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307 > Pharm > Flashcards

Pharm Flashcards

1
Q

Major Classes of Psychopharm

A

– Antipsychotics
– Mood stabilizers (Antimania)
– Antidepressants
– Antianxiety medications
– Stimulants (Amphetamines)
– Anti-Seizure/Anticonvulsants Medication

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2
Q

Four sites of pharmacodynamic action

A
  1. Receptors
  2. Ion channels
  3. Enzymes
  4. Carrier proteins
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3
Q

Types of receptor action

A

Agonist: same biologic action

Antagonist: opposite effect

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4
Q

A drug’s ability to interact with a given receptor type may be judged by 3 properties:

A
  1. Selectivity: the ability of the drug to be specific for a receptor. The more selective a drug is, the more likely it will affect only the specific receptors for which it is meant and not cause more unintended side effects.
  2. Affinity: degree of attraction or strength of bond between drug and receptor

3 Intrinsic activity: ability to produce a biologic response once it is attached to receptor. A measure of how much response a drug produces and ragnes from full agonist, to partial agonist, to antagonist.

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5
Q

Benzodiazepins are used as what 5 things:

A

sedatives, hypnotics, anxiolytics, anticonvulsants and muscle relaxants.

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6
Q

When benzodiazepines are bound to receptor-chloride channels, what occurs?

A

these drugs increase the frequency and duration of chloride ion movement through GABA into the cell, decreasing the ability of that cell to conduct an impulse

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7
Q

Define enzyme

A

complex proteins that catalyze specific biochemical reactions within cells and are targets for some drugs. Enzymes may be inhibited to produce greater neurotransmitter effect.

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8
Q

What is monoamine oxidase?

A

an enzyme that breaks down most bioamine neurotransmitters such as norepinephrine, serotonin, and dopamine

Inhibitors increase availability of catecholamines to relieve symptoms of depression

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9
Q

Efficacy

A

Ability of a drug to produce a desired response

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10
Q

Potency

A

Dose required to produce the desired biologic response

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11
Q

High vs Low Therapeutic Index

A

High therapeutic index: there is a wide range between dose at which the drug begins to take effect and dose that would be considered toxic.

Low therapeutic index: narrow range and are often carefully monitored through blood levels.

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12
Q

Types of antipsychotics

A

Typical (first generation)

Atypical (second generation- newer)

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13
Q

Types of typical antipsychotics

A

A. Phenothiazines: Chlorpromazine (CPZ) Largactil; Fluphenazine.

B. Non-Phenothiazines; Haldol, Flupentixol, Loxapine.

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14
Q

Cardiac side effects of antipsychotics

A

orthostatic hypotenstion, QT prolongation (heart muscle takes longer time to recharge between beats-shows up on EKG (some);

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15
Q

Anticholinergic effects of antipsycotics

A

dizziness, drowsiness, dry mouth, dry eyes. constipation

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16
Q

Blood dyscrasias effects of antipsychotics

A

low white blood cell; agranulocytosis

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17
Q

Side effects associated with atypical antipsychotics

A

Less side effects: but cause weight gain, hyperglycemia, decreased bone density.

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18
Q

What is EPS

A

also called drug-induced movement disorders, describe the side effects caused by certain antipsychotic and other drugs.

Produce acute and chronic/tardive side effects including involuntary/uncontrollable movements, tremors, muscle contractions

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19
Q

Acute EPS side effects

A

Akathisia: very restless or tense

Acute dystonia: involuntary muscle contractions. Movements often repetitive and may include eye spasms or blinking, twisting head, protruding tongue, extended neck, etc.

Parkinsonism: describes symptoms that resemble those of Parkinson’s disease: rigid muscles in your limbs; tremors.

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20
Q

Akathisia

A

Acute EPS side effect

very restless or tense

inability to sit still, restlessness.

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21
Q

Dystonia

A

Acute EPS side effect

involuntary muscle contractions. Movements often repetitive and may include eye spasms or blinking, twisting head, protruding tongue, extended neck, etc.

22
Q

Parkinsonism

A

Acute EPS side effect

rigidity, akinesia (slow movement), tremor, mask-like face, loss of spontaneous movements

23
Q

Treatment of EPS

A

Benztropine (Cogentin) used to treat and prevent EPS symptom. reduces the effects of certain chemicals in the body that may be unbalanced as a result of disease (such as Parkinson’s).

24
Q

Extrapyramidal symptoms are most commonly caused by:

A

typical antipsychotic drugs that antagonize dopamine D2 receptors.

The most common typical antipsychotics associated with EPS are haloperidol and fluphenazine

25
Q

Tardive Dyskinesia

A

Chronic EPS

late-onset extrapyramidal symptom. Involves repetitive, involuntary facial movements, such as tongue twisting, chewing motions and lip smacking, cheek puffing, and grimacing. You might also experience changes in gait, jerky limb movements, or shrugging.

26
Q

Neuroleptic Malignant Syndrome

A

a life-threatening idiosyncratic reaction to antipsychotic drugs characterized by:

fever, altered mental status, muscle rigidity, and autonomic dysfunction.

27
Q

List of Typical Antipsychotics

A

– Phenothiazines (Thorazine, Prolixin; Chlorpromazine [CPZ], marketed under the brand names Thorazine and Largactil among others)
– Thioxanthenes (Navane)
– Dibenzoxazepines (Loxitane)
– Haloperidol (Haldol)

28
Q

List of Atypical Antipsychotics

A

– Clozapine (Clozaril)
– Risperidone (Risperdal)
– Olanzapine (Zyprexa)
– Quetiapine (Seroquel)
– Ziprasidone (Geodon)
– Aripiprazole (Abilify)

29
Q

Antipsychotic Medication Side Effects

A
  • Cardiovascular
  • Anticholinergic
  • Weight gain
  • Endocrine and sexual side effects
  • Blood disorders
  • Miscellaneous
30
Q

2 Types of Moose Stabilizer Antimania Medications

A

Lithium Carbonate and Anticonvulsants

31
Q

Action of lithium carbonate

A

uncertain, crosses cell membranes, altering sodium transport, not protein bound

32
Q

Side effects of lithium carbonate

A

thirst, metallic taste, increased frequency or urination, fine head-and-hand tremor, drowsiness, and mild diarrhea

33
Q

Symptoms of Lithium Toxicity

A

severe diarrhea + vomiting, drowsiness, muscular weakness, tremors and lack of coordination

34
Q

What is monitored for patients on lithium

A

creatinine concentrations, thyroid hormones, and CBC every 6 months.

35
Q

What should you observe for in terms of thyroid function when a patient is on lithium

A

dry skin, constipation, bradycardia, hair loss, and cold intolerance.

36
Q

Types of anticonvulsants used for bipolar

A

Valporate and derivatives (divalproex sodium—Depakote)

Carbamazepine (Tegretol)

Gabapentin (Neurontin)

Lamotrigine (Lamictal)

Topiramate (Topamax)

37
Q

Side effects of carbamazepine (tegretol)

A

Dizziness, drowsiness, tremor, visual disturbances, nausea, and vomiting

Weight gain

Alopecia

38
Q

How is carbamazepine administered?

A
  • Side effects minimized by treating in low doses
  • Given with food
39
Q

List of Tricyclic Antidepressants

A
  • Amitriptyline (Elavil)
  • Clomipramine (Anafranil)
  • Doxepin (Sinequan)
  • Imipramine (Tofranil)
  • Trimipramine (Surmontil)
40
Q

List of secondary amine antidepressants

A
  • Amoxapine (Asendin)
  • Desipramine (Norpramin)
  • Nortriptyline (Aventyl, Pamelor)
  • Protriptyline (Vivactil)
41
Q

TCA Side Effects

A

Most common uncomfortable side effects:
– Sedation
– Orthostatic hypotension
– Anticholinergic (dry mouth, constipation, etc)

Other side effects
– Tremors
– Restlessness, insomnia, confusion
– Pedal edema, headache, and seizures
– Blood dyscrasias
– Sexual dysfunction

Adverse
– Cardiotoxicity

42
Q

List of SSRIs

A
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Fluvoxamine (Luvox)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
43
Q

Side Effects of SSRIs

A
  • Headache*
  • Anxiety
  • Transient nausea
  • Vomiting
  • Diarrhea
  • Weight gain
  • Sexual dysfunction
44
Q

Why and when are SSRIs usually given?

A

Usually given in morning, unless sedation occurs.

Higher doses, especially fluoxetine, can produce sedation.

45
Q

Action and important to remember about MAOIs

A

Inhibit the enzyme responsible for the metabolism of serotonin, dopamine, norepinephrine and tyramine

Increase levels of norepinephrine and serotonin in the CNS

Interact with food: low-tyramine diet

46
Q

List of Antianxiety medications

A

Benzodiazepines
– Diazepam (Valium)
– Lorazepam (Ativan)
– Alprazolam (Xanax)

Nonbenzodiazepines
– Buspirone (BuSpar)
– Zolpidem (Ambien)

47
Q

Side effects of antianxiety medications

A

– Sedation and CNS depression
– Tolerance and dependence (benzodiazepines)
– Avoid benzodiazepines in the elderly

48
Q

Types of stimulants and side effects

A
  • Amphetamines: methylphenidate (Ritalin), pemoline (Cylert), modafinil (Provigil)
  • Used for ADHD, narcolepsy, obesity
  • Side effects: appetite suppression, insomnia, irritability, weight loss, nausea, headache, palpitations, blurred visions, dry mouth, constipation, and dizziness
  • Effects on SNS: BP changes, tachycardia, tremors
49
Q

Action of ECT

A

Initiate generalized seizures by an electrical current

50
Q

How often is ECT done?

A

two to three times per week.

51
Q

What does ECT produce?

A

rapid relief of depressive symptoms

52
Q

Side effects of ECT

A

hypo- or hypertension, bradycardia or tachycardia, and minor arrhythmias immediately after.

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