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BHM II > Pharm 20 > Flashcards

Pharm 20 Flashcards

1
Q

Positive sxs

A

Hallucinations
Agitation
Disordered thinking

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2
Q

Negative sxs

A

Flat affect
Avolition
Social withdrawal
Impoverished

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3
Q

Cognitive sxs

A

Attention
Memory
Reasoning
Learning

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4
Q

Dopamine - 1 receptor blockade characteristics

A

Cardiovascular receptors

No correlation/ therapeutic effects on dosage of drugs

Mostly all ASEs

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5
Q

Dopamine -2 receptor blockade characteristics

A
  • Receptors in mesolimbic mesocortical pathway

Produce “typical” effects, alleviate some positive sxs of schizophrenia.

D2 receptor binding correlates with clinical dosage of drugs to control schizophrenia

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6
Q

ASEs for D2 receptor blockage

A 
Hyperprolactinemia
Amenorrhea-galactorrhea
Infertility and/or impotence
Parkinsonism
Akathisia
Dystonia
Tardive dyskinesia
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7
Q

Histamine-1 (H1)-receptor blockade characteristics

A

Blockage of H1 may be important to efficacy but many mediate ASEs of these drugs.

Therapeutic benefit is unknown

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8
Q

Histamine-1 (H1)-receptor blockade ASEs

A

Weight gain

Sedation

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9
Q

5-Hydroxytryptamine-2A (5-HT2A)-receptor blockade characteristics

A

May contribute to the efficacy of antipsychotics

May improve some negative sxs of schizophrenia

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10
Q

5-Hydroxytryptamine-2A (5-HT2A)-receptor blockade ASEs

A

weight gain

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11
Q

Muscarinic-1 (M1)-receptor blockade characteristics

A

May reduce manifestations of movement disorders but NOT the underlying pathology of the movement disorder

May mask the development of movement disorder

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12
Q

Muscarinic-1 (M1)-receptor blockade ASEs

A 
Loss of accommodation
Dry mouth
Difficulty urinating
Constipation
Delirium
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13
Q

Alpha-1 (α1)-adrenoceptor blockade characteristics

A

May provide benefit in pts with mixed psychotic illness, partially PTSD and/or in pts with nightmares

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14
Q

Alpha-1 (α1)-adrenoceptor blockade ASEs

A

Orthostatic Hypotension
Impotence
Ejaculatory disorders

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15
Q

Norepinephrine (NE) reuptake inhibition characteristics

A

Antidepressant effects

Reduced potential for weight gain

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16
Q

Norepinephrine (NE) reuptake inhibition ASEs

A

Agitation

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17
Q

Typical antipsychotic agents vs. atypical antipsychotics.

A

All antipsychotics are fairly effective at treating the positives symptoms.

The newer atypcal agents are more likely to alleviate some of the more negative symptoms.

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18
Q

Typical antipsychotic characteristics

A

They are D2 antagonist

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19
Q

Typical antipsychotic ASEs

A

Extrapyramidal toxicity
Tardive dyskinesia
Hyperprolactinemia-sexual dysfunction

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20
Q

Atypical antipsychotic characteristics

A

5HT2A/D2 antagonist

Reduced potential for extrapyramidal tox and hyperlactatemia

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21
Q

Atypical antipsychotic ASEs

A

Metabolic effects:
Weight gain
Worsening of lipid profile
Increased risk for DM and CV disease.

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22
Q

Group 1 atypical MC ASE

A

higher risk for metabolic effects

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23
Q

Group 2 atypical MC ASE

A

can still cause weight gain but lower risk compared to group 1

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24
Q

Extrapyramidal S/S

A

Dystonia
Akathisia
Parkinsonism

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25
Q

Extrapyramidal time of onset

A

Can occur at anytime of treatment

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26
Q

Extrapyramidal Tx

A

Antimuscarinic drug started ASAP (Benztropine), d/c any anticholinergic drugs

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27
Q

Movement disorders caused by direct dopamine receptor blockade

A

Parkinsonism
Akathisia
Dystonia

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28
Q

Movement disorders caused by dopamine receptor hypersensitivity

A

Tardive dyskinesia

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29
Q

3 specific txs have been approved to tx depressive phase in bipolar disorder

A

Quetiapine extended release
Olanzapine/fluoxetine
Lurasidone

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30
Q

Explain how renal clearance is effected by lithium

A

Renal clearance of lithium is reduced by diuretics, NSAID, ACE inhibitors, and ARBS

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31
Q

Mild lithium toxicity s/s

A

weak, ataxia, diarrhea, thirst, frequent urination, loopy

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32
Q

severe lithium toxicity s/s

A

coma, seizures, arrhythmias, interactable hypotension, peripheral vascular collapse

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33
Q

3 interventions that should be implemented if or when neuroleptic syndrome is suspected or confirmed.

A

Immediate withdrawal of the potentially offending drug(s)

providing hydration

and reducing fever

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34
Q

S/s of neuroleptic malignant syndrome

A

High fever in the absence of active infection.

Rigidity and other neurologic signs.

Autonomic dysfunction, the severity of which varies widely (tachycardia, hypertension, diaphoresis, etc.).

Mental status changes.

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35
Q

Why is Clozapine not 1st line for schizophrenia?

A

Not a first line drug because of its FIVE black box warnings for the class 4 specifically for Clozapine, most dangerous and requires intensive monitoring.

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36
Q

Black box warning for Clozapine are?

A

Agranulocytosis

Seizures (de novo seizure in 2-5% of pts)

Myocarditis

Orthostatic hypotension w/ and w/o syncope

37
Q

What do you need to monitor when taking Clozapine?

A

Need to monitor CBC d/t potential for agranulocytosis.

Need to input date in national registry.

Must be monitored weekly for the first 6 months of therapy

Then every other week for the next 6 months

And then at least every 4 weeks thereafter until discontinuation.

38
Q

Names of Low-potency “typical” antipsychotic drugs

A

Chlorpromazine*

Thioridazine

39
Q

Chlorpromazine blocks?

A

Block D2 receptors

40
Q

Chlorpromazine ASEs

A

sedation, orthostatic hypotension, and anticholinergic adverse effects

41
Q

Names of High-potency “typical” antipsychotic drugs

A

Haloperidol*

Fluphenazine

42
Q

Haloperidol blocks

A

Dopamine receptor antagonist, blocks muscarinic and alpha-adrenoceptors

43
Q

2 forms of Haloperidol?

A

The decanoate is a long-acting (monthly) IM injection, for long-term management of patients with poor adherence.

The lactate is a rapidly-acting IM injection that works in minutes in acute psychoses.

44
Q

Haloperidol ASEs

A

Sustained upward deviated of eyes

Head deviation to one side of back

Arching of back.
(acute dystonia)

45
Q

Names of Atypical antipsychotics group 1 drugs

A 
Olanzapine *
Risperidone*
Quetiapine *
Clozapine*
Paliperidone
Iloperidone
46
Q

Olanzapine blocks

A

Blocks dopamine D2, serotonin 5HT2, Histamine H1, muscarinic, and alpha receptors

47
Q

Olanzapine ASEs

A

Greatest risk for metabolic effects
Such as: weight gain, worsened dyslipidemia (particularly hypertriglyceridemia), and an increased risk of new-onset diabetes.

48
Q

Risperidone blocks

A

Blocks serotonin 5HT2 > dopamine D2, H1, alpha

49
Q

Risperidone ASEs

A

Higher risk for extrapyramidal effects- dose dependent but still considered “low risk” compared to others.

50
Q

Quetiapine blocks

A

Blocks dopamine D2, serotonin 5HT2, Histamine H1, muscarinic, and alpha receptors

51
Q

Quetiapine ASEs

A

Considered more “mild”, lowest risk for TD

52
Q

Key use for Quetiapine

A

ER form is FDA approved for treating depressive phase of bipolar disorder

53
Q

Clozapine blocks

A

Blocks D4 and 5-HT2, low D2 blocking effect

54
Q

Clozapine ASEs

A

5 black box warning

Very high rates of weight gain and metabolic abnormalities

Most effective antipsychotic, but is also the most dangerous, and requires intensive monitoring

Interferes with antiseizure drugs

55
Q

Name Atypical antipsychotics group 2 drugs

A

Ziprasidone*
Aripiprazole*
Lurasidone

56
Q

Ziprasidone characteristics

A

Also acts as a norepinephrine reuptake inhibitor

Low rates of weight gain

Taken with food to maximize oral bioavailability

Very commonly used as mood stabilizers

57
Q

Aripiprazole characteristics

A
  • Partial agonist at the D2- and 5-HT1A-receptors

- Antagonist at 5-HT2A-receptors.

58
Q

Aripiprazole ASEs

A 
Extrapyramidal disorder
Akathisia
Somnolence
Tremor
Insomnia
59
Q

Key use for Aripiprazole

A

FDA-approval as adjunct therapy for major depressive disorder when combined with a selective serotonin reuptake inhibitor

60
Q

Name mood stabilizer antiseizure drugs

A

Valproate*
Lamotrigine*
Carbamazepine

61
Q

Valproate characteristics

A

Antiseizure and bipolar disorder drug

Used in acute manic phases

Blocks sodium channels and t type calcium channels

62
Q

Lamotrigine characteristics

A

Most effective adjunct drugs for treating partial seizures

Tx for manic phase of bipolar disorder

63
Q

Lamotrigine ASEs

A

Severe rash-Steven Johnson syndrome

64
Q

Lithium characteristics

A

Mood stabilizer

Decreases neuronal response to serotonin and norepinephrine

65
Q

EKG changes with use of lithium

A

Flattened T wave

66
Q

Drug interactions with Lithium

A

Neuromuscular tox with Haloperidol, Diuretics, NSAIDS and Fluoxetine.

67
Q

Diagnostic criteria for schizophrenia?

A

Active sxs for >1 mo and continued over at least 6 mo

68
Q

Average age for onset of schizophrenia?

A

18-25

69
Q

Define schizophreniform disorder

A

Hallucinations and delusions or at least 5 wks but not yet 6 mos of total duration

70
Q

Schizophrenia first line tx, denies any depression and not overweight?

A

Group 1 drug, that primary antagonizes dopamine 2 receptors, and possible 5HT-2 receptor (serotonin)

Such as: Risperidone

71
Q

Describe the mechanisms of drug induced movement disorders

A

D2 receptor blockade (parkinsonism) and D2 receptor hypersensitivity (TD)

72
Q

What drug is used to tx Parkinsonism movements?

A

Benztropine 1mg BID-TID for 1 -2 wks

73
Q

After 3 yrs of being on Risperidone doctor notices lip/tongue movement smacking and spells of rapid eye blinking, what do you do?

A

reduce Risperidone dose or change to different second generation antipsychotic

Such as: Quetiapine

74
Q

Key therapeutic principle to prevent severe depression in pts receiving lithium for bipolar disorder?

A

Maintain sufficient drug levels of mood stabilizer

75
Q

Highest odd rations for suicide attempt is associated with?

A

Mania, euphoric-gradiose type

76
Q

What type of DM is associated with lithium?

A

DM insipidus

77
Q

Alternative to lithium

A

Group 1: olanzapine, risperidone, paliperidone, iloperidone, quetiapine, clozapine

78
Q

Why must ziprasidone be continued for several wks in addition to lamotrigine?

A

Takes several wks to tartare lamotrigine to an effective dose.
(Lamotrigine can causes a severe rash-Steven Johnson syndrome)

79
Q

Cornerstone therapy for bipolar depression

A

MOOD STABILIZER

80
Q

Pt is loud, disruptive, and aggressive towards patients and staff in the ED what is an appropriate med to start first?

A

Haloperidol lactate immediate release

Dose and route: IM

81
Q

What other tx can be administered to reduce agitation?

A

Lorazepam 2mg/mL IV

82
Q

Basic physical restraint guidelines

A

NEED TO CHEMICALLY BE restrained as well.

Supine

At min: one person per limb

A 5th team member applies restraints

83
Q

What is often co-administered with haloperidol and lorazepam incase of ASE?

A

Diphenhydramine IV or IM use

84
Q

Sexual dysfunction most likely d/t an increase in

A

Prolactin secretion

High risk in: First generation antipsychotic drugs: risperidone and paliperidone.

85
Q

Pt taking first gen (risperidone) c/o severe weight gain, what do you do?

A

Change to a second generation antipsychotic

Such as: Aripiprazole or Ziprasidone

86
Q

Max dose of lithium

A

1800 mg/day

87
Q

What is the maintenance dose of lithium?

A

900 - 1200 mg/day

88
Q

NMS symptoms typically develop in how many days?

A

1-3 days

BHM II (5 decks)

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