NUR 682: Psychopharmacology and

Neurophysiology for the PMHNP

Quiz Week 3 Study Guide

Harmony Rich, MSN, PMHNP-BC, APNH-BC
Neuroanatomy, Neurophysiology, and Behavior

Ch 1-3

Brain Structure and Function*

• Brainstem and Cerebellum • Broca and Wernicke’s
• Limbic system • Pineal gland
• Cerebral Cortex • L hemisphere
• Amygdala
• hippocampus • R Hemisphere
• Prefrontal Cortex
 Chemical Neurotransmission
Neurotransmitters – review where they are synthesized, and effects *
• Serotonin
• Norepinephrine
• Dopamine
• Acetylcholine
• Glutamate
• GABA (y-aminobutyric acid)
Transporters, Receptors, and Enzymes as Targets of
Psychopharmacological Drug Action
Neurotransmitter transporters as targets of drug action
G - Protein- Linked Receptors
• Agonists, partial agonists, inverse agonist, antagonist*
 Transporters, Receptors, and Enzymes as
Targets of
Psychopharmacological Drug Action
Enzymes as sites of psychopharmacological drug action
• Substrates and inhibitors; Irreversible vs. reversible binding
Cytochrome P450 drug metabolizing enzymes as targets of
psychotropic drugs
 Summary Wk 1
What to focus on?
• Neuroanatomy and behavior
• Most common binding sites
• Common psychotropic metabolizing pathways and importance
• Key neurotransmitters and location
 Wk 2
• Psychotic Disorders

• Ch. 4: Psychosis, schizophrenia, and the

neurotransmitter networks, dopamine, serotonin, and
glutamate
• Ch. 5: Targeting dopamine and serotonin receptors for
psychosis, mood and beyond- So-called “antipsychotics”
 Ch. 4: Psychosis, schizophrenia, and the neurotransmitter networks,
dopamine, serotonin, and glutamate
• Psychosis Definition
– Delusions
– Hallucinations
– Distortions (perceptual and motor)
– Paranoid psychosis/ projection
– Grandiose expansiveness
– Disorganized/ excited
– Depressive
• The three major hypotheses of psychosis and their neurotransmitter networks

• Review Positive Vs Negative symptoms

 Pathways
• Classic dopamine pathways and key brain regions
– Tuberoinfundibular dopamine pathway
– Thalamic dopamine pathway
– Nigrostriatal dopamine pathway
– Mesolimbic dopamine pathway
– Mesocortical dopamine pathway
• The glutamate hypothesis of psychosis and schizophrenia
• The serotonin hypothesis of psychosis and schizophrenia

• Review pathways, how they affect symptoms and what

medications affect pathways
 Targets of TX
• Therapeutic Mechanisms of drugs for psychosis
– Targeting mesolimbic/mesostriatal dopamine D2 receptors
• Secondary negative symptoms
– Targeting tuberoinfundibular dopamine D2 receptors
• Prolactin elevation
– Targeting nigrostriatal dopamine D2 receptors
• Motor side effects
– Drug-induced parkinsonism
– Drug-induced acute dystonia
– Akathisia
– Neuroleptic malignant syndrome
– Tardive dyskinesia
 Targets of TX
• Targeting serotonin 2A receptors with or without simultaneously targeting dopamine D2 receptors
– 5HT2a antagonists
• Schizophrenia
• Psychosis
• Negative symptoms
• Motor side effects
• Hyperprolactinemia
• Targeting serotonin 1A receptors and dopamine D2 receptors as partial agonists
– D2 partial agonism
• Fewer motor side effects
• Reduced hyperprolactinemia
• 5HT1A partial agonism
 Wk 2 focus
What to focus on?
• Psychosis - positive vs negative symptoms
• Neurotransmitter systems
• Common binding receptors/ transporters
• Therapeutic mechanisms of drugs for psychosis -
outcomes/ risks/ benefits/ monitoring
• Classic dopamine pathways and clinical presentation
• First generation vs. second generation antipsychotics -
Benefits/risks/ monitoring
 Focus COnt
• Common side effects
• Other properties,
– neuroprotective or
– Anti-suicidal
– Depression
– mania
 WK 3
• Anxiety and Trauma
• Key symptoms of anxiety disorder
– Symptom overlap between MDD and anxiety
• How do you differentiate? Look at core symptoms.
– Frequently comorbid (ex. substance abuse, ADHD,
etc.)
 Key features
● Generalized anxiety = General worry + other symptoms
● Panic disorders= Anticipatory anxiety + worry about panic
+ behavioral symptoms
● Social anxiety= Anxiety or fear r/t social performance/
exposure + predictable panic and avoidance of trigger
(social situations)
● Posttraumatic stress disorder (PTSD) = Anxiety +
reexperiencing trauma + other symptoms
 Brain anatomy
● Symptom overlap, brain circuits (fear circuits) and the amygdala
● Amygdala-centered circuit = anxiety and fear (ex. panic, phobias)
● Cortico-striato-thalamo-cortical circuit = worry/ apprehension/ obsession
● Amygdala and anterior cingulate cortex (ACC) and the orviofrontral cortex)=
fear
● Amygdala and periaqueductal gray (PAG) = motor responses of fear
● Endocrine, breathing and autonomic output of fear
● Hippocampus- Trauma memories stored in hippocampus but activate the
amygdala generating fear in PTSD
• Linking anxiety symptoms to circuits to neurotransmitters
– Anxiety/ fear associated with malfunctioning amygdala-centered
circuits
• Regulated by neurotransmitters (serotonin 5HT), GABA,
glutamate, norepinephrine, corticotropin releasing factor
(CRF)
– What about worry?
• CSTC feedback loop from prefrontal cortex
– Regulated by neurotransmitters (serotonin, GABA, dopamine,
glutamate, norepinephrine
 TX
• Treatments
– SSRIs/ SNRIs *
• Ex. Escitalopram, venlafaxine
• Action/ indication/ risk/ benefits?
– Initial effects of SNRIs vs. long term?
– Other serotonin drugs
• Ex. Buspirone
• Action/ indication/ risk/ benefits?
• A1-adrenergic blockers
– Ex. Prazosin
– Action/ indication/ risk/ benefits?
• Treatments
– Benzodiazepines
• Ex. clonazepam, alprazolam
• GABA - amygdala- fear output blunting; Enhanced inhibitory
interneurons in CSTC- reduced worry
• Indication/risks/ benefits? Short Term use only
– Alpha-2- Delta ligands
• Ex. Gabapentin/ pregabalin
• Action/ indication/ risk/ benefits?
• Combination therapy?
 Focus studies
• What to focus on?
• Dopamine and mesolimbic reward pathway*
• Substance use disorders, common treatments,
indications, risk/ benefits
– Alcohol*
– Stimulants*
– Opioid/opiates*
 TIPS
• SLOW DOWN
• Read each questions and understand what is being
asked
• Be cautious of absolutes, Never, always
• Try to avoid changing answers
• If you got something wrong on previous exams, review
that content more.
 TIPS cont
• Understand Patho of disease process and
neurotransmitter target of medication
• Know medications with black box warning!!!!!!!