Exam 3 - Mental Health

Question 1

1st generation

Conventional Antipsychotics

Answer 1

Chlorpromazine, haloperidol

Question 2

Chlorpromazine (Thorazine) , haloperidol (Haldol)

Answer 2

1st generation - conventional antipsychotics - CHEAPER
Chlorpromazine = low potency
Haloperidol = high potency
MOA: Dopamine receptor antagonist
Effects: Decrease positive symptoms
Uses: Schizophrenia
Toxicity: EPS, sedation, neuroleptic malignant syndrome

Question 3

2nd generation

Atypical antipsychotics

Answer 3

Risperidone, clozapine

Question 4

Risperidone, clozapine

Answer 4

2nd generation - atypical antipsychotics
MOA: 5-HT2 receptor antagonist, dopamine receptor antagonist, also works on seratonin
Effects: Decreased positive symptoms
Uses: Schizophrenia, bipolar disorder
Toxicity: Metabolic syndrome, sedation, EPS, seizures

Clozapine - agranulocytosis, seizures, monitor WBC,ANC. glucose weekly!

Question 5

SSRIs

Answer 5

Fluoxetine (Prozac)
1st line medication class
AE: sexual dysfunction, wt. gain, withdrawal syndrome, serotonin syndrome (flushed red face)
Watch for drug interactions with anti-platelet agents

Question 6

SNRI

Answer 6

Venlafaxine
Duloxetine - can also be used for neuropathic pain
Similar AE as SSRIs, watch for drug interactions

Question 7

TCAs

Answer 7

Imipramine - 1950s
Effective with significant AE: orthostatic hypotension, sedation, anticholinergic effects, seizures
OVERDOSE CAN BE LETHAL
Not commonly used anymore

Question 8

MAO Inhibitors

Answer 8

Last line of therapy
Hypertensive crisis - AVOID TYRAMINE
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)

Question 9

Lithium

Answer 9

MOOD STABILIZER
MOA: changes in 2nd messenger pathway for amine neurotransmitters in CNS
Decreases mood swings
Narrow therapeutic index
Plasma levels: 0.8-1.4 mEq/L, Monitor q2-3 days then 3-6 mo
Can accumulate with hyponatremia; decreased renal excretion
AE: diarrhea, vomiting, hand tremor, sedation, ataxia, edema, fatigue & thirst, CV: arrhythmia, hypotension EKG changes, thyroid disorders, diabetes insipidus, drug interactions (NSAIDs, ACE inhibitors, ARB)

Question 10

Mood Stabilizer

Answer 10

Valproic Acid/Divalproex Sodium (Depakote): target levels: 50-100 mcg/ml
Carbamazepine: reduces symptoms, protective agents recurrence of mania and depression, target levels: 4-12 mcg/ml
Lamotrigene: can be used alone or in combination, has been titrated slowly due to life-threatening skin eruptions

Question 11

Benzodiazpines

Answer 11

Used to treat acute anxiety attacks
Intensify the effects of GABA
AE: sedation & respiratory depression
The more you use them, the more you overcome the AEs
Antidote = flumazomel - seizures can happen if you reverse benzos