Pharm Flashcards
typical antipsychotics: mechanism use, potencies (include which drugs are which)
High potency: trifluoperazine, fluphenazine, haloperidol (try to fly high). these have extrapyramidal symptoms.
low potency: chlropromzaine, thioridazine (cheating theives are low). these tend to have non-neurologic side effects (anticholinergic, antihistamine, alpha-1 blockade)
MOA: block dopamine D2 receptors (increase cAMP). used for positive symptoms of schizophrenia, psychosis, acute mania, and Tourrette’s.
Major side effects of typical antipsychotics; considerations about removal
- highly lipid soluble and stored in body fats- slow to be removed from the body.
- extrapyramidal side effects. treat with benztropine (curb excess cholinergics) or diphenhydramine.
- endocrine side effects: dopamine receptor antagonism –> hyperprolactinemia –> galactorrhea; irregular menstrual periods
- side effects of blocking muscarinic (dry mouth, constipation), alpha 1 (hypotension), and histamine (sedation) receptors.
neuroleptic malignant syndrome: definition, management, treatment
seen with antipsychotics. causes fever, encephatlopathy, unstable vital signs, myoglobinuria, rigidity (rigidity and fever may cause muscle damage/necrosis).
increased enzyme levels: high LFTs, high lactate dehydrogenase, creatinine kinase.
if it progresses to rhabdomyolysis, it may casue hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia.
tx: dantrolene, D2 agonists like bromocriptine.
tardive dyskinesia and evolution of extrapyramidal side effects
tardive dyskinesia: sterotypic oral facial movements as a result of long-term anti-psychotic use.
4 hrs: acute dystonia (muscle spasm, stiffness)
4 days: akathisia (restlessness)
4 wks: bradykinesia
4 mo: tardive dyskinesia
specific antipsychotics and their side effects
chlorpromazine: corneal deposits
thioridazine: retinal deposits
haloperidol: lots of EPS, higher risk for neuroleptic malignant syndrome
atypical antipsychotics: names, mechanism use
olanzapine (zyprexa), clozapine, quetiapine (seroquel), risperidone, aripiprazole (abilify), ziprasidone (geodon).
mechanism not completely understood. various effects on 5HT2, DA, alpha, and H1 receptors.
used for both positive and negative symptoms of schizophrenia, bipolar disorder, OCD, anxiety, depression, mania, tourrettes.
side effects of the atypical antipsychotics:
fewer extrapyramidal and anticholinergic effects. olanzapine/clozapine cause VERY significant weight gain. clozapine also causes agranulocytosis, seizure.
risperidone may increase prolactin (gynecomastia, galactorrhea, decr. GnRH, LH, FSH- fertility problems). ziprasidone prolongs the QT
lithium: use: toxitities
used as a mood stabilizer- blocks relapse and acute mania. also used for SIADH
toxicity: tremor, sedation, heart block, hypothyroidism, polyuria (ADH antagonist that can cause nephrogenic diabetes insipidis), teratogenesis. fetal problems: ebstein abnormality (tricuspid valve problem in which the valves adhere o the ventricle wall. enlarged right atriu, thinned right ventricle, hypoplastic functional right ventricle), and malformation of the great vessels.
buspirone
stimulates 5-HT1a receptors.
used for generalized anxiety disorder. does not cause sedation, addiction, or tolerance, does not interact with alcohol. takes 1-2 wks to feel effect.
CNS stimulants: names, mechanism, use
methylphenidate, dextroamphetamine, methamphetamine, phentermine
increase catecholamines at the synaptic cleft, esp. DA and NE.
used for ADHD, narcolepsy, appetite control.
what drugs are used to treat bipolar disorder?
lithium, valproic acid, carbamazepine, atypical antipsychotics
carbamazepine: used, mechanism, sides
used for simple, complex, tonic-clonic seizures (first line for all), bipolar, trigeminal neuralgia.
increases Na Channel inactivation.
can cause ataxia, blood dyscarsias, liver toxicity, teratogenesis, SIADH, Stevens Johnson
teratogenesis: neural tube defects, craniofacial defects, fingernail hypoplasia, developmental delay, IUGR
valproic acid: uses, MOA
used for all seizures except status epilepticus; first line for tonic-clonic. increases Na channel inactivation, incr. GABA conc by inhibiting GABA transaminase. can cause rare but fatal hepatotoxicity, neural tube defects in a fetus (inhibits maternal folate absorption), tremor, weight gain.
