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Pharm II Exam 4 > Antipsychotic Agents & Lithium > Flashcards

Antipsychotic Agents & Lithium Flashcards

1
Q

What are the essentials of dx for schizophrenia? (6)

A

Social withdrawal

Loose thought associations

Autistic absorption in inner thoughts

Auditory hallucinations

Delusions

Sx ≥ 6 months duration

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2
Q

What plays a role in schizophrenia?

A

Serotonin: 5-HT2A receptor blockade

Dopamine: blockade of postsynaptic D2 receptors

Glutamate: hypofunction of NMDA receptors

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3
Q

Out of all of the first generation antipsychotics (FGAs), which causes the most wt gain?

A

Chlorpromazine

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4
Q

Which FGA causes significant QT prolongation?

A

Thioridazine

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5
Q

Which 2nd-gen antipsychotics should be taken w/ food? How many calories are required?

A

Lurasidone: ≥ 350 calories

Ziprasidone: ≥ 500 calories

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6
Q

Which 2nd generation antipsychotics cause wt gain?

A

Olanzapine (avoid in 1st antipsychotic episode)

Quetiapine (dose related)

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7
Q

All antipsychotics should be tapered slowly before discontinuation to avoid cholinergic rebound.
Which drug is this especially important for?

A

Clozapine

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8
Q

What is the MOA of lithium?

A

Increase the volume of brain structures involved in emotional regulation

S/a the prefrontal cortex, hippocampus, & amygdala (reflecting its neuroprotective effects)

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9
Q

What does lithium do at a neuronal level?

A

Reduces excitatory (dopamine & glutamate) but increases inhibitory (GABA) neurotransmission

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10
Q

Which 2 drug classes cause decreased clearance of lithium?

A

Thiazides & NSAIDs

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11
Q

What are ADEs of lithium?

A

Tremor

Edema

Hypothyroidism*

Renal dysfunction

Pregnancy category D*

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12
Q

What are 3 newer drugs used for bipolar disorder?

A

Carbamazepine

Lamotrigine

Valproic acid

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13
Q

What is an ADE of lamotrigine (1 of the newer drugs for bipolar d/o)?

A

Rash*

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14
Q

How do you initially treat hypomania?

A

Initiate mood stabilizer: lithium, valproate, carbamazepine, or SGAs

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15
Q

If initial tx for hypomania fails, what is your next step?

A

Consider 2 drug combo:

Lithium + an anticonvulsant or SGA

Anticonvulsant + another anticonvulsant or SGA

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16
Q

How do you initially treat mania?

A

2 or 3 drug combos + a benzo &/or antipsychotic for short term adjunctive tx of agitation or insomnia

17
Q

If initial tx for mania fails, what is your next step?

A

Consider 3 drug combo:

Lithium + anticonvulsant + antipsychotic

Anticonvulsant + another anticonvulsant + antipsychotic

18
Q

If 3-drug therapy fails in the tx of mania, what is your next step?

A

Consider ECT or add clozapine

19
Q

How do you initially treat a mild to moderate depressive episode?

A

Initiate mood-stabilizer: lithium, quetiapine, lurasidone

20
Q

How do you initially treat a severe depressive episode?

A

Optimize current mood stabilizer or initiate: lithium, quetiapine, or lurasidone

21
Q

If initial treatment for severe depressive episode fails, what is your next step?

A

Consider carbamazepine or adding antidepressant

22
Q

If second form of tx fails for severe depressive episode, what is the 3rd step?

A

Consider 3-drug combo:

Lithium + lamotrigine + antidepressant

Lithium + quetiapine + antidepressant

23
Q

If 3rd form of tx fails for severe depressive episode, what is the 4th step?

A

Consider ECT

24
Q

What are the 4 dopaminergic pathways?

A

Mesolimbic: + sx

Mesocortical: - sx

Nigrostriatal: EPS & tardive dyskinesia

Tuberophypophyseal: hyperprolactinemia

25
Q

What are overall characteristics of antipsychotics?

A

Well absorbed

Lipid soluble

Bound to plasma proteins

Metabolized by liver enzymes, renally eliminated

Long 1/2 lives

26
Q

What are relative side effects of antipsychotics?

A 
Sedation
EPS 
Anticholinergic
Orthostasis
Wt gain 
Prolactin
27
Q

What agents are used to treat EPS?

A 
Antimuscarinics
Antihistaminic
Dopamine agonist 
Benzos 
B-blockers
28
Q

How long should you continue antipsychotic therapy after remission of the 1st episode?

A

At least 12 months

Many recommend tx for at least 5 yrs

29
Q

How do you switch from 1 antipsychotic to another?

A

Taper & discontinue the 1st over at least 1-2 wks while the 2nd antipsychotic is initiated & tapered upward

30
Q

What is lithium used for?

A

Manic phase of bipolar d/o

Prevents mood swings

31
Q

What 2 classes of meds may need to be included during the initiation of lithium or valproic acid for bipolar d/o?

A

Antipsychotics & benzos due to slow onset of lithium & valproic acid

32
Q

What can precipitate mania in bipolar pts?

A

Monotherapy w/ antidepressants

33
Q

What are ADEs of carbamazepine (1 of the newer drugs for bipolar d/o)?

A

Hematotoxicity & induction of drug metabolism

34
Q

What are ADEs of valproic acid (1 of the new drugs for bipolar d/o)?

A

Hepatic dysfunction
Wt gain
Inhibition of drug metabolism

Pharm II Exam 4 (14 decks)

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