L16: Anti-psychotics II Flashcards
Which receptor is primarily associated with orthostatic hypotension?
A. M1
B. Adrenergic alpha-1
C. Beta receptors
B. Adrenergic alpha-1
FLudrocortisone is occasionally used as a volume expander in those without other options to ___
Clozapine
Drugs that act on which receptor can be hard for elderly patients with which condition to handle?
Alpha-1 adrenergic; Poor vasomotor tone
True or false: AE’s associated with drugs that act on histamine receptor include weight gain and sedation
True
Rapid discontinuation of H1-R is followed by rebound ___ and ____
insomnia; sleep disturbance
Which drug may moderate anti-psychotic-induced weight gain?
Metformin
What side effect is commonly associated with Clozapine or Risperidone use?
Orthostatic hypotension
True or False: Use of anti-psychotics can lead to dyslipidemia and impaired glycemic control
True
What are two major adverse cardiac effects seen with use of anti-psychotics?
- QRS Widening
- Increase in PR interval - Greater risk of developing arrhythmia
Which generation of anti-psychotics is most likely to give rise to neuroleptic malignant syndrome?
First generation
Neuroleptic malignant syndrome is associated with decreased activity in the D2 receptors. What are the effect on nigrostriatum?
Muscle rigidity and tremor
How can neuroleptic malignant syndrome affect hypothalamus?
Impair temp regulation ; autonomic hyper-reactivity
How to manage neuroleptic malignant syndrome?
Dantrolene can be used to treat ____, consequence of decreased activity at D2 receptors in the skeletal muscle and nigrostriatum
rhabdomyolysis
Compare and contrast Serotonin Syndrome and Neuroleptic Malignant Syndrome:
The first line agents for treating schizophrenia are ___ anti-psychotics, except ____
second-generation (Aripiprazole or Risperidone) ; clozapine (associated w/weight gain, sudden cardiac death)
How do you treat catatonic forms of schizophrenia?
IV Benzodiazepines; Anti-psychotic drugs once catatonia has ended
Treatment of schizoaffective disorder?
For psychosis…
- anti-psychotic drugs
For mood disorder…
- anti-depressants + lithium + valproic acid
Major depressive disorder (unipolar depression) with psychotic features require lower doses of ___ and ____
anti-psychotics and anti-depressants
Which drug is commonly used as an adjunct in unipolar depression?
Aripiprazole
- Lithium too
Lithium, Carbamazapine, Lamotrigine, and Valproic Acid are associated with treatment of:
A. Mania
B. Bipolar Depression
C. Unipolar Depression
B. Bipolar Depression
Which 4 drugs can be used as a monotherapy for treatment of Mania?
(LOVA)
- Aripiprazole
- Olanzapine
- Lithium
- Valproic Acid
Which two drugs can be used to treat bipolar and act as VG Na blockers?
Carbamazepine and Lamotrigine
True or False: Lamotrigine both blocks VG Na channels and stimulates GABA synthesis/inhibits GABA degradation
True
Which of the following is used in acute mania and for prophylaxis in depressive phase?
A. Carbamazepine
B. Lamotrigine
C. Valproic Acid
A. Carbamazepine
True or False: Both Carbamazepine and Lamotrigine are effective at treating acute mania
False - only Carbamazepine is effective!
True or False: Valproic Acid is increasingly used as a first choice in acute mania
True
Which of the following bipolar disorder drugs is prone to cause SJS?
A. Lamotrigine
B. Carbamazepine
C. Valproic Acid
A. Lamotrigine
B. Carbamazepine
Liver dysfunction, weight gain, and inhibition of drug metabolism are AE associated with which of the following?
A. Lamotrigine
B. Carbamazepine
C. Valproic Acid
C. Valproic Acid
True or False: Carbamazepine is associated with hematoxicity and induction of P450 drug metabolism
True
Which drug for bipolar affective disorder suppresses inositol signaling and inhibits GSK-3?
A. Lamotrigine
B. Carbamazepine
C. Valproic Acid
D. Lithium
D. Lithium
True or False: Lithium has antagonists actions on the ANS-R and specific receptors, as well as sedative effects
False - lithium does not have antagonists actions on ANS-R or specific receptors; it also does NOT have sedative effects
True or False: Both Valproic Acid and Lithium are pregnancy cat D
True
What are features of Lithium toxicity?
Tremor, edema, hypothyroid, renal dysfunction, arrythmia
True or False: Lithium has DDI with thiazides and NSAID’s
True
True or False: Chronic Lithium treatment may prolong actions of local anesthetics
True
The early stages of Li+ toxicity mimics ____ intoxications
ETOH
What should be on the DD for nausea, confusion, hypotension, seizures, dizziness?
Serotonin Syndrome
Malignant Neuroleptic Syndrome
Li Toxicity
Irreversible Li-effectuated neurotoxicity is known as ___ ___
silent syndrome
What causes silent syndrome?
Demyelination of various CNS sites
Elevated levels of Lithium (as in Silent Syndrome) can affect which parts of the brain?
Brainstem and Cerebellum
Why are some anti-psychotics effective at suppressing tics in patients with Tourette disorder?
Reduced D2 NT in basal ganglia sites
Which anti-psychotic is the only one to be FDA approved for treatment of Tourette disorder?
Aripiprazole
- note: in the past, haloperidol was used off label
Which two anti-psychotics are approved to treat irritability in ASD?
Risperidone and Aripiprazole
What is the cause of Psychosis Associated with Parkinson’s Disease?
Lewy body associated with
1) loss of raphe neurons
2) upregulation of cortical 5HT2a-R
What is currently the primary medication used to treat hallucinations and delusions of PDP?
Pimavanserin (SS 5-HT2A inverse agonist)
- note: this drug IS associated with sudden cardiac death
What causes chorea, as seen in HD?
Over activity in dopaminergic nigrostrial pathways
-increased responsiveness to PS dopamine receptors
- deficiency of NT that normally antagonizes DA
Which drug has replaced DA receptor blockade in management of chorea?
Tetrabenazine
True or False: Haloperidol can suppress chorea and be used for treating psychosis in HD
True
In rigid Huntington’s Disease, ___ can be more effective for treating psychosis and paranoia
clozapine
The most striking neurochemical disturbance in Alzheimer’s Disease is a deficiency of ___, a neurotransmitter
Ach
Which three drugs can be used to treat AD?
Low dose clozapine
Risperidone
Haloperidol
True or False: Medications w/significant anti-cholinergic properties should be avoided in elderly patients, esp. those with dementia
True
