Podcast
Questions and Answers
What is the primary function of acetylcholine in the hippocampus?
What is the primary function of acetylcholine in the hippocampus?
What happens to the neurotransmitter after it binds to the postsynaptic receptor?
What happens to the neurotransmitter after it binds to the postsynaptic receptor?
What is the name of the enzyme responsible for breaking down acetylcholine?
What is the name of the enzyme responsible for breaking down acetylcholine?
What is the term for the process by which neurotransmitters diffuse away from the synapse?
What is the term for the process by which neurotransmitters diffuse away from the synapse?
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What is the motivation behind developing cholinesterase inhibitors?
What is the motivation behind developing cholinesterase inhibitors?
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What is the process by which a presynaptic neuron reclaims a neurotransmitter?
What is the process by which a presynaptic neuron reclaims a neurotransmitter?
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What would happen if there was too much acetylcholine in the synapse?
What would happen if there was too much acetylcholine in the synapse?
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What is the suffix commonly used in enzyme names to indicate their function?
What is the suffix commonly used in enzyme names to indicate their function?
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What is the primary concern when prescribing drugs that affect cardiac conduction in geriatric patients?
What is the primary concern when prescribing drugs that affect cardiac conduction in geriatric patients?
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What is a common misconception about selective serotonin reuptake inhibitors (SSRIs)?
What is a common misconception about selective serotonin reuptake inhibitors (SSRIs)?
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Which of the following SSRIs has a statistically significant prolongation of the QT interval?
Which of the following SSRIs has a statistically significant prolongation of the QT interval?
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What is the dose limit for citalopram in the geriatric population?
What is the dose limit for citalopram in the geriatric population?
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Why might a provider still choose to prescribe citalopram despite the risks?
Why might a provider still choose to prescribe citalopram despite the risks?
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What is the primary reason to avoid using citalopram in geriatric patients?
What is the primary reason to avoid using citalopram in geriatric patients?
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What is a common misconception about antidepressants and anxiolytics?
What is a common misconception about antidepressants and anxiolytics?
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What is a key consideration when prescribing medications to geriatric patients?
What is a key consideration when prescribing medications to geriatric patients?
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What is the primary function of the sympathetic nervous system?
What is the primary function of the sympathetic nervous system?
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Which of the following is NOT a characteristic of the sympathetic nervous system?
Which of the following is NOT a characteristic of the sympathetic nervous system?
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What is the neurotransmitter of the parasympathetic nervous system?
What is the neurotransmitter of the parasympathetic nervous system?
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Which of the following is a characteristic of a sympathetic discharge?
Which of the following is a characteristic of a sympathetic discharge?
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What is the relationship between the sympathetic and parasympathetic nervous systems?
What is the relationship between the sympathetic and parasympathetic nervous systems?
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What is the primary function of the parasympathetic nervous system?
What is the primary function of the parasympathetic nervous system?
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What is the primary symptom presentation in Alzheimer's disease patients?
What is the primary symptom presentation in Alzheimer's disease patients?
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What is a common side effect of medications that affect the parasympathetic nervous system?
What is a common side effect of medications that affect the parasympathetic nervous system?
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What is the autonomic nervous system composed of?
What is the autonomic nervous system composed of?
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What was the brand name of the first cholinesterase inhibitor indicated for Alzheimer's disease?
What was the brand name of the first cholinesterase inhibitor indicated for Alzheimer's disease?
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Why was the first cholinesterase inhibitor considered 'ludicrous'?
Why was the first cholinesterase inhibitor considered 'ludicrous'?
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What was a limitation of the first cholinesterase inhibitor in terms of its interaction with other drugs?
What was a limitation of the first cholinesterase inhibitor in terms of its interaction with other drugs?
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What is the main consideration when selecting a cholinesterase inhibitor for a patient?
What is the main consideration when selecting a cholinesterase inhibitor for a patient?
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What is a characteristic of the current cholinesterase inhibitors available in the market?
What is a characteristic of the current cholinesterase inhibitors available in the market?
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What is a common assumption made by drug companies when developing new medications?
What is a common assumption made by drug companies when developing new medications?
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What is a general principle to consider when prescribing medications to patients?
What is a general principle to consider when prescribing medications to patients?
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What is the primary concern when treating psychosis in a patient with Parkinson's disease?
What is the primary concern when treating psychosis in a patient with Parkinson's disease?
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What is unique about Nuplazid compared to other antipsychotics?
What is unique about Nuplazid compared to other antipsychotics?
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What is the theorized mechanism of action for Nuplazid's control of hallucinations and psychosis?
What is the theorized mechanism of action for Nuplazid's control of hallucinations and psychosis?
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What is the role of an agonist in a biological response?
What is the role of an agonist in a biological response?
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Why is Nuplazid a better option for patients with Parkinson's disease than traditional antipsychotics?
Why is Nuplazid a better option for patients with Parkinson's disease than traditional antipsychotics?
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What is the primary advantage of Nuplazid over other antipsychotics?
What is the primary advantage of Nuplazid over other antipsychotics?
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What is the clinical conundrum when treating psychosis in a patient with Parkinson's disease?
What is the clinical conundrum when treating psychosis in a patient with Parkinson's disease?
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What is the consequence of using traditional antipsychotics to treat psychosis in a patient with Parkinson's disease?
What is the consequence of using traditional antipsychotics to treat psychosis in a patient with Parkinson's disease?
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Study Notes
Geriatric Psychopharmacology
- In geriatric psychopharmacology, it's essential to consider the potential impact of medications on cardiac conduction, especially in older adults with age-related cardiac hyperexcitability.
- Selective serotonin reuptake inhibitors (SSRIs) are generally considered safe, but they can still prolong the QT interval and increase the risk of dysrhythmia, particularly citalopram.
- Citalopram has an FDA Black Box warning for prolonged QT interval and risk of dysrhythmia and is dose-limited to 40mg for the general population and 20mg for geriatric patients.
Neurotransmission and Alzheimer's Disease
- Acetylcholine is a neurotransmitter that helps process and store memory in the hippocampus, and its loss contributes to memory loss in Alzheimer's disease.
- Cholinesterase inhibitors increase acetylcholine concentration by blocking its breakdown by the enzyme acetylcholinesterase.
- The three ways to neutralize neurotransmitters are:
- Diffusion away from the synapse
- Reuptake by the presynaptic neuron
- Enzymatic degradation
Cholinesterase Inhibitors
- The first cholinesterase inhibitor was tacrine, marketed under the brand name Cognex, but it had limitations, such as needing to be taken four times a day and interactions with cytochrome P450.
- Later formulations, such as Aricept, are more user-friendly but still have cholinergic adverse effects.
- Cholinergic adverse effects are common with cholinesterase inhibitors and are related to the parasympathetic nervous system.
Autonomic Nervous System
- The autonomic nervous system has two branches: sympathetic and parasympathetic.
- The sympathetic nervous system is responsible for the "fight or flight" response, increasing heart rate, blood pressure, and respiration.
- The parasympathetic nervous system, also known as the cholinergic system, maintains daily life functions, such as heart rate, digestion, and respiration.
Nuplazid
- Nuplazid is a medication that controls hallucinations and delusions without impacting dopamine, histamine, or muscarinic receptors.
- It has a unique mechanism of action, acting as a serotonin 2A receptor antagonist and inverse agonist to control psychosis.
- Nuplazid does not have anticholinergic or antihistamine-like side effects, making it a useful option for patients with Parkinson's disease or other dopamine-related conditions.
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Description
This quiz covers the key concepts and considerations in geriatric psychopharmacology, including prescribing for elderly patients. It focuses on important factors to think about early in the learning curve.
