1
Q
What are the three pathological changes that may occur with neurogenic disorders?
A
- Angulated (see pic) atrophic muscle fibers – denotes mild disease
- Group atrophy (groups of atrophic muscle fibers – see pic) – severe disease
- Fiber type grouping (groups of same fiber types – see pic) in chronic stage
- Different colors denote different fiber types
2
Q
What type of pathological change is this?
A
Angulated (see pic) atrophic muscle fibers
3
Q
What type of pathological change is this?
A
Group atrophy
4
Q
What type of pathological change is this?
A
Fiber type grouping (groups of same fiber types)
5
Q
What are the 5 pathological changes with myopathic disorders? Be able to recognize each one and provide characteristics
A
- Inflammation (lymphocytes, plasma cells) may be present (for example in inflammatory myopathy and some dystrophies) – see pic
- Increased variability in fiber size (round atrophic fibers and hypertrophic fibers of varying diameter) – see pic (perifascicular atrophy → dermatomyositis)
- Degeneration and regeneration (basophilia) of muscle fibers
- Macrophage infiltrate and removal of muscle fibers (myophagocytosis)
- Replacement of removed muscle fibers with adipose and connective tissue (see pic – Duchenne’s Muscular Dystrophy)
6
Q
What myopathic change is this?
A
- Inflammation (lymphocytes, plasma cells) may be present (for example in inflammatory myopathy and some dystrophies) – see pic
7
Q
What myopathic change is this?
A
Perifasicular atrophy
8
Q
What myopathic change is this?
A
- Replacement of removed muscle fibers with adipose and connective tissue (see pic – Duchenne’s Muscular Dystrophy)
9
Q
What are the clinical and pathological findings with axonal neuropathy
A
- Axonal:
- Common
- Lesions - distal>proximal
- Mild or no slowing of NCV, normal F-wave
- Denervation change in muscle (EMG, histology) in acute and chronic forms
- When treated, recovery is slow and often incomplete
10
Q
What are the clinical and pathological findings with demyelinating? neuropathy
A
- Demyelinating:
- Uncommon
- Lesions – proximal>distal in acute forms (e.g. AIDP)
- Marked slowing of NCV, reduced F-wave in acute forms
- Denervation change in muscle and onion bulbs/large nerves in chronic forms (e.g. some hereditary forms) – see pic
- When treated, recovery is rapid and complete or with minor residual deficits in most acute forms, but not in chronic forms or acute forms with significant axonal damage.
11
Q
What is this characteristic of?
A
Demyelinating neuropathy -
- Denervation change in muscle and onion bulbs/large nerves in chronic forms (e.g. some hereditary forms) – see pic
12
Q
LIST the components of a mental status exam?
A
Appearance, behavior/attitude, speech, mood/affect, thought process, thought content, perception, cognition, insight/judgement
13
Q
What part of the mental status exam is the following:
- Habitus, grooming, dress, hygiene, clothing, facial expression, stated age
A
Appearance
14
Q
What goes in the behavior/attitude portion of the mental status exam?
A
- Behavior/Attitude
- Note whether patient is cooperative, guarding, or suspicious
- Note patient’s eye contact, posturing (relaxed or tense), and psychomotor activity
- Psychomotor activity: orobuccal movements (tardive dyskinesia), wavy flexibility (catatonia), tics, mannerisms
15
Q
What goes in the speech part of a mental status exam?
A
- Speech
- Note quantity (talkative or mute), quality (spontaneous or latent), rate (slow or pressured), rhythm/prosody, volume/tone (loud or monotone), aphasia/dysarthria
- Pressured speech
- Latency
- Clang association
- Note quantity (talkative or mute), quality (spontaneous or latent), rate (slow or pressured), rhythm/prosody, volume/tone (loud or monotone), aphasia/dysarthria
16
Q
Define the following
- Pressured speech
- Latency
- Clang association
- Prosody
A
- Pressured speech: accelerated space
- Latency: increased time between speech
- Clang association: using rhyming words that mean nonsense (i.e. flippy flap)
- Prosody: emphasis on different syllables changing meaning
17
Q
What goes in the mood and affect part of the mental status exam?
A
- Mood & Affect
- Mood (subjective): patient’s self-reported emotional attitude
- Can be neutral, euphoric, depressed, anxious, or irritable
- Affect (objective): inferred from emotional responses that are usually triggered by some stimulus
- Full
- Flat
- Blunted/constricted
- Reactive
- Expansive
- Labile
- Mood (subjective): patient’s self-reported emotional attitude
18
Q
Define each of these affects
- Full
- Flat
- Blunted/constricted
- Reactive
- Expansive
- Labile
A
- Full (wide range of emotional expression)
- Flat (no emotion at all – associated with psychotic process)
- Blunted/constricted (low emotion, but little)
- Reactive (normal)
- Expansive (super happy)
- Labile (changing emotion)
19
Q
What words describes thought process?
A
- Flight of ideas
- Loosening of associations
- Tangentiality
- Circumstantiality
- Thought block
- Neologisms
- linear/goal-directed
20
Q
Define the following
- Flight of ideas
- Loosening of associations
- Tangentiality
- Circumstantiality
- Thought block
- Neologisms
- linear/goal-directed
A
- Flight of ideas (little association – maybe one word)
- Loosening of associations (no association at all)
- Tangentiality (changing subject)
- Circumstantiality (beating around bush)
- Thought block (thinking for a long time)
- Neologisms (made-up words), linear/goal-directed (normal)
21
Q
What goes in a thought content exam?
A
- Thought Content (includes risk assessment)
- Suicidality (w/ intent and plan is worse), homicidal ideations, perceptual abnormalities, delusions (see below)
- Control
- Erotomaniac
- Grandiose
- Somatic
- Persecutory
- Suicidality (w/ intent and plan is worse), homicidal ideations, perceptual abnormalities, delusions (see below)
22
Q
What are these? Define each.
- Control
- Erotomaniac
- Grandiose
- Somatic
- Persecutory
A
Delusions
- Control (external force controlling thoughts)
- Erotomaniac (unrecruited love)
- Grandiose (thinking highly of oneself)
- Somatic (body is abnormal)
- Persecutory (someone is after you)
23
Q
What goes in the perception part of the MSE?
A
- Illusions
- Hallucinations
- Auditory/visual , tactile, olfactory
- Hypnagogic, hypnopompic
24
Q
Define the following:
- Illusions
- Hallucinations
- Auditory/visual , tactile, olfactory (what do you get each of these with??)
- Hypnagogic, hypnopompic
A
- Illusions (visual misperception of an existing object – i.e rope=snake)
- Hallucinations (visual misperception of nothing – i.e. nothing=snake)
- Auditory/visual (thought disorders), tactile (substance use), olfactory (seizures)
- Hypnagogic (hallucinations before sleep), hypnopompic (hallucinations at waking) – related to sleep
25
What goes in a cognition part of the MSE?
* Cognition
* Assessed via the mini-mental status exam (MMSE – out of 30) or the Montreal Cognitive Assessment (MoCA)
* Orientation
* Memory:
* Very short-term:
* Short-term:
* Long-term:
* General information
* Calculation
* Capacity to read/write
* Visual spatial ability
* Attention
* Abstraction
26
* How are the following things assessed?
* Orientation
* Memory:
* Very short-term:
* Short-term:
* Long-term:
* General information
* Calculation
* Capacity to read/write
* Visual spatial ability
* Attention
* Abstraction
* Cognition
* Assessed via the mini-mental status exam (MMSE – out of 30) or the Montreal Cognitive Assessment (MoCA)
* Orientation: assess orientation to time, person, and place
* Memory:
* Very short-term: repeat list of items immediately
* Short-term: repeat list of items within 3-5 minutes
* Long-term: recall events over last days/months/years
* General information: assess patient’s ability to recall info from history or current events
* Calculation: subtract from 7 starting from 100
* Capacity to read/write: assess ability to read/write a word/sentence
* Visual spatial ability: ability to draw a full, correct clock
* Attention: spelling words backwards
* Abstraction: assess patient’s ability to think abstractly (i.e. how are an orange and an apple alike?)
27
Define insight and judgement
* Insight/Judgement
* Insight (awareness of illness), judgement (capability for appropriate actions)
28
# Define the following terms
* Psychosis
* Delusion
* Bizarre delusions
* Non-bizarre delusions
* Hallucination (what conditions are these common in???)
* Visual, auditory , olfactory, gustatory, tactile
* Disorganized speech
* Disorganized behavior
* Psychosis: inability to distinguish reality from fantasy
* Delusion: false belief not consistent with patient’s intelligence and cultural background
* Bizarre delusions: delusions that are not possible in real life (i.e martians)
* Non-bizarre delusions: belief that could be true, but is not (i.e. spying neighbor)
* Hallucination: false sensory perceptions not associated with real external stimuli
* Visual (medical \> psychiatric), auditory (psychiatric \> medical), olfactory (epilepsy/brain tumors – smell burning rubber), gustatory (epilepsy), tactile (alcohol withdrawal and stimulant use – cocaine crawlies)
* Disorganized speech: disorganized thoughts (tangential speech to nonsensical speech)
* Disorganized behavior: inappropriate behavior with unclear motivation (i.e. multiple coats on a warm day)
29
# Define the following
* Catatonic behavior
* Impaired functioning
* Negative symptoms
* Positive symptoms
* Catatonic behavior: extreme levels of motor activity (increased or decreased)
* Impaired functioning: inability to perform normal activities (failing at school or work)
* Negative symptoms: blunted affect, anhedonia, apathy, alogia (lack of speech), lack of interest and socialization
* Positive symptoms: hallucinations, delusions, disordered speech, bizarre behavior
30
What is criteria A?
* Criteria “A”: delusions, hallucinations, disorganized speech, disorganized behavior, negative sx (2 of these)
* Delusions or hallucinations alone are adequate for dx
31
For Schizophrenia
* Duration
* Criteria?
* Not secondary to?
* Phases
* Schizophrenia:
* Duration: \> 6 months (active sx for 1 month)
* Criteria “A” must be followed
* Not secondary to medical condition, substance use, mood, or schizoaffective disorder
* Phases of schizophrenia
* Prodrome: decline in function that precedes first psychotic episode
* Psychotic (active): perceptual disturbances, delusions, or disordered thought
* Residual: occurs between episodes of psychosis marked by negative sx including flat affect (hallucinations may occur)
32
For Schizophrenifomr disorder
* Duration
* Criteria?
* Not secondary to?
* Schizophreniform disorder
* Duration: 1 – 6 months (only difference from schizophrenia)
* Criteria “A” must be followed
* Not secondary to medical condition, substance use, mood, or schizoaffective disorder
33
For schizoaffective disorder:
* Duration
* Criteria?
* Schizoaffective disorder
* Criteria:
* Meets criteria for major depressive disorder (MDD), manic, or mixed episode and _concurrently_ meets criteria for schizophrenia
* Delusions or hallucinations for 2 weeks in absence of mood disorder (above disorders) sx
* Have mood sx present for substantial portion of psychotic illness
34
For brief psychotic disorder:
* Duration
* Criteria?
* Not secondary to?
* Trigger
* Prognosis
* Brief psychotic disorder
* Duration: 1 day to 1 month
* Criteria “A” must be followed
* Not secondary to medical condition, substance use, mood, or schizoaffective disorder
* Trigger: stress (bereavement, sexual assault, etc)
* Prognosis: will return to baseline functioning usually
35
For Unspecified Schizophrenia Spectrum Disorder/Psychotic Disorder
disorder
* Criteria?
* Duration
* Unspecified Schizophrenia Spectrum Disorder/Psychotic Disorder
* Criteria
* Duration or symptom criteria are not met
* Post-partum psychosis
* Inability to determine of primary due to GMC or substance use
36
For delusional disorder
* Criteria?
* Duration
* Delusional disorder
* Criteria
* Non-bizarre fixed delusions for at least 1 month
* Schizophrenia Criteria “A” not met
* No functioning impairment
37
Differentiate between psychotic sx and psychotic disorder?
* Psychotic symptoms do not mean you have a psychotic disorder (i.e. delirium)
* Psychotic disorder does not mean you have schizophrenia (i.e. delusional disorder)
38
What is the epidemiology of schizophrenia?
* 1% of population, equal in men (ages 18-25) and women (ages 25-46)
* Modes increase in children born in spring and early winter
39
What is the etiology of schizophrenia (genetics, structural, imaging?)
* Etiology
* Genetics
* Some form of inheritance, commonly linked to chromosome 6 and 8 à pruning of dendrites
* 50% penetrance in monozygotic twins
* Structural abnormalities: reduced volume (prefrontal cortex, thalamus, hippocampus, STG), increased volume (lateral/third ventricles, and basal ganglia)
* Brain imaging: PET/SPECT show decreased frontal lobe flow; ventriculomegaly; decreased total gray matter volume
40
What are the altered dopaminergic pathways in schizophrenia? What happens when these are blocked?
* Altered dopaminergic pathways (blockage)
* Mesolimbic system: increases motor activity → positive symptoms
* Mesocortical: decreases motor activity → negative symptoms
* Nigrostriatal pathway: decreases motor activity → extrapyramidal symptoms
* Tuberoinfundibular: decreases motor activity → increases prolactin → decreases libido → sexual dysfunction, galactorrhea, gynecomastia
41
What is the involvement of dopaminergic pathways in schizophrenia?
* Involvement in Schizophrenia and Tx
* Mesolimbic system and mesocortical pathways are dysfunctional → Schizophrenia
* Nigrostriatal pathway and tuberoinfundibular pathways are modulated in treatment
42
General pathophys of psychotic disorders
* Pathophysiology of psychotic disorders
* Bottom line: increased dopamine → increased psychosis
* Serotonin and glutamate can increase or decrease dopamine
* Serotonin also directly has effects on glutamate
43
Non-phamacological tx for psychosis
* CBT, different types of therapy, family education, case workers, vocational training, etc
44
For typical antipscyhotics (1st gen)
* What do they typically end with?
* Basic MOA (secondary actions too)
* Storage
**Typical Antipsychotics (-azine)**
* MOA: block D2 receptor and secondary M1/H1/alpha-1 blockade
* Storage: body fats (lipid soluble) – slowed to be removed
45
What typical antipsychotics have a high potency? Low potency?
* Potency:
* High (Effects: EPS): trifluoperazine, fluphenazine, haloperidol (Try 2 Fly High)
* Low (Effect: anticholinergic/antihistamine/anti-alpha): chlorpromazine, thioridazine
46
What are EPS sx of typical antipyschotics? Define based on onset and provide treatments for each!
* D2 blockade: EPS, endocrine changes, sexual dysfunction
* EPS
* **Hours to days: Dystonic reactions**
* Description: uncoordinated spastic movements of muscle groups (i.e. trunk, tongue, face)
* Tx: benztropine
* **Days to months: Akathisia, Parkinsonism**
* Akathisia: extreme restlessness and pacing; may lead to insomnia
* Tx: beta blockers
* Parkinsonism: tremors of extremities
* Tx: Oral antiparkinsonian drugs
* **Months to years: Tardive dyskinesia**
* Description: involuntary and potentially irreversible movements around oral area
* Dx: Abnormal Involuntary Movement Scale (AIMS)
* Tx: benztropine; change dosage of meds
47
What is a syndrome that can occur with D2 blockade with typical antipscyhotics? Explain signs and sx (mnemonic). Provide treatment!
* Neuroleptic malignant syndrome (life-threatening)
* Signs/sx (Malignant FEVER): Myoglobinuria (breakdown of muscles from movement), Fever, Encephalopathy, Vitals unstable, Enzymes increased, Rigidity of muscles
* Tx: discontinuation of antipsychotic, Dopamine agonists (bromocriptine/dantrolene)
48
Provide other SE of tpyical anti-pscyhotics based on the receptors the meds block. Provide other SE
* H1 blockade: sedation, drowsiness, weight gain, hypotension
* Alpha-1 blockade: postural hypotension, reflex tachycardia, dizziness
* M1 blockade: blurred vision, dry mouth, sinus tachycardia, constipation, urinary retention, memory dysfunction
* Other: corneal deposits (chlorpromazine), retinal deposits (thioridazine), QT prolongation
49
For atypical antipscyhotics/second-gen
* What do the names end with?
* MOA?
**Atypical Antipsychotics/Second-Generation (-apine, -peridone, -idone)**
* MOA: post-synaptic blockade of D2 receptor and secondary 5HT-2A blockade
* Equal efficacy as first-generation; less side effects
50
What is a special type of atypical antispsyhcotic? What is its MOA?
* \*\*Aripiprazole: partial D2 agonist
* Hyperdopaminergic areas (mesolimbic area) → antagonist →+ sx
* Hypodopaminergic areas (mesocortical area) → agonist → - sx
51
What are the side effects of atypical antipsychotics? General benefits? General SE?
* Benefits: rare EPS, rare increase in prolactin, reduced negative sx
* Side effects: prolonged QT
52
For the following atypical antipsychotics provide SE:
* -Apines
* Clozapine
* Risperidone
* Olanzapine
* Ziprasidone
* Quetiapine
* -Apines: Metabolic syndrome
* Clozapine: agranulocytosis, seizures, reduced risk of suicide, must monitor CBC
* Risperidone: increased prolactin (only second gen), less weight gain
* Olanzapine: weight gain
* Ziprasidone: prolongs QT interval, dizziness, somnolence
* Quetiapine: lenticular opacities, HA, increased AST
53
Epidemiology of depression?
* Epidemiology: Females, ages 18-25, multiracial, medical students
54
Criteria of major depressive disorder (mnemonic)
* Criteria (SMIGECAPS):
* 5/9 symptoms below, 2 weeks period,
* Sleep changes, Mood depressed, Interest lost (anhedonia), Guilt/worthlessness, Energy decreased, Concentration diminished, Appetite change, Psychomotor agitation/retardation, Suicidal ideations
* 1 of these must be loss of interest or depressed mood
* Not due to substance abuse/medical condition, but have social/occupational impairment; No hx of manic or hypomanic episodes
55
For major depressive disorder, list the different specifiers
Seasonal pattern, atypical, melancholic, peripartum, catatonic features
56
# Define the following MDD specifiers
Seasonal pattern, atypical, melancholic, peripartum, catatonic features
* Seasonal pattern: temporal association between episodes and time of year
* Atypical features: mood reactivity (actually laughs at joke), weight gain, hypersomnia, leaden paralysis (heavy feeling in arms/legs), rejection sensitivity
* Melancholic features: loss of pleasure (worse in morning), anorexia
* Psychotic features: delusions, hallucinations
* Peripartum onset: onset during pregnancy or within 4 weeks postpartum
* Different from postpartum blues:
* Characterized by: depressed affect, tearfulness, fatigue, resolves 10 days postpartum
* Catatonic features: catalepsy (posture held against gravity), wavy flexibility, stupor, agitation, mutism, negativism (opposes instructions), posturing, mannerisms, stereotypies (repetitive non-goal directed movements), grimacing, echolalia (mimics speech), echopraxia (mimics movements)
57
For persistent depressive disorder (Dysthymic Disorder)
* Criteria?
* What is the period of no sx allowed?
* Duration?
* Cannot meet which criteria?
**Persistent Depressive Disorder (Dysthymic Disorder)**
* Criteria:
* Depressed mood most days for at least 2 years (1 year in children)
* 2 of the following:
* Poor appetite, insomnia/hypersomnia, low energy/fatigue, poor self-esteem, decreased concentration/difficulty making decisions, hopelessness
* Cannot have lack of symptoms \> 2 months
* Mild depression with no discrete episodes (major depressive episode)
* No manic/hypomanic/cyclothymic criteria met; not due to psychosis, substance use, or medical condition
* Bottom line: 2 D’s → 2 years of depression → 2 sx → never asymptomatic \> 2 months
58
For premenstrual dysphoric disorder
* Different from what?
* Criteria?
* Duration?
**Premenstrual Dysphoric Disorder**
* Different from PMS (general irritability)
* 5 symptoms (at least 1 from each category below) in final week leading up to menses → improve during/after menses
* * Affective lability, irritability/anger/conflict, depressed mood/hopelessness, anxiety/tension/on edge
* Decreased interest, difficulty concentrating, lethargy/fatigue, appetite change, insomnia/hypersomnia, feeling overwhelmed, physical sx (pain, bloating, weight gain)
59
For disruptive mood dysregulatioj
* Age at dx?
* Criteria?
* Duration?
* Not due to what?
**Disruptive Mood Dysregulation**
* Criteria: severe recurrent temper outbursts (out of proportion) of verbal or physical aggression; \> 3 times a week; persistently irritable in between outbursts
* Diagnosed initially between age 6-18 y/o
* No mania with elevated mood for \>1 day
* Not due to substance, medical or neurological condition
60
For grief/bereavement
* 5 stages of grief?
* What may the patient experience?
* Duration?
* How is it different from depression\>
**Grief/Bereavement**
* 5 stages of grief (Kubler-Ross): denial, anger, bargaining, depression, acceptance
* May experience hallucinations, positive emotions, emptiness
* Duration: less than 1 year; sx less than 2 months
* Different from depression:
* No suicidal thoughts, sx less than 2 months, inability to have pleasure
61
For Adjustment Disorder with Depressed Mood
* Trigger?
* Criteria
* Sx are not that of?
* Resolution time
**Adjustment Disorder with Depressed Mood**
* Maladaptive/emotional behavior develops after a stressful life event (job loss etc)
* Criteria:
* Development of behavior/emotional sx within 3 months after event and sx produce:
* Excessive distress OR significant impairment in function
* Sx are not that of bereavement
* Sx resolve within 5 months of removal of stressor
62
What do biological amines have to do with depression?
Provide rate limiting steps of specific NTs. Which monoamines may be deficient?
* Biogenic amines (monoamine hypothesis)
* Deficiency of monoamines (tryptophan → serotonin, Norepi, dopamine)
* Tryptophan converts Kynurenine during depression
* Tyrosine hydroxylase (Norepi) and Tryptophan hydroxylase (serotonin) are the rate limiting steps in monoamine synthesis
63
What neuroanatomical structures are affected in depression?
* Neuroanatomical structures: PFC, amygdala, hippocampus (show volume reduction on MRI; decreased dorsolateral PFC activity)
64
How does congitive theory work in depression
* Cognitive theory:
* Cognitive triad: negative view of self, world, and the future
* Cycle: Emotion/core belief (“I am useless”) → Biased/overgeneralized Negative Thought (“No one cares”) → Negative Action (not going to work)
65
How does depression and antidepressants affect sleep?
**Depression and Sleep**
* Depression: increased REM, decreased slow-wave sleep (shortened REM latency, prolonged first REM period, increased REM density)
* Anti-depression: reduced REM, increased slow-wave sleep (increased REM latency)
66
What are the forms of depression treatment? list all.
**Depression Treatment**
* Psychotherapy/cognitive behavioral therapy: mild depression
* Challenge negative thoughts and negative actions
* Antidepressants – moderate to severe
* Electro-convulsive therapy (ECT): Highest rates of response
* A/E: Cognitive impairment, memory problems mostly resolve
* Transcranial magnetic stimulation (TMS): Use of magnetic field to bring about depolarization (SE: seizures)
* Deep Brain Stimulation (DBS): Subgenual cingulate cortex; limited evidence
* Vagal Nerve Stimulation
* Phototherapy – seasonal pattern
67
* For SSRI
* MOA
* General SE:
* Selective Serotonin Reuptake Inhibitors (SSRIs)
* MOA: inhibits serotonin reuptake by serotonin transporters → increased serotonin in terminal
* SE (fewer than TCAs): GI distress, SIADH, sexual dysfunction, suicidal thoughts (not contraindication)
68
What two syndromes can you get with SSRIs? What are their etiologies and sx?
* Serotonin Syndrome
* Etiology: Due to excess serotonin secondary to SSRIs, stoppage of MAOI, combos of sertotnergic drugs (i.e. Tramadol, linezolid)
* Signs/sx: AMS, GI sx, diaphoresis, myoclonus/hyperreflexia
* Discontinuation Syndrome
* Suspect after: use of short-life drug (i.e. Paroxetine)
* Sx: dizziness, HA, N/V, anxiety, paresthesias
69
What drugs are known for P450 reactions? What effect does this have?
* P450 reactions: fluoxetine, fluvoxamine paroxetine (less metabolism of drugs like Tamoxifen, TCAs, etc)
70
What drugs are indicated for the following
* OCD
* Long half life
* QTC
* Short half life
* Less interactions
* Indications
* OCD: Fluvoxamine, Sertraline
* Longest half-life: Fluoxetine (if non-compliant pt)
* QTC prolongation: citalopram
* Short half-life: Fluvoxamine, paroxetine
* Less interactions: Citalopram
71
For Selective Norepinephrine Reuptake Inhibitors (SNRI):
* MOA
* SE
* Drug names (3)
* Selective Norepinephrine Reuptake Inhibitors (SNRI)
* MOA: inhibits serotonin and norepinephrine reuptake by serotonin transporters → increased serotonin and norepinephrine in terminal
* SE: HTN
* Drugs: Venlafaxine, Duloxetine (used for pain), Desvenlafaxine
72
For tricylcics:
* MOA
* SE
* Secondary amines vs tertiary amines
* Toxicity
* Tricyclics (TCAs)
* MOA: inhibits 5-HT and NE reuptake in CNS
* SE: anticholinergic effects, antihistaminergic effects (sedation), alpha blockage (hypotension)
* Secondary amines (Nortriptyline, Desipramine, Maprotiline) have less of these side effects than Tertiary amines (Imipramine, Amitriptyline)
* Toxicity: cardiac arrhythmias/convulsions/coma (3 Cs) secondary to Na blockade, wide QRS (administer bicarb)
73
For monoamine oxidase inhibitor (MAOIs)
* MOA (A & B)
* Drugs (based on selectivity)
* SE
* Monoamine Oxidase Inhibitors (MAOIs)
* MOA: Inhibits monoamine oxidase located on mitochondria → increases [NT]
* MAO A: metabolizes Serotonin, NE, Epi
* MAO A&B: metabolizes Dopamine, Tyramine
* Drugs:
* Irreversible, non-selective: Phenelzine, Tranylcypromine
* Irreversible, MAO-B selective: Selegiline
* SE: CNS stimulation, hypertensive crisis w/ ingestions of tyramine (a.a. in wine, cheese, and preserved meats)
74
What is the MOA, SE, and use (if applicable) for the following drugs:
* Bupropion
* Mirtazapine
* Trazodone
* Nefazodone
* Atypical antidepressants
* Bupropion
* MOA: inhibits reuptake of NE and dopamine
* SE: seizures (people w/ eating disorders), tachycardia, insomnia
* Uses: smoking cessation, sexual dysfunction
* Mirtazapine
* MOA: alpha-2 antagonist → increase release of NE and 5HT
* Blocks 5HT2/3 and H1 receptors
* SE: sedation, increased appetite/weight gain, dry mouth
* Trazodone
* MOA: blocks 5HT2, alpha1, and H1 receptors and inhibits 5HT reuptake
* SE: sedation, priapism (traZZZobone)
* Uses: insomnia
* Nefazodone
* MOA: blocks 5HT2, alpha1, and H1 receptors and inhibits 5HT reuptake
* SE: hepatotoxicity
75
What is the MOA, SE, and use (if applicable) for the following drugs:
* Varenicline
* Vilazodone
* Vortioxetine
* Varenicline
* MOA: nicotinic Ach agonist
* SE: sleep disturbance, depress mood
* Uses: smoking cessation
* Vilazodone
* MOA: inhibits 5HT reuptake + 5HT1A agonist
* SE: HA, GI issues, weight gain, anticholinergic effects
* Vortioxetine
* MOA: inhibits 5HT reuptake + 5HT1A agonist
* SE: nausea, sexual dysfunction, abnormal dreams, anticholinergic effects
