_MEDS: Depression, Schizophrenia, Bipolar, Anxiety

Question 1

Class/s of meds used for schizophrenia?
What symptoms do each class affect? (NT & S/S)

Answer 1

+ Typical antipsychotics – FGA - first generation - affects POSITIVE symptoms ONLY
+ Atypical, antipsychotics – SGA - second generation - affects POSITIVE & NEGATIVE symptoms

Question 2

Typical antipsychotics used - names (art museum)

Answer 2

+ haloperidol (truck halo lights) – Haldol
+ chlorpromazine – Thorazine
+ fluphenazine (flip phone) – Prolixin

Question 3

Typical antipsychotics side effects - name 6!!!

Answer 3

+ EPS symptoms
+ NMS
+ “Cholinergic side effects“ (COLA bottle) – urine, retention, dry mouth, tachycardia, constipation
+ orthostatic hypertension - dizzy standing
+ sedation (avoid alcohol/sedatives)
+ cardiac arrhythmias - torsades des points (deadly)
+ agranulocytosis

Question 4

Atypical antipsychotics used - names (surprise party)

Answer 4

+ Clozapine - Clozaril
+ olanzapine - Zyprexa
+ aripiprazole - Abilify
+ risperidone - Risperdal
+ quetiapine - Seroquel
+ ziprasidone - Geodon

Question 5

Side effects of atypical antipsychotics – SGAs

Answer 5

+ Anticholinergic effects!!!
+ photosensitivity
+ sedation/lethargy
+ TD, EPS, and MS (lower risk than FGAs)
+ metabolic syndrome: ⬆️ weight, ⬆️ cholesterol, ⬆️ triglycerides, ⬆️ blood sugar

Question 6

What classes of symptoms do first generation and second generation antipsychotic effect?
What neurotransmitters to effect?

Answer 6

+1st GEN: positive symptoms, dopamine
+ second GEN: positive and negative symptoms, dopamine & serotonin

Question 7

Medical intervention for NMS

Answer 7

+ stop medications - antipsychotic
+ Dopamine agonists
+ muscle relaxants – dantrolene or benzodiazepine
+ frequent vital signs, treat, fever, lab tests

Question 8

• What type of crisis/delirium can be caused from antipsychotics?
• Interventions?

Answer 8

+ anti-cholinergic crisis
+ Discontinue medication
+ gastric lavage, charcoal
+ physostigmine

Question 9

• What syndrome can be caused by antipsychotics?
• Intervention?

Answer 9

+ EPS
+ Benztropine (Cogentin)

Question 10

What class is benztropine/Cogentin

Answer 10

+ anti-cholinergic / anti-parkinson

Question 11

What is the drug of choice for bipolar disorder?

Answer 11

+ Lithium

Question 12

Normal side effects for Lithium

Answer 12

+ Fine hand tremor
+ polyuria
+ mild thirst
+ mild nausea - take w/food
+ mild weight gain
+ sedation
+ acne
+ cognitive problems
+ hair loss

Question 13

• Early signs lithium toxicity
• interventions

Answer 13

+ Increased nausea, vomiting, diarrhea, increased thirst and polyuria, SLURRED SPEECH, MUSCLE WEEKNESS
+ hold medication! Measure blood lithium levels – reevaluate dose

Question 14

Advanced signs of lithium toxicity

Answer 14

+ Coarse hand tremor + mental confusion + muscle, hyper irritability + in coordination + EEG changes
+ ** HOLD MEDICATION**
+ Obtain blood level and reevaluate dose
+ treat more serious symptoms

Question 15

Severe signs of lithium, toxicity and intervention

Answer 15

+ Ataxia
+ serious EEG changes, SEIZURES
+ blurred vision, tinnitus, blurred vision
+ Severe hypotension, coma, death
+ clonic movements, in coordination
+ large output of the dilute urine
+ STOPP MEDICATION facilitate excretion by gastric lavage, give emetic, treatment with urea, mannitol

Question 16

Other medication’s that treat bipolar

Answer 16

+ Valproic acid/Depakote – – increases levels of GABA. Levels 50-100.
+ carbamazepine/Tegretol — decreases synaptic transmission in CNS by affecting sodium levels — for rapid cyclers

Question 17

First line management of acute Mania – medication

Answer 17

+ Antipsychotics – olanzapine first, then the others

Question 18

First line treatment for bipolar, while waiting for lithium to work

Answer 18

+ Olanzapine/fluoxetine combo for bipolar depression + qeutiapine monotherapy
+ Prevention of relapse of mania/depression – olanzapine and quetiapine mono therapies

Question 19

First line medication‘s for depression
- How do they work?

Answer 19

+ SSRIs
+ blocks reuptake of serotonin
+ fewer side effects than TCAs – better compliance from patients

Question 20

• Common side effects of SSRIs
• Serious side effects

Answer 20

+ Sexual dysfunction, weight gain, stomach issues, headaches, dizziness, some anticholinergic symptoms (urine retention, constipation, dry mouth)
+ Serotonin syndrome – hypertension, tachycardia, hyperpyrexia, agitation

Question 21

What do SSRIs treat besides depression?

Answer 21

+ OCD
+ anxiety
+ eating disorders

Question 22

Common SSRIs

Answer 22

+ Fluoxetine/Prozac
+ paroxetine/Paxil
+ sertraline/Zoloft

Question 23

Second line of treatment for depression?
What NT do they affect?

Answer 23

+ SNDIs and SNRIs
+ duloxetine, venlaflaxine
+ Norepinephrine 

Question 24

Medication for depression that’s rarely used anymore – highly anticholinergic

Side effects?

Answer 24

+ TCAs
Side effects are anticholinergic/adrenergic: tachycardia, postural, hypotension, drowsiness, dysrhythmias, cardiotoxic, heart blocks
+ CAN OD ON 1 mo SUPPLY
+ Amitriptyline, nortriptyline, imipramine, Clomid, Fermin

Question 25

Effective treatment for depression, but complicated to manage

Answer 25

+ MAOIs - monoamine oxidase inhibitors
+ phenelzine
+ tranylcypromine /parnate

Question 26

Frontline medication’s for anxiety disorder

Answer 26

+ SSRIs – fluoxetine, sertraline, paroxetine,
+ SNRIs – venlafaxine

Question 27

Medication for severe anxiety attack. – PRN

Answer 27

Anxiolytics: Benzodiazepines
– lorazepam
– clonazepam
– alprazolam

Question 28

Class of medication used to treat OCD - only one FDA approved

Answer 28

TCAs - clomipramine
+ more effective than SSRI/SNRI