Memorable
Psychopharmacology / Stahls
Essential Psychopharm
,Pharmacodynamics - CORRECT ANSWERS--What the body does to the drug
-What the drug does to the body
Synapses
-Neurotransmitters are stored in vesicles prior to being released
-When pre-synaptic neuron is activated it releases neurotransmitters which diffuse
across the synapse to activate receptors.
-This depolarizes the post-synaptic neuron and causes it to "fire".
-The post-synaptic neuron then propagates a wave of depolarization, known as an
action potential, down to the next neuron and the process repeats.
- The Neurotransmitters in the synapse cannot simply remain there. They will
-diffuse away
- Get broken down by an enzyme
- Pumped back into pre-synaptic neuron for storage or use(known as reuptake) -
CORRECT ANSWERS-
Upregulation/Downregulation of post-synaptic neurons
The brain strives for homeostasis and will act to counterbalance any perceived excess. -
CORRECT ANSWERS-Post-synaptic neuron can make itself more sensitive to
stimulation by increasing the number of receptors available on their membranes
Or decrease sensitivity by decreasing the number of receptors on the membrane of the
post-synaptic neuron.
2 Rules of Neurotransmission
- What goes up must come down/ What goes down must come back up.
- With great power comes great responsibility. - CORRECT ANSWERS-- Someone on
excitatory drugs will often experience a low energy "crash" during withdrawal.
- Refers to the phenomenon where both efficacy and the adverse effects of any
particular drug are intrinsically linked. If a drug is powerful it is more likely to have
severe side effects. More power more potential for harm.
-It's always best to attempt treatment with the least powerful option that will still produce
good results.
Drug Effects
Full agonist:
Partial agonist:
,Antagonist:
Inverse Agonist: - CORRECT ANSWERS--Mimics the effect of a neurotransmitter
-Mimics it but only to a certain lower point
-Blocks the effect of a neurotransmitter
- Produces the opposite effect
CYP450 enzymes
Group of most important ones - CORRECT ANSWERS--Enzyme family most important
in metabolizing drugs. Most psychotropic drugs target CYP450 enzymesreside in the
liver and gut.
1A2, 2B6, 2D6, 2C9, 2C19, 3A4.
Serotonin (5-HT 1-7) 5-hydroxytryptamine
Has so many roles in the body because 5-HT receptors are found all over.
You can remember that serotonin effects many __________________. (Mnemonic)
Comes from the Raphe Nuclei. Think SIRotonin RAPHE nuclei - CORRECT
ANSWERS-DOMAINS
D epression: involved in regulation of mood
O bsession: When someone washes hands brian would use serotonin to help you feel
satisfied that your hands are washed. In OCD pt's the satisfaction process has broken
down and they return to re-wash their hands.
M igraines: help abort migraine once started
A nxiety: GAD
I ntestines: 90% of 5-HT is in your GI tract. drives gut motility SSRI's cause diarrhea and
GI upset
N ausea: Zofran which blocks 5-HT is effective at decreasing nausea
S exual: disfunction is #1 reason why pt's stop taking SSRI's.
Catecholamines mediate the sympathetic nervous system
What are the 3 main neurotransmitters that are known as catecholamines? - CORRECT
ANSWERS-Serotonin
Dopamine
Norepinephrine
Serotonin Syndrome:
, Mnemonic:
What meds to treat?
Severity of syndrome can vary. In lesser forms it produces mild discomfort. However, in
its extremes there is significant mortality rate 2-12%.
Progression: Rhabdomyolysis, renal failure, convulsions, coma= DEATH - CORRECT
ANSWERS-serotonin raised to toxic levels in the brain; greater risk for patients taking 2
or more drugs raising serotonin;
Txt
1.Stop medication
2.Supportive care
3.Cyproheptadine (5HT antagonist)
4.ECT in emergencies
-DC med and start benzos or antihistamines
Shiz and SHIVERS
Shiz is for diarrhea
S shivering fairly unique to serotonin syndrome and helps distinguish from other
hyperthermic conditions
H hyperreflexia and myoclonus are seen
I ncreased temp.
V ital sign instability, HR RR BP can fluctuate wildly
E ncephalopathy acute changes in mental status following change in drug regimen can
be telltale sign
R estlessness
S weating diaphoresis is an autonomic response.
SSRI discontinuation syndrome
Mnemonic:
•Gradual taper of medications
•Least likely with Fluoxetine and Vortioxetine (Trintellix/Brintellix)- may consider short
trial to mitigate symptoms
•Symptoms usually begin within 5 days of treatment cessation
•Consider a 4-week taper (longer with Paxil and Effexor) - CORRECT ANSWERS-
FINISH
F lu-like symptoms: fatigue,aches, headache, diarrhea
I nsomnia: vivid or disturbing dreams
N ausea
Psychopharmacology / Stahls
Essential Psychopharm
,Pharmacodynamics - CORRECT ANSWERS--What the body does to the drug
-What the drug does to the body
Synapses
-Neurotransmitters are stored in vesicles prior to being released
-When pre-synaptic neuron is activated it releases neurotransmitters which diffuse
across the synapse to activate receptors.
-This depolarizes the post-synaptic neuron and causes it to "fire".
-The post-synaptic neuron then propagates a wave of depolarization, known as an
action potential, down to the next neuron and the process repeats.
- The Neurotransmitters in the synapse cannot simply remain there. They will
-diffuse away
- Get broken down by an enzyme
- Pumped back into pre-synaptic neuron for storage or use(known as reuptake) -
CORRECT ANSWERS-
Upregulation/Downregulation of post-synaptic neurons
The brain strives for homeostasis and will act to counterbalance any perceived excess. -
CORRECT ANSWERS-Post-synaptic neuron can make itself more sensitive to
stimulation by increasing the number of receptors available on their membranes
Or decrease sensitivity by decreasing the number of receptors on the membrane of the
post-synaptic neuron.
2 Rules of Neurotransmission
- What goes up must come down/ What goes down must come back up.
- With great power comes great responsibility. - CORRECT ANSWERS-- Someone on
excitatory drugs will often experience a low energy "crash" during withdrawal.
- Refers to the phenomenon where both efficacy and the adverse effects of any
particular drug are intrinsically linked. If a drug is powerful it is more likely to have
severe side effects. More power more potential for harm.
-It's always best to attempt treatment with the least powerful option that will still produce
good results.
Drug Effects
Full agonist:
Partial agonist:
,Antagonist:
Inverse Agonist: - CORRECT ANSWERS--Mimics the effect of a neurotransmitter
-Mimics it but only to a certain lower point
-Blocks the effect of a neurotransmitter
- Produces the opposite effect
CYP450 enzymes
Group of most important ones - CORRECT ANSWERS--Enzyme family most important
in metabolizing drugs. Most psychotropic drugs target CYP450 enzymesreside in the
liver and gut.
1A2, 2B6, 2D6, 2C9, 2C19, 3A4.
Serotonin (5-HT 1-7) 5-hydroxytryptamine
Has so many roles in the body because 5-HT receptors are found all over.
You can remember that serotonin effects many __________________. (Mnemonic)
Comes from the Raphe Nuclei. Think SIRotonin RAPHE nuclei - CORRECT
ANSWERS-DOMAINS
D epression: involved in regulation of mood
O bsession: When someone washes hands brian would use serotonin to help you feel
satisfied that your hands are washed. In OCD pt's the satisfaction process has broken
down and they return to re-wash their hands.
M igraines: help abort migraine once started
A nxiety: GAD
I ntestines: 90% of 5-HT is in your GI tract. drives gut motility SSRI's cause diarrhea and
GI upset
N ausea: Zofran which blocks 5-HT is effective at decreasing nausea
S exual: disfunction is #1 reason why pt's stop taking SSRI's.
Catecholamines mediate the sympathetic nervous system
What are the 3 main neurotransmitters that are known as catecholamines? - CORRECT
ANSWERS-Serotonin
Dopamine
Norepinephrine
Serotonin Syndrome:
, Mnemonic:
What meds to treat?
Severity of syndrome can vary. In lesser forms it produces mild discomfort. However, in
its extremes there is significant mortality rate 2-12%.
Progression: Rhabdomyolysis, renal failure, convulsions, coma= DEATH - CORRECT
ANSWERS-serotonin raised to toxic levels in the brain; greater risk for patients taking 2
or more drugs raising serotonin;
Txt
1.Stop medication
2.Supportive care
3.Cyproheptadine (5HT antagonist)
4.ECT in emergencies
-DC med and start benzos or antihistamines
Shiz and SHIVERS
Shiz is for diarrhea
S shivering fairly unique to serotonin syndrome and helps distinguish from other
hyperthermic conditions
H hyperreflexia and myoclonus are seen
I ncreased temp.
V ital sign instability, HR RR BP can fluctuate wildly
E ncephalopathy acute changes in mental status following change in drug regimen can
be telltale sign
R estlessness
S weating diaphoresis is an autonomic response.
SSRI discontinuation syndrome
Mnemonic:
•Gradual taper of medications
•Least likely with Fluoxetine and Vortioxetine (Trintellix/Brintellix)- may consider short
trial to mitigate symptoms
•Symptoms usually begin within 5 days of treatment cessation
•Consider a 4-week taper (longer with Paxil and Effexor) - CORRECT ANSWERS-
FINISH
F lu-like symptoms: fatigue,aches, headache, diarrhea
I nsomnia: vivid or disturbing dreams
N ausea
