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psychiatry > Anti-Pyschotics (2) > Flashcards

Anti-Pyschotics (2) Flashcards

1
Q

What affect does Closapine have on
D4 and 5-HT2
D2
Muscarnic

A

Blocks D4 and 5‐HT2 receptors
• Little effect on D2
• Muscarinic antagonist

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2
Q

Clozapine (atyipcal) has what effect on + and - symptoms

A

Improves + symptoms in pts not helped by others

Improves negative symptoms

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3
Q

What are 2 big sideffects of Clozapine

A

Lowers seizure threshold

can cause fatal agranulocytosis

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4
Q

Effect of Olanzapine on
5-HT2
D1 and D2
D4

A

Potent 5-HT antagonist

D1, D2 ANTagonist, some D4

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5
Q

What is the side effect profile of olanzapine

A

few EPS and less seizure concern then Clozapine

Weight gain and diabetes adn possible abuse (snorting)

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6
Q

Combined D2 and 5HT-2 antagonist with greater reduction in negative sypmtoms and less EPS

A

Risperidone

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7
Q

has less seizure and antimuscarninic acitiviy then Clozapine

A

Risperidone

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8
Q

What is the active metabolite of Risperidone, how is it administered

A

Paliperidone

given as injection

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9
Q

Drug with simular effects on schizophrenia as risperidone and olanzapine but with a shorter half life

A

Quetiapine

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10
Q

What antipyschotic is approved for augmentation in depression

A

Quetiapine

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11
Q

5-HT2 and D2 antagonist

may ahve 5-HT1a agonist activity, no weight gain

A

Ziprasidone

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12
Q

A partial D2 agonist and 5HT2 antagonist, also approved for adjunct to tx depression

A

Aripiprazole

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13
Q

Uses of Antipsychotics

A 
Acute episodes
Chronic schizophrenia
Manic episodes
Schizoaffective
Augment depression
Tourettes
Antiemesis
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14
Q

What drugs do we tx schizoaffective disorder with?

A

Paliperidone

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15
Q

What antipyschotics can we use to augment depression

A

Aripiprizole, olanzapine, quetiapine

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16
Q

What meds can we use to tx manic episodes or bipolar disorder

A

aripriprazole, olanzapine, quetiapine, ziprasidone, risperidone, asenapine

17
Q

Meds used to tx Tourettes

A

haloperidole or pimozide

18
Q

Prevalance of Bipolar Disorder

A

2.6% of adults and 82.9% are severe

not reporeted by sex or age with onset at 25

19
Q

Criteria for Manic Episode

A 
Inflated self esteem/grandiosity
Decreased need for sleep
Talkativeness
Flight of ideas
Distractibility
Increased goal directed activity
excess involvement in pleasurable activities
20
Q

Bipolar I and II has emphasis with changes in

A

mood and changes in activity

21
Q

Med used to tx bipolar

A

Lithium

22
Q

Monovalaent cation of light alkali
has no effect on normals
blocks manic behavior

A

Lithium

23
Q

Lithium, by inhibiting ______ may cause depletion of second messenger PIP2 adn thus reduce release of IP3 and DAG

A

recycling of inositol substrates

24
Q

Lithium has complete absorption in ______

peak serum level in _____

A

6-8 hours

2 to 4 hours

25
Q

What is the half life of lithium in young adults and elderly

A

YA: 18-24 hrs
elderly: 30-36

26
Q

LIthium is ____ to plasma proteins

Has volume of distribtution_____

A

unbound

Equal to total body water

27
Q

Lithium has CSF concentration is ______ of plasma concenteation
_____ of single dose is eliminated in urine

A

40-50%

95%

28
Q

How do Na levels affect Li levels:

A

Increased Na excretion causes clinically significant increases in Li levels. ie. Thiazide diuretics, losses of fluids or electrolytes.

29
Q

Therapeutic window of Li

Effect of ACE and ANGII inhibitors on Li

A
  • Narrow therapeutic window (0.6to1.25mEq/liter. Important to monitor levels.
  • ACE inhibitors and AngiotensinII receptor blockers can also raise Li levels
30
Q
  • Fatigue and muscular weakness
  • Tremor - may be treated with beta-blockers
  • GI symptoms
  • Slurred speech and ataxia
A

side effects of Lithium

31
Q

Serious toxicity at plasma levels about 2 to 3 times levels

A

o Impaired consciousness
o Rigidity and hyperactive deep reflexes
o Coma

32
Q

• Lithium levels are affected by plasma____ levels thus interactions with diuretics and some antihypertensives

A

sodium

33
Q

Clinical uses of Lithium

A
  • Treat mania and prevent recurrences of bipolar disease.
  • May be useful in preventing recurrences of unipolar depression in some patients.
  • Schizoaffective disorder*.
  • Cluster Headaches*.
34
Q

Use to tx bipolar: Acts at sodium channel; CNS side effects such as sedation, confusion and ataxia

A

Carbamazepine

35
Q

o Used as first line drug in bipolar disorder; sedating

A

Valproic acid and divalproex sodium (Depakote)

36
Q

o antiseizure agents that also acts at sodium channels or glutamate receptors.
o Warning on suicidal ideation.
also used to tx bipolar

A

Lamotrigene (Lamictal®) and topiramate (Topamax®) –off Label

37
Q

What can be Rx for initial tx of manic episodes seen in bipolar

A

haloperidol or clonazepam

38
Q

a combination of olanzapine and fluoxetine.

o Indicated for bipolar disorder, depressive and treatment resistant major depressive disorder.

A

Symbyax®

psychiatry (19 decks)

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