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Pharm 2 Exam 2 > Psych 1 > Flashcards

Psych 1 Flashcards

1
Q

What are the 2 categories of antipsychotics?

A

Typical antipsychotics (first generation antipsychotics; FGA)
Atypical antipsychotics (second-generation antipsychotics; SGA)

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2
Q

Uses for antipsychotics

A

delusions, hallucinations, paranoid behavior, non-psychiatric disorders (nausea and intractable hiccups)

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3
Q

What causes the antipsychotic action in meds?

A

antipsychotic action comes from their blocking of CNS dopamine receptors in the mesocortical/mesolimbic dopamine tracts of the brain

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4
Q

Blocking of dopamine can lead to?

A

Extrapyramidal effects
Hypersecretion of prolactin
Antiemetic action
Sedation and weight gain
High doses - confusion, memory loss, delirium, tachycardia, and dry skin

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5
Q

Which antipsychotics block histamine receptors and cause sedation/ weight gain?

A

quietiapine and olanzapine

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6
Q

EPS is caused by?

A

Result of accumulated use of antipsychotics over several years of exposure

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7
Q

Akathisia

A

Inability to sit still, tapping of feet, restlessness

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8
Q

Dystonia

A

A state of muscle spasms of face, tongue, back, and neck

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9
Q

When can dystonia occur w/ antipsychotics?

A

first 5-30 days of use of the medication

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10
Q

Parkinson-like symptoms

A

Mask-like face, tremors, shuffling gait, and hypersalivation, which mimic the four classic signs of Parkinson’s disease

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11
Q

Tardive dyskinesia (TD)

A

characterized by rhythmic tongue protrusion, puffing of cheeks, and puckering of mouth

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12
Q

When can TD occur with antipsychotic use?

A

may occur after 3 months of exposure to an antipsychotic, but usually occurs after several years

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13
Q

Neuroleptic malignant syndrome (NMS)

A

emergency (can be fatal) that includes a combination of hyperthermia, rigidity (extrapyramidal effect), and autonomic dysregulation

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14
Q

NMS characteristics

A

Characterized by body temperature exceeding 100.4°F (may go as high as 107°F), altered level of consciousness, tachycardia, labile BP, diaphoresis, tachypnea, urinary or fecal incontinence, rigidity, stupor, coma, and acute renal failure

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15
Q

Tx of NMS

A

Stop offending drug
Supportive tx - hyperthermia and ventilation
Dantrolene, bromocriptine or amantadine - can be used to reverse dopamine blockage and free up the rigidity

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16
Q

Long term affects of antipsychotics

A

Other long-term use can affect weight, cholesterol, and glucose metabolism (exacerbate metabolic syndrome)

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17
Q

Why should antipsychotics be tapered off in most cases?

A

may experience nausea, vomiting, dizziness, tremors, and withdrawal dyskinesia if stopped cold turkey

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18
Q

Which antipsychotic drugs produce the greatest EPS?

A

haloperidol, fluphenazine

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19
Q

Which antipsychotics cause the greatest anti-cholinergic and antihistamine effects?

A

thioridazine, chlorpromazine

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20
Q

Antipsychotic Black Box warning

A

elderly patients with dementia-related psychosis may have an increased risk of mortality

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21
Q

Phenothiazines examples

A

1st gen
haloperidol
chlorpromazine
fluphenazine
prochlorperazine

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22
Q

Phenothiazines MOA

A

Block dopamine at the chemoreceptor trigger zone, and peripherally inhibit the vagus nerve in the GI tract

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23
Q

Phenothiazines use

A

Acute, idiopathic psychotic illnesses marked by agitation
Bipolar disorder
Schizophrenia
Management of nausea and vomiting
Migraines
Intractable hiccups (Chrlorpromazine)

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24
Q

Phenothiazines SE

A

orthostatic hypotension, QT prolongation
Hyperglycemia, weight gain
Dry mouth, constipation, increased appetite
Decreased libido, inhibited ejaculation, urinary retention
Extrapyramidal syndrome (EPS), drowsiness, neuroleptic malignant syndrome

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25
Q

Amphetamines + phenothiazides result in what?

A

Decrease antipsychotic effect of the phenothiazides

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26
Q

Phenothiazides can do what to DM?

A

Increase BS thus result in weaker control of DM

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27
Q

Dopaminergic antiparkinson drugs (Levodopa) + phenothiazides?

A

Antagonize the antipsychotic effect of the phenothiazides

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28
Q

Phenothiazines contraindications

A

Parkinsonism
Blood dyscrasias
Severe liver impairment
Severe cardiac disease - Avoid use with other drugs that cause QT prolongation
Severe CNS depression

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29
Q

Why are Atypical Antipsychotics atypical?

A

Considered atypical because of their superior ability to not induce extrapyramidal side effects (EPSE) or elevation of prolactin levels

30
Q

What is special about clozapine?

A

Clozapine is the only atypical antipsychotic with clear evidence of efficacy in treatment-resistant schizophrenia.

31
Q

Clozapine increases risk of what?

A

increased risk of agranulocytosis, seizures, and myocarditis

32
Q

Atypical Antipsychotics examples

A

aripiprazole
clozapine
lurasidone
olanzapine
paliperidone
quetiapine
risperidone
ziprasidone

33
Q

Atypical Antipsychotics MOA

A

Partially interfere with the binding of serotonin at its receptor sites in the cortex, blocking serotonin, which inhibits the release of dopamine

34
Q

Atypical Antipsychotics use

A

Psychosis in patients with schizophrenia
Depression or mania with psychotic features
Bipolar disorder
Severe agitation and delusions in patients with dementia

35
Q

Atypical Antipsychotics SE

A

QT prolongation, orthostatic hypotension, reflux tachycardia
Clozapine can cause agranulocytosis
Weight gain

36
Q

Atypical Antipsychotics Black Box warning

A

Clozapine - agranulocytosis, orthostatic hypotension, bradycardia, syncope, and increased mortality in demented geriatrics

37
Q

Atypical Antipsychotics contraindications

A

Liver impairment

38
Q

When switching antipsychotic meds, what methods are available?

A

“wash out” or a “cross-titration.”

39
Q

Miscellaneous Antipsychotics examples

A

pimozide
loxapine
molindone
thiothixene

40
Q

Miscellaneous Antipsychotics MOA

A

Competitively block postsynaptic dopamine receptors and increase turnover of dopamine in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla

41
Q

Miscellaneous Antipsychotics use

A

Psychotic episodes when a tranquilizing effect also needed (good for agitated pts)
Tourette’s syndrome (pimozide)

42
Q

Miscellaneous Antipsychotics SE

A

Orthostatic hypotension
Weight gain
decreased sexual functioning

43
Q

barbiturates, hypnotics, narcotics, alcohol, or antihistamines + Miscellaneous Antipsychotics can cause?

A

CNS depressants (barbiturates, hypnotics, narcotics, alcohol, or antihistamines) taken with a typical antipsychotic further increase CNS depression.

44
Q

Miscellaneous Antipsychotics contraindications

A

Parkinsonism
Blood dyscrasias
Severe liver impairment
Severe cardiac disease
Severe CNS depression

45
Q

What is the Abnormal Involuntary Movement Scale (AIMS)?

A

Scale used to monitor motor function in pts taking antipsychotics to monitor for early signs of EPS

46
Q

How is acute psychosis tx?

A

In cases of acute psychoses, rapid and effective sedation is usually achieved by combining an antipsychotic with a benzodiazepine (IM or IV) - Haldol + lorazepam

47
Q

Atypical antipsychotics are better because?

A

Fewer anticholinergic effects
Less dystonia and parkinsonism
Lower risk of tardive dyskinesia
Potential minimization of other adverse effects (orthostatic hypotension)

48
Q

In addition to medication tx, what is another important factor in schizophrenia tx?

A

A support structure is important

49
Q

How long do antidepressants need to start working?

A

Therapeutic effects may take 4-8 weeks to manifest.

50
Q

Third-line agents to tx depression?

A

MAOIs

51
Q

MAOIs must be stopped for 14 days before switching meds, why?

A

Irreversibly inhibit monoamine oxidase; before any other drugs are administered for depression, the MAOIs must be stopped for 14 days

52
Q

MAOI examples

A

tranylcypromine
Phenelzine
isocarboxazid

53
Q

MOAI MOA

A

Irreversible, nonselective inhibitors of the enzyme monoamine oxidase in its CNS storage sites

54
Q

MAOIs use

A

Refractory unipolar depression

55
Q

MAOI SE

A

Orthostatic hypotension
Constipation, nausea
dizziness, headache, insomnia

56
Q

MAOI interactions

A

Amphetamines, antidiabetic drugs, SSRIs

57
Q

SSRI + MAOI can lead to what?

A

SSRIs, tricyclic antidepressants, and other drugs/alcohol with CNS effects when interacting with MAOIs can cause serotonin syndrome and increased risk of hypertensive crisis.

58
Q

MAOI contraindications

A

Liver impairment
Renal impairment
Cardiovascular disorders

59
Q

Foods high in Tyramine

A

aged cheese, beer, wine, pickled products, liver, raisins, bananas, figs, avocados, chocolate, yogurt, and meat tenderizer

60
Q

TCAs are considered _____ line agents

A

2nd

61
Q

TCA examples

A

amitriptyline
doxepin
nortriptyline

62
Q

TCA MOA

A

increasing levels of norepinephrine and serotonin in the synaptic cleft

63
Q

TCA uses

A

Depression
Neuropathic pain (amitriptyline)
Enuresis
Obsessive compulsive disorder
Panic disorder
Fibromyalgia
Headache
Irritable bowel syndrome

64
Q

TCA SE

A

dry mouth, urinary retention
Orthostatic hypotension, prolonged QT
weight gain
Sedation, engaging in unusual or dangerous activities

65
Q

TCA black box warning

A

increased suicidality in adolescents (up to age 24)

66
Q

In which pts is Doxepin contraindicated in?

A

Glaucoma or urinary retention

67
Q

How long does it take TCAs to work?

A

Therapeutic/beneficial effects may take 2 to 3 weeks.

68
Q

Abrupt TCA d/c can cause what?

A

Abrupt discontinuation after long-term use may lead to withdrawal syndrome in 36-72 hours, including dizziness, nausea, paresthesias, anxiety/insomnia lasting for 3-7 days.

69
Q

Which TCA is the least sedating?

A

Nortriptyline

70
Q

Which TCAs are the most sedating?

A

amitriptyline, and doxepin

Pharm 2 Exam 2 (8 decks)

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