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PC 707 Pharmacology > Module 7 Unit C Mood Stabilizers and Antipsychotics > Flashcards

Module 7 Unit C Mood Stabilizers and Antipsychotics Flashcards

1
Q

What are the indications for the Lithium Mood Stabilizers (Eskalith, Lithobid, Lithostat, & Lithium carbonate)?

A

Bipolar I, maintenance
Bipolar I, acute manic/mixed
Schizoaffective disorder

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2
Q

What is the MOA of the Lithium Mood Stabilizers (Eskalith, Lithobid, Lithostat, & Lithium carbonate)?

A

Unknown and complex

Alters sodium transport across cell membranes in nerve and muscle cells
Alters metabolism of neurotransmitters, including catecholamines and serotonin

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3
Q

What D2D interactions are associated with the Lithium Mood Stabilizers (Eskalith, Lithobid, Lithostat, & Lithium carbonate)?

A

NSAIDs, diuretics (esp thiazides) Angiotensin-converting enzyme inhibitors, metronidazole (Flagyl) acetazolamide

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4
Q

What is the BBW associated with the Lithium Mood Stabilizers (Eskalith, Lithobid, Lithostat, & Lithium carbonate)? What are the symptoms?

A

Toxicity levels can occur at doses close to therapeutic levels.
Toxicity symptoms: Slurred speech, confusion, severe GI

Hepatotoxicity and pancreatitis

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5
Q

What monitoring is required with the Lithium Mood Stabilizers (Eskalith, Lithobid, Lithostat, & Lithium carbonate)?

A

Lithium levels must be monitored.

Kidney function.

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6
Q

What condition is often caused by long term use of Lithium?

A

Hypothyroidism is often caused by long-term use of lithium.

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7
Q

What is the indication for Carbamazepine (Tegretol)?

A

Bipolar Disorder

Seizures

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8
Q

What is the MOA of Carbamazepine (Tegretol)?

A

suppresses sodium influx

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9
Q

What D2D interactions are associated with Carbamazepine (Tegretol)

A

CYP450 3A4 inducers can lower plasma levels of carbamazepine

CYP450 3A4 inhibitors can increase plasma levels of carbamazepine

Carbamazepine can decrease plasma levels of hormonal contraceptives and adversely affect their efficacy

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10
Q

What BBW is associated with Carbamazepine (Tegretol)?

A

Serious dermatologic reactions/SJS and HLA-B*1502 Allele

Aplastic anemia/agranulocytosis

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11
Q

What are the indications for Valproic acid (Depakote)?

A

Partial seizures, Absence seizures, Bipolar disorder (acute manic), migraine headache prophylaxis

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12
Q

What is the MOA of Valproic acid (Depakote)?

A

Blocks voltage-sensitive sodium channels by an unknown mechanism
Increases brain concentrations of GABA by an unknown mechanism.

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13
Q

What is the BBW associated with Valproic acid (Depakote)?

A

Hepatotoxicity

Increased hepatotoxicity risk in mitochondrial disease

Fetal Risk

Pancreatitis

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14
Q

What are the indications for Lamotrigine (Lamictal)?

A

Bipolar I disorder, maintenance (helps in depressive phase)
Partial seizures
Seizures, primary generalized tonic-clonic
Migraine headache with aura prophylaxis

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15
Q

What is the MOA of Lamotrigine (Lamictal)?

A

Acts as a use-dependent blocker of voltage-sensitive sodium channels
Interacts with the open channel conformation of voltage-sensitive sodium channels
Interacts at a specific site of the alpha pore-forming subunit of voltage-sensitive sodium channels
Inhibits the release of glutamate and aspartate

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16
Q

What is the BBW associated with Lamotrigine (Lamictal)?

A

SJS/Serious Rash

17
Q

What are the first-generation antipsychotics?

A

Haloperidol (Haldol)

Chlorpromazine

18
Q

What are the indications for the first-gen antipsychotics (Haldol & chlorpromazine)?

A

Antipsychotic

Schizophrenia

19
Q

What is the MOA of the first-gen antipsychotics (Haldol & chlorpromazine)?

A

Block receptors in and out of CNS such as dopamine, acetylcholine, histamine, and norepinephrine. They suppress symptoms of psychosis.

20
Q

What monitoring should be done with the first-gen antipsychotics (Haldol & chlorpromazine)?

A

Blood monitoring – CBC, electrolytes, liver, and heart functions.

21
Q

When are the first-gen antipsychotics (Haldol & chlorpromazine) contraindicated?

A

It is contraindicated in patients who are severely depressed or comatose or with Parkinson’s.

22
Q

What D2D interactions are associated with the first-gen antipsychotics (Haldol & chlorpromazine) contraindicated?

A

anticholinergics, CNS depressants, Levodopa.

23
Q

What are the Second Generation/Atypical Antipsychotics?

A 
Clozapine (clozaril) 
Olanzapine (zyprexa) 
Ziprasidone
(Geodon) 
Aripirazole (Abilify) 
Seroquel
24
Q

What are the indications for the Second Generation/Atypical Antipsychotics (Clozapine, Olanzapine, Ziprasidone, Aripirazole)?

A

Schizophrenia

25
Q

What is the MOA of the Second Generation/Atypical Antipsychotics (Clozapine, Olanzapine, Ziprasidone, Aripirazole)?

A

D2 antagonist and serotonin 2A antagonist

26
Q

What adverse effects are seen with the Second Generation/Atypical Antipsychotics (Clozapine, Olanzapine, Ziprasidone, Aripirazole)?

A

Cardiometabolic risks: weight gain, obesity, dyslipidemia, diabetes, and accelerated cardiovascular disease.

27
Q

What is the BBW associated with the 2nd gen Antipsychotics-Clozapine (Clozaril)?

A

Clozapine can cause life-threatening agranulocytosis and has been associated with myocarditis.

28
Q

What drugs prolong QT?

A

FGA antipsych: Chlorpromazine, Haldol, Thioridazine

SSRIs: Citalopram (celexa), Escitalopram (Lexapro)

29
Q

Common S/E with lithium

A

Nausea, fine-hand tremors, increased urination, and thirst.

30
Q

Side effects of Tegretol

A

Common: Nausea, dizziness, headache, dry mouth, constipation, skin rash
Rare BBW: Agranulocytosis/aplastic anemia, Sevens-Johnson syndrome, allele

31
Q

Monitoring with Tegretol

A

LFTs and CBC w/plt

32
Q

Side effects of Depakote

A

Common: Nausea, diarrhea, abdominal cramps, sedation, tremor
Rare: Increased liver enzymes, Stevens-Johnson syndrome
BBW: Hepatoxicty, fetal risk, pancreatitis

33
Q

Side effects Lamictal

A

Common: Dizziness, ataxia, somnolence, diplopia, nausea, headache, hepatotoxicity
BBW: Life-threatening rashes, including Stevens-Johnson syndrome

34
Q

D2D Lamictal

A

Oral contraceptives are inducer, so will increase levels of lamictal.

35
Q

Safety/SE of Haldol?

A

Common: extrapyramidal side effects, acute dystonia, parkinsonism, akathisia, tardive dyskinesia, sedation, hypotension

Prolonged QT
Hyperglycemia

36
Q

BBW Haldol

A

Mortality in elderly

37
Q

BBW 2nd generation/atypical antipsch

A

Suicide in adolescants.

Mortality in elderly

38
Q

What is Neuroleptic Malignant Syndrome (NMS)

A

The most severe potential adverse effect of antipsychotics.
Syndrome: Muscular rigidity, hyperthermia, altered consciousness, and autonomic dysfunction
Associated with: antiemetics, lithium, anticholinergic, and serotonergic agents

PC 707 Pharmacology (39 decks)

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