CNS 2 Exam 3 Flashcards
Q: Which anticonvulsants are commonly used to manage bipolar disorder?
A: Carbamazepine, Valproic Acid, and Lamotrigine.
Q: What is Lithium used for in bipolar disorder, and what are other conditions it may treat?
A: Lithium is the drug of choice (DOC) for manic episodes, long-term prophylaxis, and preventing suicide. It’s also used for alcoholism, migraines, bulimia/anorexia, schizophrenia, and glucocorticoid-induced psychosis.
Q: Describe the mechanism of action of Lithium in the CNS.
A: The exact mechanism is unknown. Lithium may regulate catecholamine release by increasing norepinephrine and serotonin uptake, reducing norepinephrine release from presynaptic vesicles, and inhibiting norepinephrine action in the postsynaptic neuron.
Q: What are the early adverse effects of Lithium?
A: Fatigue, headache, confusion, memory problems, nausea/vomiting, weight gain, hair loss, acne, renal toxicity, tremors, polyuria/thirst, goiter, and hypothyroidism.
Q: What is the therapeutic range of Lithium for acute mania and chronic management?
A: Acute Mania: 1-1.5 mEq/L; Chronic Management: 0.6-1.2 mEq/L.
Q: What should be monitored to prevent Lithium toxicity?
A: Lithium levels, renal function, hydration status, and sodium levels should be monitored.
Q: What are signs of Lithium toxicity?
A: Nausea, vomiting, diarrhea, ataxia, confusion, agitation, slurred speech, and tremor.
Q: How does sodium intake affect Lithium levels?
A: A sudden decrease in sodium intake may raise Lithium levels, while a sudden increase may lower them. Stable sodium intake is essential.
Q: What are the three major objectives of schizophrenia drug therapy?
A: 1) Suppress acute episodes, 2) Prevent exacerbations, and 3) Maintain the highest possible level of functioning.
Q: What is unique about depot antipsychotics?
A: Depot antipsychotics are long-acting, injectable formulations used for long-term maintenance, dosed every 2-4 weeks, and have a lower relapse rate.
Q: List the types of extrapyramidal symptoms (EPS) and when they typically appear.
1) Acute Dystonia: Hours/days – muscle spasms, treated with diphenhydramine or benztropine.
2) Parkinsonism: Within 1 month – stooped posture, shuffling gait, treated with anti-ACh drugs.
3) Akathisia: First 2 months – pacing/squirming, treated with anti-ChE drugs.
4) Tardive Dyskinesia: Late onset, often irreversible – tongue rolling, lip smacking, switch to SGA.
Q: Why are second-generation antipsychotics (SGAs) preferred over first-generation antipsychotics (FGAs)?
A: SGAs have a lower risk of EPS and often have improved tolerability, though they may cause metabolic effects like weight gain, DM, and dyslipidemia.
Q: What is a unique side effect of Clozapine, an SGA?
A: Fatal agranulocytosis. WBCs should be monitored before and during treatment.
Q: What is Neuroleptic Malignant Syndrome, and how is it treated?
A: NMS is a rare, serious reaction to FGAs characterized by sweating, rigidity, fever, and autonomic instability. Treatment includes Dantrolene for muscle rigidity and bromocriptine (DA agonist).
Q: Which neurotransmitters are targeted by different classes of antidepressants?
A: SSRIs target serotonin; SNRIs target serotonin and norepinephrine; TCAs affect serotonin and norepinephrine; MAOIs inhibit the breakdown of serotonin, norepinephrine, and dopamine.
