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Summer pharm 4 > antipsychotics > Flashcards

antipsychotics Flashcards

1
Q

Essentials in diagnosing schizophrenia

A 
social withdrawal 
lose thought associations (shift topic to topic) 
Autistic absorption in inner thoughts 
Auditory hallucinations 
Delusions 
Sx at least 6 months
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2
Q

What are the different types of schizo

A 
Schizophrenic d/o 
Delusional d/o 
Schizoaffective d/o 
Schizophreniform d/o 
Brief psychotic d/o
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3
Q

What are the dopaminergic pathways

A

Mesolimbic: + Sx
Mesocortical: - Sx
Nigrostriatal: EPS, tardive dyskinesia
Tuberophypophyseal: hyperPRL

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4
Q

What are + Sx

A

suspicious
delusions
hallucinations
conceptual disorganization

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5
Q

What are - Sx

A

flat affect
alogia (aphasia)
anhedonia
avolition

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6
Q

What are cognitive Sx

A

impaired attention
impaired memory
impaired executive function

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7
Q

What is the hypothesis behind schizophrenia Tx

A

5-HT2a receptor block; modulate release of dopamine, NE, glutamate, GABA, and ACh
Block post-synaptic D2 receptors in CNS, mesolimbic (+), and striatal (EPS)

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8
Q

What can hypofunction of NMDA receptors on GABA neurons lead to

A

Diminished inhibitory influences on neuronal function
Glutamate can lead to hypertsimulation of cortical neurons
(idk what any of this means- slide 9)

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9
Q

What other receptors are involved in PD of antipsychotics

A

A-adrenergic blocking action
5-HT2/2a antagonists
5-HT1d agonists
D2 and 5-HT1a partial agonists

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10
Q

What are first gen antipsychotics

A 
Chlorpromazine 
Fluphenazine 
Haloperidol 
Loxapine 
Perphenazine 
Thioridazine 
Thiothixene 
Trifluperazine
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11
Q

What are second gen antipsychotics

A 
Aripiprazole
Clozapine 
Lurasidone 
Olanzipine 
Risperidone 
(not all inclusive)
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12
Q

What are the overall PK of antipsychotics

A 
Well absorbed 
Lipid soluble 
Bound to plasma proteins 
Metabolized by liver enzymes 
Renally eliminated 
Long half lives
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13
Q

What ADE should you monitor on someone taking antipsychotics

A 
Akathisia (inner restlessness) 
Anticholinergic ADE 
Glucose intolerance 
HLD 
Orthostatic hypotension 
HyperPRL 
Sedation 
Sexual dysfunction 
Tardive dyskinesia 
Weight gain
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14
Q

Monitor for these ADE in specific antipsychotics

A 
Clozipine (2): Agranulocytosis (WBC), Sialorrhea (excess drooling 
Inhaled Loxapine (1): Bronchospasm, respiratory distress/depression/arrest
Long acting Olanzapine (2): post-injection sedation, delirium syndrome
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15
Q

Antipsychotic toxicity can lead to

A

Dose dependent EPS: bradykinesia, rigidity, tremoe, akathisia, dystonias
Tardive dyskinesia: choreathetoid movements of lips and buccal muscle (appear at 6 months-yrs later)

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16
Q

How do you treat toxicities associated with antipsychotics

A

Dose dependent EPS (parkinson like Sx): muscarinic blockers and Diphenhydramine
Tardive dyskinesia: No Tx

17
Q

What specific drugs treat EPS 2/2 antipsychotics

A

Benztropine, Trihexyphenidyl (antimuscarinic)
Diphenhydramine (antihistamine)
Amantadine (D agonist)
Lorazepam, Diazepam, Clonazepan (benzos)
Propranolol (BB)

18
Q

Haloperidol is usually automatically paired with

A

Benztropine (anti-muscarinic)

19
Q

Schizophrenia Tx addresses

A 
Psychosocial component 
Psychiatric pharm 
co-occurring mental d/o
Tx adherence 
Medical problems
20
Q

Goal for schizo Tx is

A

First 7 days: decrease agitation, hostility, anxiety, aggression. Normalize sleep and eating
Wk 2-3: improve socialization, self-care, mood
Wk 6-8: Improve formal thought disorder

21
Q

How do you maintain therapy (avoid relapses) in schizo

A

Continue meds for 12 mo. after remission of first episode, but most recommend 5 years
Lifetime lowest dose of pharm therapy
Taper Clozapine and other 1st gens slowly to avoid cholinergic rebound

22
Q

How do you switch someone to a different antipsychotic

A

Taper the first down slowly and d/c over 1-2 weeks

At the same time, initiate the new antipsychotic and taper upward

23
Q

What agents are used to treat Bipolar disorder

A

Lithium*: Tx manic phase, and prevent recurrent manic and depressive episodes
Valproic acid, Carbamazepine, Lamotrigine, Quetiapine, Olanzapine

24
Q

What do you need to do when treating bipolar disorder (with meds)

A

Include antipsychotics and benzos during initiation to slow the onset of lithium or valproic acid

25
Q

What can monotherapy with antidepressants do to bipolar patients

A

Precipitate mania!

Diagnosis needs to be correct w/ bipolar b/c SSRI’s expose mania

26
Q

How does lithium work

A

Increase volume of brain structures that regulate emotions (pre-frontal cortex, hippocampus, amygdala)= Neuroprotective
Reduces excitatory NT (dopamine, glutamate) and increases inhibitory NT (GABA)
-Suppresses IP3 and DAG signaling

27
Q

What are the PK of lithium

A

Absorption: complete in 6-8 hrs, peak plasma in 30min-2hr
Distribution: no protein binding. some sequestered in bone
Metabolism: none
Excretion: Urine (renally)! half life is 20 hrs

28
Q

What are the effects of Lithium

A

No sedation! no specific ANS or CNS receptors

29
Q

Lithium clearance is decreased by

A

Thiazides

NSAIDs

30
Q

Toxic ADE of lithium are

A 
tremor 
edema 
Hypothyroid*
renal dysfunction 
*Pregnancy category D
31
Q

What are newer drugs used for manic component of bipolar disorder and their ADE

A

Carbamazeoine: ataxia, diplopia
Lamotrigine: nausea, dizziness, HA
Valproic acid: GI distress, weight gain, alopecia
-unclear mechanism

32
Q

What are toxicities of new manic Tx drugs

A

Carbamazepine: hematotoxicity
Lamotrigine: Rash
Valproic acid: hepatic dysfunction, weight gain

33
Q

First line for hypomania

A

Lithium, valproate, carbamazepine, Second gen antipsychotics
Consider + Benzo to combat initial insomnia

34
Q

First line for mania

A

2-3 drugs: lithium, valproate, second gen antipsychotic + a benzo short term for insomnia, or lorazepam for catatonia

35
Q

First line for mild-moderate depressive episode

A

Optimize or initiate: Lithium, Quetipine, Lurasidone

36
Q

First line for severe depressive episode

A

Optimize or initiate: lithium, Quetipine, Lurasidone

Add fluoxetine ot olanzapine if also w/ psychosis

Summer pharm 4 (14 decks)

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