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pharmacology 2 > CNS & Psychiatric Drugs > Flashcards

CNS & Psychiatric Drugs Flashcards

1
Q

What kind of antianxiety/antidepressant is your patient likely to be taking if they need to avoid eating foods like avocados, cheese, liver, fava beans, and chianti?

A

Monoamine oxidase inhibitors (MAOIs)

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2
Q

Are there any dietary restrictions for MAO-B inhibitors?

A

No, even though the MAO-B subtype metabolizes tyramine, there are no dietary restrictions except when taken at very high doses.

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3
Q

For which antidepressants can overdose be lethal?

A

MAOIs, TCAs

but not SSRIs

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4
Q

What are some side effects of overdose of MAOIs?

A

tachycardia, hyperthermia, hypermetabolism (including rigidity), seizures, coma

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5
Q

What may be used as treatment of MAOI overdose?

A

Dantrolene (muscle relaxant, also used for MH)

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6
Q

Should MAOIs be stopped prior to anesthesia?

A

No, there is no data to support stopping for 2-3 weeks prior to anesthesia.

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7
Q

What are some possible drug interactions you may want to consider in the OR when your patient is on MAOIs?

A
  1. Sympathomimetics should be used with caution (use direct > indirect)
  2. Consider avoiding epi in local/regional anesthetics
  3. Opioids have a potential for excitatory OR depressive reactions w/ meperedine.
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8
Q

What drug do we give as treatment of choice for bipolar (manic-depressive) disorder?

A

Lithium

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9
Q

How do we dose lithium?

A

It requires the measurement of plasma concentrations.

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10
Q

Where is lithium reabsorbed?

A

As it is filtered by the kidney, it gets reabsorbed in the proximal tubule, competing with sodium.

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11
Q

What does dehydration or diuretics do to lithium levels?

A

Sodium depletion may increase the levels of lithium.

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12
Q

What are some side effects of lithium?

A

polydipsia, polyuria, hypothyroidism

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13
Q

What are some drug interactions associated with lithium?

A
  1. prolonged responses to depolarizing AND nondepolarizing NMBs
  2. Avoid diuretics (loop, thiazide) & NSAIDs
  3. Neuroleptic drugs can increase risk of extrapyramidal side effects and NMS
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14
Q

What are symptoms of lithium toxicity?

A

lethargy, weakness, tremor, QRS widening, heart block, hypotension, confusion, seizures.

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15
Q

What causes exacerbation of lithium toxicity?

A

dehydration, sodium restriction, diuretics, NSAIDs, dialysis

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16
Q

What is given as treatment of schizophrenia primarily, with some affect on bipolar disorder?

A

Antipsychotic drugs (neuroleptic)

Haloperidol (Haldol) & droperidol are most common.

Others: Chloropromazine (Thorazine), clozapine (Clozaril), risperidone (Risperdal)

17
Q

What is the mechanism of antipsychotic drugs like Haldol?

A

They block the dopamine receptors

18
Q

How are antipsychotic drugs metabolized?

A

Hepatic metabolism

19
Q

What are the side effects of antipsychotic drugs?

A
  1. Extrapyramidal effects like movement disorders (all except clozapine)
  2. Neuroleptic Malignant Syndrome
  3. CV effects
  4. Endocrine effects
  5. CNS effects
  6. Agranulocytosis (Clozapine)
20
Q

Describe the extrapyramidal effects of antipsychotic drugs.

A
  1. Tardive dyskinesia: abnormal involuntary movements of face, neck, tongue
  2. Acute dystonic reaction: muscle rigidity/cramping of face/neck/tongue, larynx
  3. Parkinsonism: Rigidity, tremor, bradykinesia/akinesia
  4. Akathesia = restlesness
21
Q

What can you give for an acute dystonic reaction?

A

diphenhydramine (Benadryl) or benztropine (Cogentin) – Anticholinergics

22
Q

What are symptoms of NMS (neuromuscular malignant syndrome)?

A

hyperthermia, muscular hypertonicity, autonomic instability, mental status changes, and rigidity leading to possible vent requirement or myonecrosis (renal failure)

23
Q

What is the incidence of NMS w/ Antipsychotic drugs?

A

0.5-1%

24
Q

What are the mortality rates of NMS with antipsychotic drugs?

A

20-30%

25
Q

How do you treat NMS?

A

Dantrolene (relaxes muscles)

Amantadine/bromocriptine (dopamine agonists)

26
Q

Does nondepolarizing NMBs cause flaccid paralysis in NMS or in MH?

A

NMS. NOT in MH.

27
Q

What are the CV effects caused by antipsychotic drugs like Haldol?

A
  1. Alpha blockade, causing orthostatic hypotension.

2. Prolonged QTc, causing Vtach or toursades

28
Q

What are the endocrine effects of antipsychotic drugs like Haldol?

A
  1. Blocked inhibition of prolactin –> galactorhea, gynecomastia
  2. Decreased corticotropin release –> decreased corticosteroids
  3. Weight gain, hyperglycemia
29
Q

What are the CNS effects of antipsychotic drugs?

A

sedation, anti-emetic effects, dysphoric responses (especially with droperidol)

30
Q

Which drug specifically causes agranulocytosis, a lowered WBC count/immune system.

A

Clozapine, antipsychotic drug

31
Q

Are there any drug interactions we need to be concerned about if our patient is on antipsychotic drugs?

A

Yes, the potentiation of opioids.

pharmacology 2 (4 decks)

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