final review Flashcards
What is SS?
-Fever, tachycardia, HTN, CLONUS(hyperflex), Shits/shivers
-a/w: SSRI, SNRI, MAOI, triptans, analegisics, St Wort, cough med, tryptophan
-TX: NO BB, NO antichol. GIVE BZD, Cyproheptadine (antihistamine), olanzapine.
What is NMS?
-Fever, Tachy, HTN, RIGIDITY!, abn labs (high CK, high WBC, rhabdo).
- seen with FGA more often
-TX: antichol (Dantrolene, bromocriptine, amantadine) Give some dopa back bc it’s too blocked.
EPS? Three reversible manifestations
-Dystonia: oculogyric crisis, sustained muscle contraction, torticollis– eyes, neck, long muscle contracts
-Akathesia: restless!
-Parkinson’s
How to treat 3 reversible manifestations of EPS
-Dystonia: antichol: benzotropine, biperden, antihist:diphenhydramine
-Akathesia: BB, mirtazapine (tetracyclic antidepressant), cyproheptadine (antihistamine), BZD
-Parkinsons: antichol–benzotropine (avoid w/ older ppl); amantadine
Irreversible EPS
TD: chronic; involn lower face, limbs, trunk movement.
TX: VMAT inhib: Valbenazine, deutetrabenzine
SGA: clozapine
Gingko biloba
Whate are 4 dopamine pathways ?
-Mesocortical: neg schz symptoms– flat affect, impaired cognition
-Mesolimbic: positive schz symptoms– SUD = attempt to correct pathway but, may activate positive symptoms
-Nigrostriatal: regulated coordination of movement. Parkinson’s has ~ 80% decrease in this area
-Tuberinfundibular: prolactin secretotion
6 neurotransmitters
- DA
- NE
- Serotonin
- Glumate
- GABA
- Acetycholine
Dopamine hypothesis
-decreasing mesocort; increasing mesolimb; neutral nigro & tuberoinfund.
-meds attempting to dec dopa activity in mesolimbic to stop psychosis
-mesocortical pathway has incr dopa causing neg symptoms
~~ D2 receptor gatekeepers; occupy = neg feedback; disease or meds that inc dopa will produce or enhance positive symptoms.
Defining feature of schiz?
psychosis
– a/w schiz, mania, depression, cognitive disorders, bipolor, dementia, PTSD, depression, BPD
Schiz: positive & negative symptoms
-Positive: most dramatic, hosp maybe, target of most meds
-Neg: few meds target this; make life hard to fxn
FGA
-D2 anatag: HIGH EPS & NMS risks
–emotional quiet, affective indiff, psychomotor slowing
MEDS:
-thorazine
-chlopromazine : se of corneal deposits
-thioridazone
-haldol: high potency: EPS risk, QTc prolong–torsades
-fluphenazine, procholorperazine, loxapine, periciazine, trifluoperazine, flupentixol, zuclopentixol, methotrimeprazine
SGA
-D2/5HT2A antagonist (less D2=less risk EPS)
–more weight gain, metobolic SE, Inc chol, DM2
MEDS::
-clozapine: agranulocytosis; REM program– last resort
-risperadone: prolactin- gynecomastia, low BP
-paliperidone: like risperadone
-quetiapine: sedating
-olanzapine: wt gain, sedating
-ziprasidone: QTc prolong
-asenapine: SL– w/o food/water
-lurasidone: good for bipolar depression
Third Gen antipsychotic
aripiprazole
Which antipsychotics are used with ped population?
Aripiprazole, risperidone= metformin maybe for wt gain
Which antipsychotics r/t sedation?
PINES: quetiapine, olanzapine, clozapine, asenapine (SL)
less pip, rip, done
Which antipsychotics wt gain?
PINES
less pip, rip, done
Which antipsychotic causes anticholinergic SE?
PINES
Which antipsychotic causes EPS?
DONES
less in pines
Which antipsychotics can cause hypotension?
PINES & DONES– less in brex, cariprazine, lurasidone
Which antipsychotics causes QTc ?
PINES & DONES
less with pip, rip, zole
Significant SE of SSRI
hyponatremia, SS, discontinue syndrome, suicide risk, sexual dysfxn, dec seizure w/ wellbutrin
SGA MOA
5HT2A (antagonist/inverse agonist)
5HT2A stimulated by serotonin & blocks DOP release (dec dopamine).
Pimavanserin
5HT2A inverse agonist– parkinson’s psychosis
