Psychiatric agents

Question 1

4 major categories of psychiatric agents

Answer 1

 Antipsychotics (psychotic disorders particularly schizophrenia)
 Anxiolytics (anxiety disorders, insomnia, nausea and vomiting in cancer therapy)
 Antidepressants (depression-reactive, major and bipolar disorders)
 Mood stabilizers (antidepressant—bipolar disorders)

Question 2

 Important neurotransmitters in regard to the use of psychiatric medications

Answer 2

 Dopamine: Cognition, emotional responses, motivation, movement, attention,
 Serotonin: Role in mood, sleep rhythms and arousal
 Norepinephrine: Control of arousal, vigilance, mood, anxiety, fight-or flight response
 Gamma-aminobutyric acid (GABA): Regulation of anxiety. Inhibits nervousness. Calms down the brain, decreases the firing within the brain.

Question 3

two major categories of antipsychotics

Answer 3

1. Typical (traditional) (First Generation): 1) Phenothiazines or 2) Nonphenothiazines
    Older generation of drugs, less targeted, more side effects
2. Atypical (Second Generation): more targeted, less side effects
    Effective for treating schizophrenia & other psychotic disorders unresponsive to typical antipsychotics. Also used if intolerant of typical antipsychotics

Question 4

What is the underlying mechanism in antipsychotics?

Answer 4

They block dopamine receptors

Question 5

What are the two types of Typical (first generation) antipsychotics?

Answer 5

1. Phenothiazine and 2. non-phenothiazine

Question 6

Typical antipsychotics have a STRONG/WEAK affinity for D2 (dopamine) receptors?

Answer 6

STRONG (this is why they often cause EPS)

Question 7

What are the main categories of symptoms in extrapyramidal syndrome (EPS)?

Answer 7

1. pseudoparkinsonism
2. acute dystonia
3. akathisia
4. tardive dyskinesia (worst)
5. Neuroleptic Malignant Syndrome (NMS) (rare but potentially fatal)

Question 8

manifestations of Akathisia

Answer 8

• restless
• trouble standing still
• pacing
• feet in constant motion, rocking back & forth

Question 9

manifestations of acute dystonia

Answer 9

• facial grimacing
• involuntary upward eye movement
• muscle spasms of the tongue, face, neck, and back (back muscle spasms cause trunk to arch forward)
• Laryngeal spasms

Question 10

manifestations of tardive dyskinesia

Answer 10

-protrusion and rolling of tongue
-sucking and smacking movements of the lips
-chewing motion
-facial dyskinesia
-involuntary movements of the body and extremities
(TYPICALLY OCCURS AFTER 1 YR OF TAKING DRUG. SHOULD BE DISCONTINUED IMMEDIATELY WHEN/IF SIGNS OCCUR.)

Question 11

What is the treatment for neuroleptic malignant syndrome?

Answer 11

Treatment (supportive care) 
	Immediate W/D of antipsychotics
	Adequate hydration
	Hypothermic blankets
	Antipyretics
	Benzodiazepines 
	Muscle relaxants

Question 12

Two types of anxiety

Answer 12

1. Primary anxiety: NOT caused by medical conditions or drug use (use anxiolytics to Tx)
2. Secondary anxiety: IS caused by drug use, medical/psych disorders (rare to use anxiolytics)

Question 13

What are the 3 types of antidepressants?

Answer 13

1. Tricyclics (TCA)
2. SSRIs
3. Atypical antidepressants
4. Monoamine oxidase inhibitors (MAOIs)

Question 14

What is the prototype Tricyclic (TCA) drug?

Answer 14

Amitriptyline (Elavil)

Use: major depression

Question 15

What is the action of Amitriptyline (Elavil)

Answer 15

• Blocks uptake/reuptake (removal of) norepinephrine & serotonin
• Effective & LESS expensive than SSRIs & other drugs (BUT MORE SIDE EFFECTS)
• Elevate mood, ↑interest in ADL, & ↓insomnia
• Usually given at night to ↓problems re: sedative action

Question 16

What are the side effects/adverse reactions of Amitriptyline (Elavil)

Answer 16

• Sedation, dizziness, blurred vision, dry mouth and eyes, urinary retention, constipation, weight gain, GI distress, sexual dysfunction
• Orthostatic hypotension, dysrhythmia, EPS, blood dyscrasias (an abnormal or disordered state of a body part)

Question 17

What are the interactions of Amitriptyline (Elavil)

Answer 17

• Also blocks histamine and anticholinergic receptors
• Increased CNS effects with alcohol and other CNS depressants
• Increased sedation and anticholinergic effects with phenothiazines, haloperidol