NURS 660 Psychopharmacology Exam 1 Review 2023

NURS 660 Psychopharmacology Exam 1 Review 2023. Know the positive and negative symptoms of schizophrenia, where they originate from, and what medications treat these symptoms. Positive symptoms:  psychosis, hallucinations, delusions  Mesolimbic origin  Medications: D2 antagonists Negative symptoms:  more related to mood disturbance, apathy, anhedonia, neuroleptic dysphoria, cognitive blunting  Mesocortical/prefrontal cortex, nucleus accumbens, reward circuit origins  Medications: None FDA indicated. Least likely to help are first generations r/t lack of 5HT2A action. Cognitive symptoms:  Attention issues, learning, problem solving, modulating behavior based on social cues, verbal fluency  Dorsolateral prefrontal cortex origin  Medications: 2. Identify the emerging neurobiological hypothesis of schizophrenia. Dopamine Hypothesis:  Hyperactivity of dopamine in mesolimbic pathway;  Mesocortical pathway hypoactivity of dopamine Glutamate Hypothesis:  NMDA receptor hypofunction/dysconnectivity on GABA interneuron o NMDA receptor needs glycine and glutamate  Possible issue with neurodevelopment/degeneration  Glutamate hypothesis leads to downstream overactivity of dopamine in mesolimbic, underactive mesocortical Serotonin Hypothesis  Serotonin hyperfunction o Hallucinogen psychosis o Parkinson’s Psychosis = over-production of 5HT2A receptors o Psychosis in dementia = over-excitation/unclear-inhibition  5HT2A receptor hyperfunction in cortex o Agonism of 5HT2A, some 5HT2C o Visual hallucinations, mystical delusions, insightfulness  Serotonin production o Tryptophan transporter  Serotonin destroyed via MAO enzyme  Neurodegeneration process that destroys GABA interneurons creating imbalance between serotonin and BABA neurotransmission at glutamate neurons in cerebral cortex o May lead to excessive activation of glutamate neurons via 5HT binding at 5HT2A receptors  5HT2a receptors are targets for drugs to treat psychosis in Parkinson’s and dementia 3. Identify the different dopamine pathways and what role each pathway plays in relation to schizophrenia/psychosis and treatment. Dopaminergic Pathways  Mesolimbic – (Ventral tegmental area to nucleus accumbens) – overactive, too much dopamine activation of dopaminergic neurons = positive symptoms  Mesocortical – (VTA to Cortex) – underactive dopamine from VTA to cortex = negative symptoms  Nigrostriatal – [substantia nigra to striatum (including caudate + putamen)] – decreased dopamine causes drug-induced Parkinsonism, EPS  Tuberoinfundibular – (dopaminergic neurons to hypothalamus inhibits prolactin release from pituitary gland) – decreased dopamine disinhibits the hypothalamus causing increased prolactin resulting in galactorrhea and amenorrhea (decrease FSH) 4. Identify potential medical emergencies associated with antipsychotic medications and how to manage these emergencies.