Banderas: Just the Stuff in Red Flashcards
Etiology of positive symptoms of schizophrenia
Excess DA in mesolimbic system
Etiology of negative symptoms of schizophrenia
Deficiency of DA in mesocortical system (2ry to excess 5HT)
Goals of treatment of schizophrenia?
Decrease DA in the mesolimbic system
Increase DA in the mesocortical system via 5HT block
Low potency 1st gen antipsychotic?
Chlorpromazine
High potency 1st gen antipsychotic?
Haloperidol
2nd gen antipsychotics?
Quick, Zippy CAR
Q = quetiapine Z = ziprasidone C = clozapine A - aripiprizole R = risperidone
MOA of 1st gen antipsychotics
Non-specific D2 antagonism
MOA of 2nd gen antipsychotics
5HT2A antagonism
Weak D2 block
Special considerations with clozapine
Decreases seizure threshold (dose-dependent)
QT prolongation risk
Agranulocytosis (requires monitoring)
Most metabolic effects (DM II, lipids, etc)
Tx for antipsychotic-induced dystonia?
Anticholinergics (often prescribed with first gen antipsychotics)
What to do when patient develops tardive dyskinesia?
D/c 1st gen antipsychotic and switch to 2nd gen antipsychotic
Consideration with IV haloperidol?
Especially likely to cause QT prolongation
Compare AE of low- and high-potency 1st gen anti psychotics
Low: more anti-HAM effects
High: more EPS effects
2nd gen antipsychotics causing QT prolongation?
Greatest risk with clozapine and ziprasidone
Buzzword: cataracts
Quetiapine
Antipsychotics with least potential for weight gain
Aripiprazole and ziprasidone
Action of SSRIs
Inhibit reuptake of serotonin; effect of 5HT1A receptors mediates antidepressant effects
Your patient runs out of his SSRI medication before leaving town and cannot refill it while away. What may occur?
Discontinuation effects (anxiety, rebound depression, flu-like symptoms, etc)
Fluoxetine has long half-life (“self-tapering”) and can help avoid this problem, but also can cause interactions if initiating another therapy.
Which SSRIs hold the highest risk of QT prolongation
Es/citalopram
Which SSRI has the worst sexual side effects?
Paroxetine
Which SSRIs should not be used in a patient who has insomnia?
Fluoxetine and sertraline - these are mildly stimulating
What is the MOA of trazadone?
SSRI
5HT2A antagonism
H1 antagonism
What might be a good adjunctive therapy for a patient currently taking an SSRI but struggling with insomnia?
Trazadone
Which antidepressant is most associated with orthostatic hypotension?
Trazadone
MOA of SNRIs
Antagonizes POSTsynaptic a2 receptors
Antagonizes 5HT POSTsynaptic receptors
Inhibit reuptake of serotonin and NE
Which antidepressant might be prescribed to a patient concerned about sexual side effects?
Bupropion
Should bupropion be taken in AM or PM?
AM - mildly stimulating
Special considerations with mirtazapine
High incidence of sedation and weight gain
When using cyclic antidepressants to treat depression-related insomnia, what should be considered?
Much lower dose is used for sleep than for antidepressant effect
What is the action of benzodiazepines?
Promote GABA binding to GABAa receptors –> Cl conductance
A low dose of benzo is good for what effect?
Calming and decreased anxiety (higher dose = sedation)
What is an appropriate tx for an acute, severe anxiety crisis?
Benzodiazepine, IV or PO
What are appropriate tx options for chronic anxiety?
SSRIs/antidepressants
Buspirone
Antipsychotics
What is the goal of ADHD pharmacotherapy?
Optimal dosing to improve NE signaling and better direct DA firing
What is the association between ADHD treatment and subsequent substance abuse disorders?
Kids with untreated ADHD are 1.9 fold more likely to develop a substance abuse disorder later in life than those kids who are appropriately treated
