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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
Extrapyramidal time of onset
Can occur at anytime of treatment
26
Extrapyramidal Tx
Antimuscarinic drug started ASAP (Benztropine), d/c any anticholinergic drugs
27
Movement disorders caused by direct dopamine receptor blockade
Parkinsonism Akathisia Dystonia
28
Movement disorders caused by dopamine receptor hypersensitivity
Tardive dyskinesia
29
3 specific txs have been approved to tx depressive phase in bipolar disorder
Quetiapine extended release Olanzapine/fluoxetine Lurasidone
30
Explain how renal clearance is effected by lithium
Renal clearance of lithium is reduced by diuretics, NSAID, ACE inhibitors, and ARBS
31
Mild lithium toxicity s/s
weak, ataxia, diarrhea, thirst, frequent urination, loopy
32
severe lithium toxicity s/s
coma, seizures, arrhythmias, interactable hypotension, peripheral vascular collapse
33
3 interventions that should be implemented if or when neuroleptic syndrome is suspected or confirmed.
Immediate withdrawal of the potentially offending drug(s) providing hydration and reducing fever
34
S/s of neuroleptic malignant syndrome
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.
35
Why is Clozapine not 1st line for schizophrenia?
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.
36
Black box warning for Clozapine are?
Agranulocytosis Seizures (de novo seizure in 2-5% of pts) Myocarditis Orthostatic hypotension w/ and w/o syncope
37
What do you need to monitor when taking Clozapine?
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
Names of Low-potency “typical” antipsychotic drugs
Chlorpromazine* | Thioridazine
39
Chlorpromazine blocks?
Block D2 receptors
40
Chlorpromazine ASEs
sedation, orthostatic hypotension, and anticholinergic adverse effects
41
Names of High-potency “typical” antipsychotic drugs
Haloperidol* | Fluphenazine
42
Haloperidol blocks
Dopamine receptor antagonist, blocks muscarinic and alpha-adrenoceptors
43
2 forms of Haloperidol?
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
Haloperidol ASEs
Sustained upward deviated of eyes Head deviation to one side of back Arching of back. (acute dystonia)
45
Names of Atypical antipsychotics group 1 drugs
``` Olanzapine * Risperidone* Quetiapine * Clozapine* Paliperidone Iloperidone ```
46
Olanzapine blocks
Blocks dopamine D2, serotonin 5HT2, Histamine H1, muscarinic, and alpha receptors
47
Olanzapine ASEs
Greatest risk for metabolic effects Such as: weight gain, worsened dyslipidemia (particularly hypertriglyceridemia), and an increased risk of new-onset diabetes.
48
Risperidone blocks
Blocks serotonin 5HT2 > dopamine D2, H1, alpha
49
Risperidone ASEs
Higher risk for extrapyramidal effects- dose dependent but still considered "low risk" compared to others.
50
Quetiapine blocks
Blocks dopamine D2, serotonin 5HT2, Histamine H1, muscarinic, and alpha receptors
51
Quetiapine ASEs
Considered more "mild", lowest risk for TD
52
Key use for Quetiapine
ER form is FDA approved for treating depressive phase of bipolar disorder
53
Clozapine blocks
Blocks D4 and 5-HT2, low D2 blocking effect
54
Clozapine ASEs
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
Name Atypical antipsychotics group 2 drugs
Ziprasidone* Aripiprazole* Lurasidone
56
Ziprasidone characteristics
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
Aripiprazole characteristics
- Partial agonist at the D2- and 5-HT1A-receptors | - Antagonist at 5-HT2A-receptors.
58
Aripiprazole ASEs
``` Extrapyramidal disorder Akathisia Somnolence Tremor Insomnia ```
59
Key use for Aripiprazole
FDA-approval as adjunct therapy for major depressive disorder when combined with a selective serotonin reuptake inhibitor
60
Name mood stabilizer antiseizure drugs
Valproate* Lamotrigine* Carbamazepine
61
Valproate characteristics
Antiseizure and bipolar disorder drug Used in acute manic phases Blocks sodium channels and t type calcium channels
62
Lamotrigine characteristics
Most effective adjunct drugs for treating partial seizures Tx for manic phase of bipolar disorder
63
Lamotrigine ASEs
Severe rash-Steven Johnson syndrome
64
Lithium characteristics
Mood stabilizer Decreases neuronal response to serotonin and norepinephrine
65
EKG changes with use of lithium
Flattened T wave
66
Drug interactions with Lithium
Neuromuscular tox with Haloperidol, Diuretics, NSAIDS and Fluoxetine.
67
Diagnostic criteria for schizophrenia?
Active sxs for >1 mo and continued over at least 6 mo
68
Average age for onset of schizophrenia?
18-25
69
Define schizophreniform disorder
Hallucinations and delusions or at least 5 wks but not yet 6 mos of total duration
70
Schizophrenia first line tx, denies any depression and not overweight?
Group 1 drug, that primary antagonizes dopamine 2 receptors, and possible 5HT-2 receptor (serotonin) Such as: Risperidone
71
Describe the mechanisms of drug induced movement disorders
D2 receptor blockade (parkinsonism) and D2 receptor hypersensitivity (TD)
72
What drug is used to tx Parkinsonism movements?
Benztropine 1mg BID-TID for 1 -2 wks
73
After 3 yrs of being on Risperidone doctor notices lip/tongue movement smacking and spells of rapid eye blinking, what do you do?
reduce Risperidone dose or change to different second generation antipsychotic Such as: Quetiapine
74
Key therapeutic principle to prevent severe depression in pts receiving lithium for bipolar disorder?
Maintain sufficient drug levels of mood stabilizer
75
Highest odd rations for suicide attempt is associated with?
Mania, euphoric-gradiose type
76
What type of DM is associated with lithium?
DM insipidus
77
Alternative to lithium
Group 1: olanzapine, risperidone, paliperidone, iloperidone, quetiapine, clozapine
78
Why must ziprasidone be continued for several wks in addition to lamotrigine?
Takes several wks to tartare lamotrigine to an effective dose. (Lamotrigine can causes a severe rash-Steven Johnson syndrome)
79
Cornerstone therapy for bipolar depression
MOOD STABILIZER
80
Pt is loud, disruptive, and aggressive towards patients and staff in the ED what is an appropriate med to start first?
Haloperidol lactate immediate release Dose and route: IM
81
What other tx can be administered to reduce agitation?
Lorazepam 2mg/mL IV
82
Basic physical restraint guidelines
NEED TO CHEMICALLY BE restrained as well. Supine At min: one person per limb A 5th team member applies restraints
83
What is often co-administered with haloperidol and lorazepam incase of ASE?
Diphenhydramine IV or IM use
84
Sexual dysfunction most likely d/t an increase in
Prolactin secretion High risk in: First generation antipsychotic drugs: risperidone and paliperidone.
85
Pt taking first gen (risperidone) c/o severe weight gain, what do you do?
Change to a second generation antipsychotic Such as: Aripiprazole or Ziprasidone
86
Max dose of lithium
1800 mg/day
87
What is the maintenance dose of lithium?
900 - 1200 mg/day
88
NMS symptoms typically develop in how many days?
1-3 days

BHM II (5 decks)

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