Anti-Psychotic

Question 1

Anti-Psychotic medications

Answer 1

Should be handled by a Psychiatrist. However we will see them in primary care

Question 2

Conventional

Answer 2

First developed to treat schizophrenia by clocking dopamine-2 (D2) receptors It reduced hyperactivity in the mesolimbic dopamine pathway

Question 3

Caused extrapyramidal side effects

Answer 3

Tardive dyskinesia which can be irreversible

Prolactin levels also increase.

Question 4

Atypical antipsychotics

Answer 4

work on D2 antagonism with serotonic-2A antagonism. Fewer negative side effects. Weight gain, obesity, dyslipidemia, diabeters and CVD. Clozapine and olanzapine have the highest risk while ziprasidone and aripiprazole have the lowest risk.

Question 5

Seizure medicatoins

Answer 5

These clients need to be followed by a neurologist

Question 6

Partial seizures and tonic-clonic seizures

Answer 6

Carbamazapine (Tegretol)
Can cause bone marrow suppresion, has many drug interactions, particularly oral contraceptives and folic acid. High incidence of Stevens-Johson syndrome in Asians patients. Must screen for the variant HLA-B1502 allele prior to initiating

Question 7

Grand mal seizures - tonic/clonic

Answer 7

Phenytoin (Dilantin)

Used to prevent seizures after head injuries, etc. Lots of drug-drug interactions

Question 8

Petit mal seizures

Answer 8

Valproic acid and lamotrigine have fewer side effects and are preferred. Can use Zarontin, Depakote or Lamictal. Do platelet counts. Watch for bruises and bleeding.

Question 9

These lead to oral contraceptives not working because of the CYP450 enzymes.

Answer 9

Better to use progestin only pills or depo shot

Question 10

Seizures and pregnancy

Answer 10

Due to many quit taking their medications. Need to take meds. Slight risk of teratogenicity. It is complex.

Question 11

Most antiepileptic drugs will pass to breastmilk

Answer 11

THE AAP says to use Zarontin, Tegretol, Dilantin, and Depakene. Don’t use Lamictal. Monitor infant for jaundice, drowsiness, etc.

Question 12

During menopause

Answer 12

Women need to take high calcium 1200 mg and vitamin D 600 IU’s per day.

Question 13

Parkinsons

Answer 13

Imbalance between Dopamine and acetylcholine (Ach)

Question 14

Parkinsons

Answer 14

Tremor at rest
rigidity
postural instability
breadykinesia
can cause depression, psychosis, etc.

Question 15

Goal of treating parkinsons

Answer 15

reduce symptoms

Levodopa combined with carbidopa is the most effective

Question 16

Adverse effects of Levodopa

Answer 16

nausea, dyskineisas, hypotension and psychosis

Question 17

First generation antipsychotic drugs block dopamine receptors

Answer 17

Amino acids compete with levodopa for absorption from the intestine and across the blood brain barrier.. High protein diet can reduce therapeutic effects

Question 18

Drugs for PD

Answer 18

Dopamine agonists-Pramipexole an oral nonergot dopamine agonist first line for motor symptoms
It can be used alone early or added to Levodopa later
Adverse effects: nausea, dyskinasia, hallucinations, TAKE WITH FOOD

Question 19

Anticholinergic drugs for PD

Answer 19

relieve symptoms by blocking cholinergic receptors. Amantadine is commonly used.
Causes dry mouth, constipation, etc.

Question 20

Alzheimers

Answer 20

Cannot be cured. just help with symptoms

Question 21

None of them work great

Answer 21

NMDA- Mamenda
or Cholinesterase inhibitors-Aricept (mild), Exelone (moderate) Cognex (May elevate LFTs and cause liver toxicity. many drug interactions.