NSG 552
EXAM 3 STUDY GUIDE
(Weeks 9-11)
Psychopharmacology - Wilkes University
, Week 9
Classic Opioid withdrawal symptoms – yawning, diarrhea, diaphoresis,
rhinorrhea, dilated pupils.
Remember OTL (Outside the liver)-Oxazepam, Temazepam, and Lorazepam are
metabolized outside the liver hence making it safe for patients with any hepatic
issues.
Disulfiram (Antabuse) is the best option for highly motivated patients’ d/t the
aversion reaction it causes.
Remember that Wellbutrin (Zyban) is prescribed for smoking cessation.
Dopamine is the most involved and reward pathways in the brain.
Wernicke encephalopathy is characterized by a classic triad of signs and
symptoms: confusion, cerebellar dysfunction (e.g., ataxia), and oculomotor
dysfunction. The most common presenting symptom of Wernicke
encephalopathy is mental status change, whereas the most common physical
exam finding is gait ataxia. Thiamine is often given with/ improvement of
symptoms.
The 16-year-old patient is using marijuana for anxiety. The PMHNP should
consider Fluoxetine (Prozac) because it is first-line for anxiety (SSRI) and
approved for this age group –
A CIWA score of >15 is indicative of severe withdrawal symptoms.
Wernicke encephalopathy and Korsakoff syndrome are different conditions
that often occur together in patients with alcohol use disorder. Both are due to
brain damage caused by a deficiency of Vitamin B1
Naloxone is the drug of choice to reduce the risk of adverse reactions and
further complications in cases of suspected opioid overdose.
Lorazepam, Chlordiazepoxide, and Acamprosate are all used in Alcohol use
disorders. Methadone is used for Opioid use disorder.
Substance Use Disorders (SUD)
,Each substance use disorder can be categorized into:
1. Acute intoxication phase
2. Maintenance phase
3. Withdrawal phase
Reversible syndrome caused by a specific substance affecting memory,
judgement, behavior or social or occupational functioning = Intoxication
Substance specific symptoms that occur after stopping or reducing use =
Withdrawal
Positive rewards of reinforcement associated with SUD is mediated by this
neurotransmitter = Ventral tegmental area (VTA) and the Nucleus
accumbens (NAC) reward center
DA release w/in the reward center is enhanced = by the release of
natural morphine-like neurotransmitters (Neuropeptides- enkephalins,
beta-endorphins)
Repeated drug use = DA system becomes increasingly sensitized
NOTE: All addictive drugs increase DA in the nucleus accumbens
DA, a neurotransmitter, plays crucial role in reward processing et
motivation
From nucleus accumbens (NAC) + Amygdala to prefrontal
cortex = involved in learning “this feels good”
From Amygdala to VTA = memory “this felt good last time”
Amygdala to NAC = emotional cues from internal or external
triggers (e.g. seeing a bag of heroin signals an impulsive action to
use)
VTA= reward region
NA-Nucleus accumbens – connects the limbic system to the motor system
Prefrontal cortex- executive functioning, impulse control
, Drugs of abuse act in the brain Reward pathway either
1. Enhance DA release
2. Enhance DA effects in the NA or related structures or produce effects
similar to DA
DOPAMINE = primary neurotransmitter involved in pleasure/reward
released in nucleus accumbens (NAc) = the release reinforces the
behavior (more likely to repeat it)
Mesolimbic pathway: neural network in the brain plays crucial role in
reward, motivation, and pleasure = VTA, NAc, and amygdala
DA cell bodies originate in the ventral tegmental area (VTA) in the
midbrain
DA neurons project to the nucleus accumbens (NAc),
The amygdala (AMYG), and hippocampus in the ventral striatum,
connects to both the VTA and the Nac
Classes of SUD
Stimulants = caffeine, nicotine, amphetamines, cocaine, ectasy
Depressants = benzodiazepines, alcohol
Narcotics = opioids
Hallucinogens = lysergic acid diethylamide (LSD), marijuana
EXAM 3 STUDY GUIDE
(Weeks 9-11)
Psychopharmacology - Wilkes University
, Week 9
Classic Opioid withdrawal symptoms – yawning, diarrhea, diaphoresis,
rhinorrhea, dilated pupils.
Remember OTL (Outside the liver)-Oxazepam, Temazepam, and Lorazepam are
metabolized outside the liver hence making it safe for patients with any hepatic
issues.
Disulfiram (Antabuse) is the best option for highly motivated patients’ d/t the
aversion reaction it causes.
Remember that Wellbutrin (Zyban) is prescribed for smoking cessation.
Dopamine is the most involved and reward pathways in the brain.
Wernicke encephalopathy is characterized by a classic triad of signs and
symptoms: confusion, cerebellar dysfunction (e.g., ataxia), and oculomotor
dysfunction. The most common presenting symptom of Wernicke
encephalopathy is mental status change, whereas the most common physical
exam finding is gait ataxia. Thiamine is often given with/ improvement of
symptoms.
The 16-year-old patient is using marijuana for anxiety. The PMHNP should
consider Fluoxetine (Prozac) because it is first-line for anxiety (SSRI) and
approved for this age group –
A CIWA score of >15 is indicative of severe withdrawal symptoms.
Wernicke encephalopathy and Korsakoff syndrome are different conditions
that often occur together in patients with alcohol use disorder. Both are due to
brain damage caused by a deficiency of Vitamin B1
Naloxone is the drug of choice to reduce the risk of adverse reactions and
further complications in cases of suspected opioid overdose.
Lorazepam, Chlordiazepoxide, and Acamprosate are all used in Alcohol use
disorders. Methadone is used for Opioid use disorder.
Substance Use Disorders (SUD)
,Each substance use disorder can be categorized into:
1. Acute intoxication phase
2. Maintenance phase
3. Withdrawal phase
Reversible syndrome caused by a specific substance affecting memory,
judgement, behavior or social or occupational functioning = Intoxication
Substance specific symptoms that occur after stopping or reducing use =
Withdrawal
Positive rewards of reinforcement associated with SUD is mediated by this
neurotransmitter = Ventral tegmental area (VTA) and the Nucleus
accumbens (NAC) reward center
DA release w/in the reward center is enhanced = by the release of
natural morphine-like neurotransmitters (Neuropeptides- enkephalins,
beta-endorphins)
Repeated drug use = DA system becomes increasingly sensitized
NOTE: All addictive drugs increase DA in the nucleus accumbens
DA, a neurotransmitter, plays crucial role in reward processing et
motivation
From nucleus accumbens (NAC) + Amygdala to prefrontal
cortex = involved in learning “this feels good”
From Amygdala to VTA = memory “this felt good last time”
Amygdala to NAC = emotional cues from internal or external
triggers (e.g. seeing a bag of heroin signals an impulsive action to
use)
VTA= reward region
NA-Nucleus accumbens – connects the limbic system to the motor system
Prefrontal cortex- executive functioning, impulse control
, Drugs of abuse act in the brain Reward pathway either
1. Enhance DA release
2. Enhance DA effects in the NA or related structures or produce effects
similar to DA
DOPAMINE = primary neurotransmitter involved in pleasure/reward
released in nucleus accumbens (NAc) = the release reinforces the
behavior (more likely to repeat it)
Mesolimbic pathway: neural network in the brain plays crucial role in
reward, motivation, and pleasure = VTA, NAc, and amygdala
DA cell bodies originate in the ventral tegmental area (VTA) in the
midbrain
DA neurons project to the nucleus accumbens (NAc),
The amygdala (AMYG), and hippocampus in the ventral striatum,
connects to both the VTA and the Nac
Classes of SUD
Stimulants = caffeine, nicotine, amphetamines, cocaine, ectasy
Depressants = benzodiazepines, alcohol
Narcotics = opioids
Hallucinogens = lysergic acid diethylamide (LSD), marijuana
