Pharm psych - Neuroleptics and Mood Stabilizer

Question 1

Typical and atypical antipsychotics work on which receptors?

Answer 1

1) Block dopamine D2 receptors 2) Block both D2 and serotonin 2A receptors

Question 2

Although atypical antipsychotics are used to treat dementia and delirium, there is increased risk of what in the elderly?

Answer 2

All-cause mortality and stroke

Question 3

What are the first line antipsychotic drugs?

Answer 3

Both typical and atypical antipsychotics.

Question 4

What are examples of low potency antipsychotics?

Answer 4

Chlorpromazine (thorazine), thioridazine (mellaril)

Question 5

Low potency typical antipsychotics have higher incidence of [ ], lower incidence of [ ], and more lethality due to [ ]

Answer 5

1) Higher incidence of anticholinergic and antihistaminic side effects compared to high potency antipsychotics 2)lower incidence of EPS and NMS 3) more lethality due to QTC prolongations with potential for heart block and ventricular tachycardia

Question 6

With low potency typical antipsychotics what is the risk for agranulocytosis and seizure compared to high potency drugs.

Answer 6

Rare agranulocytosis. Higher risk for seizure compared to the high potency neuroleptics.

Question 7

What are the side effects of chlorpromazine and what can it also treat?

Answer 7

Orthostatic hypotension, bluish skin discoloration, cause photosensitivity. Deposits in lens and cornea. It can also treat nausea and vomiting and intractable hiccups

Question 8

What is thioridazine a/w?

Answer 8

retinitis pigmentosa

Question 9

What are examples of mid potency antipsychotics?

Answer 9

Loxapine (loxitane), thiothixene (navane) - can cause ocular pigment change, trifluoperazine (stelazine) - can reduce anxiety, perphenazine (trilafon).

Question 10

What are exmaples of high potency antipsychotics?

Answer 10

Haloperidol (haldol), fluphenazine (prolixin), pimozide(orap)

Question 11

High potency antipsychotics have greater risk for?

Answer 11

EPS and tardive dyskinesia.

Question 12

Pimozide is what kind of drug? What is it a/w

Answer 12

High potency antipsychotic. A/w heart block, ventricular tachycardia, other cardiac effects.

Question 13

What is a deconoate form of drug?

Answer 13

Long acting IM form. Available for haldol and fluphenazine - useful if patient doesn’t like taking medications

Question 14

Positive sx of schizophrenia thought to be treated by action of medications in which pathway?

Answer 14

Mesolimbic dopamine pathway = includes nucleus accumbens, amygdala, fornix, and hippocampus

Question 15

Negative sx of schizophrenia thought to occur due to?

Answer 15

dopamine action in the mesocortical pathway

Question 16

EPS sx thought to occur due to?

Answer 16

Dopamine pathways in nigostriatum.

Question 17

Increased prolactin is due to dopamine action in?

Answer 17

Tuberoinfundibular pathway

Question 18

What are the major side effects of typical antipsychotics?

Answer 18

1) anti-dopaminergic i.e. EPS and hyperprolactinemia 2) Anti-HAM (histamine, adrenergic, muscarinic) 3) Tardive dyskinesia and less commonly, NMS, elevated liver enzymes/jaundice, skin discoloration, ophtho issues

Question 19

What are the anti-dopaminergic effects of typical antipsychotics?

Answer 19

1) EPS - Parkinsonism, Akathisia, dystonia 2) Hyperprolactinemia.

Question 20

Neurolopetic Malignant Syndrome is characterized by?

Answer 20

FALTERED. - Fever(most common sx), autonomic instability (HTN, tachycardia, diaphoresis), leukocytosis, tremor, elevated CPK, rigidity, excessive sweating, delirium

Question 21

Antipsychotics lower the threshold for?

Answer 21

Seizures

Question 22

What percent chance is there of developing tardive dyskinesia for every year on antipsychotics?

Answer 22

1%

Question 23

What is the onset of acute dystonia, EPS/akathisia, TD?

Answer 23

Hours to days, days to months, months to years.

Question 24

Main differences in side effects of atypical antipsychotics vs typical

Answer 24

Less EPS, tardive dyskinesia, and NMS. May be more effective at treating negative sx of schizophrenia

Question 25

Atypicals are also used to treat?

Answer 25

Acute mania, bipolar disorder and as adjunctive medications in unipolar depression.sometimes used in personality disorders and certain childhood psych disorders.

Question 26

What are the major atypical antipsychotics?

Answer 26

Clozapine (clozaril), risperidone (risperdal), quetiapine (seroquel), aripiprazole (abilify), olanzapine (zyprexa), and ziprasidone (geodon).

Question 27

What is Consta?

Answer 27

Long acting injectable form of risperidone

Question 28

What are some of the key points of clozapine (clozaril)

Answer 28

Only antipsychotic to show decreased suicide risk; less likely to cause tardive dyskinesia, a/w tachycardia and hypersalivation, 2-5% incidence of seizures; 1-2% incidence of agranuolcytosis; more anticholinergic side effects than other atypical or high potency typicals; development of myocarditis. STOP clozapine if absolute neutrophil count drops below 1500/microL.

Question 29

What is the mechanism of aripiprazole (Abilify)

Answer 29

Unique mechanism of partial D2 agonism.

Question 30

Newer, expensive atypical antipsychotics?

Answer 30

PAI - paliperidone (invega), asenapine (saphris), iloperidone (Fanapt)

Question 31

What are the main side effects of atypical antipsychotics?

Answer 31

Metabolic syndrome, weight gain, hypeglycemia, hyperlipidemia, QTC prolongation, liver function - need yearly monitoring for elevated LFTs and ammonia, some anti-HAM effects.

Question 32

Which mood stabilizer is the only one shown to reduce suicidality

Answer 32

Lithium

Question 33

What can be used as an adjunct to mood stabilizers to treat acute mania

Answer 33

Antipsychotics

Question 34

What are mood stabilizers used for?

Answer 34

Treat acute mania and prevent relpases of manic episodes in both bipolar and schizoaffective disorders.

Question 35

What are the commonly used mood stabilizers?

Answer 35

Lithium and anticonvuslants - particularly lamotrigine, valproate and carbamazepine.

Question 36

What is lithium used for?

Answer 36

drug of choice for acute mania, prophylaxis for both manic and depressive episodes in BP and schizoaffective disorders. Used also in cyclothyia and unipolar depression.

Question 37

What is the therapeutic range for lthium

Answer 37

0.6-1.2. Toxic>1.5, lethal >2.0

Question 38

Prior to initiating lithium, patients should have what?

Answer 38

EKG, blood count, basic chemistries, thyroid function tests, pregnancy test. Note lithium is metabolized by kidney. Beware of kidney function

Question 39

What is onset of action and how often should blood levels be hecked

Answer 39

Onset 5-7 days. Check in 5 days, and then every 2-3 days until therapeutic.

Question 40

What pain med should you not prescribe to a patient taken lithium

Answer 40

IBUprofen

Question 41

What are the side effects of lithium

Answer 41

Weight gain, sedation, nephrogenic diabetes, clinicians should monitor lithium levels, TSH, and kidney function, fine tremor; GI disturbance’ thryoid enlargement/hypothyroidism; EKG changes, benign leukocytosis; Ebstein’s anomaly, cardiac defect in babies to moms taking lithium

Question 42

When prescribing lithium, it is important to monitor what levels?

Answer 42

Thyroid, creatinine and lithium

Question 43

Patients on clozapine should have what tests done routinely?

Answer 43

WBC counts to monitor for agranulocytosis. Perform weekly for first 6 months and then decrease frequency thereafter

Question 44

How do you tx extrapyramidal sx?

Answer 44

Reducing the dose of antipsychotic, introducing anticholinergic like benztropine (cogentin), and an antihistaminergic (benadryl), or antiparkinsonian medicaton like amantadine