too much it can lead to what physical and psychiatric problems?
What is Type 2 diabetes, obesity, CVS disease, anxiety, depression, mood disorders, and cognition. Stahl p. 269
Caffeine is an inducer of what Cytochrome P450 enzyme pathway?
What is CYP 1A2. Stahl p. 47
This anticonvulsant/mood stabilizer’s induction of the Cytochrome P450 3A4 pathway when added to patients previously stable on clozapine, iloperidone, lurasidone, or zotepine does what to their medication concentration? requiring a dose increase or decrease?
Carbamazepine, reduces them, increase, Stahl p. 49
This neurotransmitter is involved in voluntary movement, learning, memory & sleep. Too much is associated with depression. Too little has been associated with dementia.
Acetylcholine
Reduce inactivation of acetylcholine and potentiate neurotransmission. Indicated for mild to moderate Alzheimer's disease. Often combined with Memantine (Namenda).
Cholinesterase Inhibitors
This circuit is considered the "worry loop" and can lead to problems with anxiety/obsessions.
What is the cortico-striato-thalmo-cortico loop?
The neurotransmitters acetylcholine, histamine, and epinephrine are involved in _______ pathways that can influence _______ in mood disorders?
What are arousal pathways and cortical arousal?
This happens when neurotransmitter inactivation mechanisms are blocked by a drug
What is indirect full agonism?
These meds used to treat migraines can cause serotonin syndrome if combined with SSRI's
What are triptans- [sumatriptan (Imitrex), almotriptan, naratriptan (Amerge)], carbamazepine (Tegretol), and valproic acid (Depakene)