Anti-Pyschotics (2)

Question 1

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

Answer 1

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

Question 2

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

Answer 2

Improves + symptoms in pts not helped by others

Improves negative symptoms

Question 3

What are 2 big sideffects of Clozapine

Answer 3

Lowers seizure threshold

can cause fatal agranulocytosis

Question 4

Effect of Olanzapine on
5-HT2
D1 and D2
D4

Answer 4

Potent 5-HT antagonist

D1, D2 ANTagonist, some D4

Question 5

What is the side effect profile of olanzapine

Answer 5

few EPS and less seizure concern then Clozapine

Weight gain and diabetes adn possible abuse (snorting)

Question 6

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

Answer 6

Risperidone

Question 7

has less seizure and antimuscarninic acitiviy then Clozapine

Answer 7

Risperidone

Question 8

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

Answer 8

Paliperidone

given as injection

Question 9

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

Answer 9

Quetiapine

Question 10

What antipyschotic is approved for augmentation in depression

Answer 10

Quetiapine

Question 11

5-HT2 and D2 antagonist

may ahve 5-HT1a agonist activity, no weight gain

Answer 11

Ziprasidone

Question 12

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

Answer 12

Aripiprazole

Question 13

Uses of Antipsychotics

Answer 13

Acute episodes
Chronic schizophrenia
Manic episodes
Schizoaffective
Augment depression
Tourettes
Antiemesis

Question 14

What drugs do we tx schizoaffective disorder with?

Answer 14

Paliperidone

Question 15

What antipyschotics can we use to augment depression

Answer 15

Aripiprizole, olanzapine, quetiapine

Question 16

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

Answer 16

aripriprazole, olanzapine, quetiapine, ziprasidone, risperidone, asenapine

Question 17

Meds used to tx Tourettes

Answer 17

haloperidole or pimozide

Question 18

Prevalance of Bipolar Disorder

Answer 18

2.6% of adults and 82.9% are severe

not reporeted by sex or age with onset at 25

Question 19

Criteria for Manic Episode

Answer 19

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

Question 20

Bipolar I and II has emphasis with changes in

Answer 20

mood and changes in activity

Question 21

Med used to tx bipolar

Answer 21

Lithium

Question 22

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

Answer 22

Lithium

Question 23

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

Answer 23

recycling of inositol substrates

Question 24

Lithium has complete absorption in ______

peak serum level in _____

Answer 24

6-8 hours

2 to 4 hours

Question 25

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

Answer 25

YA: 18-24 hrs elderly: 30-36

Question 26

LIthium is ____ to plasma proteins | Has volume of distribtution_____

Answer 26

unbound | Equal to total body water

Question 27

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

Answer 27

40-50% | 95%

Question 28

How do Na levels affect Li levels:

Answer 28

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

Question 29

Therapeutic window of Li | Effect of ACE and ANGII inhibitors on Li

Answer 29

* Narrow therapeutic window (0.6to1.25mEq/liter. Important to monitor levels. * ACE inhibitors and AngiotensinII receptor blockers can also raise Li levels

Question 30

* Fatigue and muscular weakness * Tremor - may be treated with beta-blockers * GI symptoms * Slurred speech and ataxia

Answer 30

side effects of Lithium

Question 31

Serious toxicity at plasma levels about 2 to 3 times levels

Answer 31

o Impaired consciousness o Rigidity and hyperactive deep reflexes o Coma

Question 32

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

Answer 32

sodium

Question 33

Clinical uses of Lithium

Answer 33

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

Question 34

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

Answer 34

Carbamazepine

Question 35

o Used as first line drug in bipolar disorder; sedating

Answer 35

Valproic acid and divalproex sodium (Depakote)

Question 36

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

Answer 36

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

Question 37

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

Answer 37

haloperidol or clonazepam

Question 38

a combination of olanzapine and fluoxetine. | o Indicated for bipolar disorder, depressive and treatment resistant major depressive disorder.

Answer 38

Symbyax®