Exam 2-Wk7 Flashcards
week 7
EPS sx’s
5
acute dystonia, akathisia, parkinsonism, TD, neuroleptic malignant syndrome
NMS
neuroleptic malignant syndrome
life threatening, high fever, diaphoresis, unstable BP, dysrhythmias, AMS
AMS: altered mental state
Akathisia
motor restlessness
acute dystonia
acute sustained contraction of muscles, usually of the head, neck, and back
parkinsonism
Having tremor, muscle rigidity, stooped posture, and a shuffling gait.
TD
unusual tongue or face movements
Treatment for NMS
3
- antipyretics
- electrolyte replacements
- muscle relaxants
Treatment for acute dystonia
3
- Anticholinergics
- diphenhydramine
- benztropine
Treatment for Akathisia
3
- beta-adrenergic blockers
- anticholinergics
- benzodiazepines
Treatment for Parkinsonism
2
anticholinergic drugs and amantadine
Treatment for TD
and risk of treatment
valbenazine improves TD symptoms but can cause QT prolongation
hypoxia
insufficient oxygen at tissue level
hypoxemia
insufficient oxygen in blood
Drug class that causes QT prolongation
2
FGA, SGA
Drug class that causes Orthostatic Hypotension
3
TCAs, FGA, SGA
Benefits of CNS depression
- decreased anxiety
- improved mood
- antipsychotic effects
- anticonvulsant effects
- anti-spasm effects
- anesthesia
- decreased pain
- improved sleep
Risks of CNS depression
oversedation, respiratory depression, mental confusion
2 neurotransmitters inhibited in CNS depression
ACh and dopamine
Inhibition of ACh results
less anxiety, improved sleep
Inhivition of dopamine results
less psychotic, less hyperactivity
CNS depression continuum
A/A, lethargic, obtunded, stupor/semi-coma, coma
Are CNS depression drugs on the BEERS list?
yes
What is SES
Serotonin Syndrome
Signs/Sx’s of SES
- alt mental status (anxiety, agitation, confusion)
- HTN, tachycardia
- tremors, muscle rigidity
- incoordination
- sweating
- fever
- seizure
Causes of SES
SSRI’s, MAOi’s, TCAs, St Johns Wort, opioids, triptans, amphetamines
Treatment of SES
- stop all serotonergic drugs
- treat vital signs
- usually resolves in 24 hours
Drug-Drug/ Drug-herbal interactions with CNS depressants
1 drug, 3 herbal
- Drug- Drug: antihistamines
- Drug-herbal: melatonin, kava, valerian
alcohol withdrawl complications
DT- agitation, confusion, hallucinations, tremors, panic attacks, paranoia, coma, death
DT: delirium tremens
Alcohol withdrawl tx
seizures/DT vs hallucinations
- DT/seizures: benzos (diazepam/lorazepam)
- Hallucinations: antipsychotics (risperadone)
Alchohol DDI with
Cardiovascular
4
DDI=drug-drug interaction
- beta blockers
- statins
- antianginals
- anticoagulants
Alchohol DDI with
CNS drugs
4
DDI=drug-drug interaction
- antianxiety
- antidepressants
- antipsychotics
- antiseizure
Alchohol DDI with
pain meds
3
DDI=drug-drug interaction
- analgesics
- NSAIDs
- opioids
Best MDD tx
2
CBT/CAM
What does CBT stand for?
comprehensive behavioral therapy
What does CAM stand for?
complimentary alternative therapy
Difference between Bipolar 1 vs 2
1: cycle between mania and depression
2: cycle between hypomania for at least a week, to severe depression
Delusions
unfounded beliefs, grandiose, hyperreligious, paranoia
Hallucinations
seeing/hearing/feeling something not present
Causes of psychosis/es
3
- neurotransmitter imbalance
- genetic
- environmental factors
MAOi Drug-Food Interactions
Broad Categories
5 + misc
- processed meats
- ETOH
- dairy
- some fruits/veggies
- fish
- misc
MAOi Drug-Food Interactions
Fruits/veggies
avocados, bananas, canned figs, fermented soybeans, bean pods, raisins
MAOi Drug-Food Interactions
Fish
- dried
- fermented
- smoked
- pickled
MAOi Drug-Food Interactions
Misc
5
- Yeast
- Some soups
- protein supplements
- soy sauce
- shrimp paste
MAOi Drug-Drug Interactions
Drug Classes
2
- Opioids
- Antidepressants
SSRI/SNRI’s
Adverse Effects
7
- EPS
- SES
- QT prolongation
- SI risk
- SIADH
- Seizures
- Hyponatremia
SSRI/SNRI’s
Common side effects for non-adherence
2
- Weight Gain
- Sexual Dysfunction
Lithium Toxic levels
> 1.5 mEq
Overdose Tx for
Benzodiazepines
flumazenil
Overdose Tx for
Barbituates
None. Activated charcoal
Overdose Tx for
TCA’s
None. Activated charcoal