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psychopharm2 Flashcards

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1
Q

midpotency typical antipsychotics examples

A

Loxapine, thiothixene, trifluoperazine, perphenazine

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2
Q

loxapine

A

loxitane; higher risk of seizure; metabolite is an antidepressant

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3
Q

thiothixene

A

Navane; can cause ocular pigment changes

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4
Q

trifluoperazine

A

stelazine; can reduce anxiety

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5
Q

perphenazine

A

trilafon; mid potency typical antipsych

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6
Q

high potency typical antipsychotics

A

lower dose needed to achieve the effect; cause less sedation, orthostatic hypotension, and anticholinergic effects; greater risk for EPS and tardive dyskinesia

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7
Q

examples of high potency typical antipsychotics

A

heloperidol, fluphenazine (prolixin); pimozide (orap)

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8
Q

haloperidol

A

haldol; decanoate form availabe (long acting injectable)

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9
Q

fluphenazine

A

prolixin; decanoate form available

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10
Q

pimozide

A

orap; assoc with heart block, v tach and other cardiac effects

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11
Q

components of the mesolimbi pway

A

assoc with pos sx of schizophrenia; nuc accumbens, fornix, the amygdala, and the hippocampus

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12
Q

neg symptoms for schizophrenia

A

dopamine in the mesocortical pway; think cortex involved in personality so neg sx of schizo

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13
Q

EPS symptoms localized wheere

A

nigrostriatum; think parkinsons is involved in this

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14
Q

tuberoinfundibbular

A

prolactin

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15
Q

what are the EPS side effects associated with typical antipsychotics

A

parkinsonism, akathisia, dystonia (torticollis, contraction of the tongue, eyes)

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16
Q

what does hyperprolactinemia cause?

A

decreaed libido, galactorrhea, gynecomastia, impotence, amenorrhea, osteoporosis

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17
Q

what are the main categories of side effects of the typical antipsychotics?

A

Anti-dopaminergic, Anti-HAM, TD, and less commonly neuroleptic malignant syndrome; opthalmologic problems; derm problems; seizures

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18
Q

epi of TD

A

most often occurs in older women

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19
Q

epi of neuroleptic malig syndrome

A

young males early in treatment with both atypical and typical antipsychotics

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20
Q

characteristics of neuroleptic malignant syndrome

A

FALTERED; fever, autonomic instability, leukocytosis, tremor, elevated CPK, rigidity, excessive sweating, and delirium

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21
Q

treatment of neuroleptic malig syndrome

A

discontinue offending med and administrate supportive care

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22
Q

optho problems seen with typical antipyschotics

A

irreversible retinal pigmentation with high doses of thioridazine, deposits in lens and cornea with chlorpromazine

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23
Q

derm problems seen with typical antipsychotics

A

rashes and photosensitivity (blue-gray skin discoloration with chlorpromazine)

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24
Q

seizures and antipsychotics

A

low potency anti-psychotics are more likely to cause seizures than high potency

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25
Q

how are atypical antipsychotics different from typical in terms of mecahnism of action?

A

atypical blocks both dopamine and seratonin; they are more effective in treating the negative sx of schizophrenia

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26
Q

side effects for atypicals

A

less likely to cause EPS, TD, or neuroleptic malig syndrome;

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27
Q

examples of atypical antipsychotics

A

clozapine (clozaril), risperidone (resperidal), quetiapine (seroquel), olanzipine (zyprexa), ziprasidone (geodon), aripiprazole (abilify), paliperidone (invega), asenapine (saphris), iloperidone (fanapt)

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28
Q

clozapine

A

clozaril, less likely to cause TD, assoc with tachycardia and hypersalivation, more anticholinergic SE, myocarditis can develop, risk of agranulocytosis and seizures

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29
Q

the only antipsychotic shown to decr the risk of suicide

A

clozapine

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30
Q

when to stop clozapine

A

if absolute neutrophil count drops below 1500

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31
Q

risperidone

A

can cause increased prolactin, some orthostatic hypotension and reflex tachycardia, has long acting injectable form called Consta

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32
Q

quetiapine

A

seroquel; common side effects incl seadation and orthostatic hypotension

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33
Q

olanzipine

A

zyprexa; common side effect is weight gain

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34
Q

ziprasidone

A

geodon; less likely to cause weight gain

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35
Q

aripiprazole

A

abilify; unique mecahnism of partial D2 agonism; can be more activating (akathisia) and less sedating; less potential for weight gain

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36
Q

newer expensive atypical antipsychotics

A

paliperidone, asenapine, iloperidone

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37
Q

side effects of atypical antipsychotics

A

metabolic syndrome, some anti-HAM side effects, weight gain, hyperlipidemia, hyperglycemia, liver function, QTc prolongation

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38
Q

what are mood stabilizers used for?

A

acute mania and to help prevent relapses of manic episodes in bipolar disorder and schizoaffective disorder

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39
Q

less commonly, mood stabilizers like lithium can be used for

A

potentiation of antidepressants, potentiation of antipsychotics, enhancement of abstinence in tx of alcoholism, tx of aggression and impulsivity

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40
Q

what are the mood stabilizers

A

lithium and anticonvulsants like valproic acid, lamotrigine, and carbamazepine

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41
Q

lithium

A

drug of choice for acute mania and as a prophylaxis for both manic and depressive episodes n bipolar and schizoaffective disorders; can also be used in cyclothymia and unipolar depression

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42
Q

how is lithium metabolized and what consequences does this have?

A

metabolized by the kidney, so you must adjust dose and monitor levels if patient has renal dysfunction

43
Q

prior to initiating lithium, patients must have what?

A

ECG, basic chemistries, thyroid function test, a CBC, and a pregnancy test

44
Q

onset of action for lithium

A

5-7 days

45
Q

checking blood levels in patients on lithium

A

unlike SSRIs, blood levels of lithium correlate with clinical efficacy and should be checked after 5 days and then every 2-3 days until therapeautic

46
Q

major downsides to lithium

A

side effects and narrow therapeutic range

47
Q

side effects of lithium

A

toxic levels cause AMS, tremors, convulsions, and death; other side effects incl tremor, nephrogenic DI, GI disturbance, weight gain, sedation, thyroid enlargement, hypothyroidism, ECG changes, benign leukocytosis, Ebstein’s anomaly

48
Q

lithium can cause ebstein’s anomaly. What is that?

A

cardiac defect in abbies born to mothers taking lithium

49
Q

carbamazepine

A

tegretol; esp useful in treating mixed episodes and rapid-cycling bipolar disorder, and less effective for the depressed phase

50
Q

carbamazepine also used in the treatment of what

A

trigeminal neuralgia

51
Q

how does carbamazepine work

A

blocks sodium channels and inhibits action potential

52
Q

onset of action of carbamazepine

A

5-7 day

53
Q

side effects of carbamazepine

A

most common are GI and CNS (drowsiness, ataxia, sedation, confusion); possible skin rash (SJS), leukopenia, hyponatremia, aplastic anemia, thrombocytopenia, and agranulocytosis

54
Q

other SE of carbamazepine

A

elev of liver enzymes, causing hepatitis; teratogenic effecs in pregnancy

55
Q

drug interactions and carbamazepine

A

induces cyp 450; induces its own metabolism, requiring increasing dosages

56
Q

carbamazepine toxicity

A

confusion, stupor, motor, restlessness, ataxia, tremor, nystagmus, twitching and vomitting

57
Q

valproic acid

A

depakote and depakene; useful in treating mixed episodes of bipolar disorder as well as rapid cycling

58
Q

valproic acid levels

A

usually checked after 3-5 days

59
Q

lamotrigine

A

lamictal: an anticonvulsant; effective for bipolar depression but not for acute mania or prevention of mania

60
Q

lamotrigine mech of action

A

works on sodium channels that modulate glutamate and aspartate

61
Q

most common side effects of lamotrigine

A

dizziness, sedation, etc; but most serious side effect is Stevens-johnson syndrome

62
Q

how is SJS with lamotrigine minimized

A

start with low doses and increase them slowly

63
Q

valproate will increase lamotrigine levels and lamotrigine with decrease valproate levels

A

right

64
Q

oxcarbazepine

A

trileptal; as effective in mood disorders as carbamazepine, but better tolerated and less risk of rash and hepatotoxicity

65
Q

gabapentin

A

neurontin; often used adjunctively to help with anxiety and sleep; little efficacy in bipolar

66
Q

pregabalin

A

lyrica; used in general anxiety disroder and fibromyalgia; little efficacy in bipolar

67
Q

tiagabine

A

gabitril; may be helpful with anxiety

68
Q

topiramate

A

topamax; helpful with impulse control disorder and anxiety; beneficial side effect is weightloss; can cause hypochloremic, non-anion gap met acidosis and kidney stones

69
Q

most limiting side effect of topiramate

A

cognitive slowing

70
Q

anxiolytics/hypnotics include which drugs

A

benzos, barbiturates, and buspirone

71
Q

benzos

A

potentiate the effects of GABA; relatively safer in overdose than barbiturates

72
Q

long acting benzos

A

half life greater than 20 hours; diazepam (valium), clonazepam (klonopin)

73
Q

intermediate acting benzos

A

half life 6-20 hours; alprazolam (xanax), lorazepam (ativan), oxazepam (serax), temazepam (restoril)

74
Q

short acting benzos

A

less than 6 hours; triazolam (halcion), midazolam (Versed)

75
Q

diazepam

A

valium; used during detox from alc or sedative-hypnotic-anxiolytics and for seizures

76
Q

clonazepam

A

Klonopin; treatment of anxiety, incl panic attacks; avoid with renal dysfunction; longer half life allows for once daily dosing

77
Q

alprazolam

A

xanax; tx of anxiety, incl panic attacks; short onset, so high abuse potential

78
Q

lorazepam

A

ativan; tx of panic attacks, alc and sedative hypnotic anxiolytic detox; not metabolized by the liver

79
Q

oxazepam

A

serax; alcohol ad sedative-hypnotic-anxiolytic detox; not metabolized by the liver

80
Q

benzos notmetabolized by the lier

A

LOT; lorazepam, oxazepam, temazepam

81
Q

temazepam

A

restoril;decreasingly used for tx of insomnia due to dependence; not metabolized by the liver

82
Q

triazolam

A

halcion; short-acting benzo; treatment of insomnia

83
Q

midazolam

A

versed; short acting benzos; primarily used in med and surgical settings

84
Q

side effects of benzos

A

drowsiness, impairment of intellectual function; anterograde amnesia

85
Q

toxicity of benzos

A

resp depression, esp when combined with alcohol

86
Q

examples of non-benzo hypnotics

A

zolpidem (ambien); dephenhydramine (benadryl); chloral hydrate (noctec, somnote); ramelteon (rozerem)

87
Q

zolpidem

A

ambien, just like zaleplon (sonata), and eszopiclone (Lunesta); selective bindng to benzo receptor 1, which is responsible for sedation

88
Q

diphenhydramine

A

benadryl; antihistamine; side effects are sedation, dry mouth, constip, urinary retention, and blurry vision

89
Q

chloral hydrate

A

Noctec, Somnotec; not commonly prescribed due to tolerance and dependence; lethal in overdose, causing hepatic and liver failure

90
Q

Ramelteon (Rozerem)

A

non benzo hypnotic; Selective melatonin MT1 and MT2 agonist; no tolderance or dependence

91
Q

examples of non-benzo anxiolytics

A

buspirone (BuSpar); hydroxyzine (Atarax); Barbiturates; propranolol

92
Q

buspirone

A

buSpar; partial agonist of the 5HT-1A receptor; has slow onset than benzos (takes 1-2 weeks for effect); not that effective, so often used in combo with another agent like SSRI for treatment of anxiety

93
Q

in what population is buspirone good and why?

A

good in alcoholics because it does not potentiate the CNS depression of alcohol; also has a low potential for abuse/addiction

94
Q

Hydroxyzine

A

atarax; antihistamine; quick acting short term med

95
Q

barbiturates

A

eg. Butalbitol, phenobarbitol, amobarbitol, pentobarbitol; rarely used now because lethality of overdose and side effect profile

96
Q

propranolol

A

beta blocker; useful for treating the autonomic side effects of panic attacks; can also be used to treat akathisia (side effect of typical antipsychotics)

97
Q

examples of psychostimulants

A

dextroamphetamine and amphetamines; methylphenidate; atomoxetine; modafinil

98
Q

dextroamphetamine and amphetamines

A

dexedrine, adderall

99
Q

methylphenidate

A

ritalin, Concerta; watch for leukopenia, anemia, incr LFTs

100
Q

atomoxetine (strattera)

A

presynaptic norepi transport inhib; less appetite suppression and insomnia

101
Q

modafinil

A

Provigil; used in narcolepsy

102
Q

acetylcholinesterase inhib

A

donepezil (Aricept); galantamine (Reminyl); Rivastigmine (Excelen); Tacrine (Cognex); Memantine (Namenda)

103
Q

acetylcholinesterase inhib patch

A

less side effects; rivastigmine (Excelon)

Psych (23 decks)

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