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PPC3 Exam 3 > Psychopharmacology 3 > Flashcards

Psychopharmacology 3 Flashcards

1
Q

Atypical Antipsychotics Doses

A
  1. Olanzapine (Zyprexa): 0.15-0.20 mg/kg: 2.5-20 mg
  2. Quetiapine (Seroquel) – 25 to 600 mg
  3. Clozapine (Clozaril) – 6.25 to 25 mg initially: 75 to 500 mg
  4. (WBC count needs to be monitored – Aripiprazole (Abilify) – 2-30 mg
  5. (FDA indications for children 13-17)
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2
Q

Side effect profile of atypical antipsychotics (3)

A
  1. Prolactin abnormalities
  2. Extrapyramidal side effects (akathisia [involutary movement disorder])
  3. Monitor for BP, weight, BMI, Fasting glucose, Lipids, and ECG in 3 months after starting and then yearly
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3
Q

Indications for Risperidone: Indications and Side effects (3)

A
  1. Schizophrenia, bipolar disorder, mania, and irritability and aggression seen in autism

Side Effects

  1. Risperidone is associated with more prolactin‐related and sexual adverse effects than other second generation antipsychotics, weight gain and extrapyramidal symptoms
    * For dystonic reaction → give Benadryl 15mg IV
  2. Most likely to cause an elevated prolactin
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4
Q

Indications for Aripiprazole (Abilify) (9)

A
  1. FDA approval for Tourette syndrome
  2. Schizophrenia for 13 year old and older
  3. Acute bipolar and maintenance in ages greater than 10
  4. Treatment of irritability and aggression in autism 6‐17 years
  5. Most weight neutral
  6. Least Extra pyramidal effects
  7. Most qualitative improvement in depressive symptoms
  8. Best side effect profile in terms of weight pain, elevated QT
  9. Increased risk of suicidal thinking in children and adolescents, and young adults (18 to 24) with major depressive disorder (Black Box)
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5
Q

Indications for Quetiapine (Seroquel)

A

FDA approval for childhood schizophrenia (adolescent, mania, bipolar disorder (age 10 and over) and autism

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6
Q

Quetiapine (Seroquel) Side Effects (3)

A
  1. Increased risk of suicidal thinking in children and adolescents, and young adults (18 to 24) with major depressive disorder (Black Box)
  2. Has an intermediate effect on sedation and weight pain
  3. Needs to be tapered—abrupt discontinuation: insomnia, nausea and vomiting, headache, diarrhea, dizziness, irritability.
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7
Q

Indications: Olanzepine (Zyprexa) (2)

A
  1. FDA approval (ages 13 and above)
  2. Management of schizophrenia and BD, as well as off‐label in several other circumstances and with other diagnoses, including disruptive behavioral disorders, anorexia, autism spectrum disorders (ASD), Tourette syndrome and tic disorders.
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8
Q

Olanzepine (Zyprexa) Side Effects (5)

A
  1. Causes more dyslipidemia than other second generation antipsychotics.
  2. Weight gain is equal to Clozaril and is among the top causes of weight gain
  3. Is not quite as sedating as clozapine but is higher in the sedation category than the rest of the atypical antipsychotic agents
    * Sedation syndrome particularly if given IM
  4. Black box due to post injection delirium/sedation syndrome following extended release IM injection
  5. HYPERLIPIDEMIA and weight gain
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9
Q

Atypical Antipsychotics: Monitor (9)

A
  1. Personal, medical, family hx: annually
  2. Lifestyle behaviors, sedation and somnolence, ht., wt., and BMI: each visit
  3. Sexual and reproductive dysfunction: during titration, then every 3 months
  4. Parkinsonism, akathisia: during titration, at 3 months, then annually
  5. BP, AR, LFTs: at 3 months then annually
  6. Electrolytes, blood count, renal tests: annually
  7. Fasting blood glucose and lipids: at 3 months and then every 6 months
  8. ECG: only if on ziprasidone (geodon); baseline and at 3 months
  9. Prolactin: if symptomatic
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10
Q

Common Side Effect Profiles of Psychotropic (9)

A
  1. Antidepressants
  2. AEDs
  3. Lamotrigine
  4. Stimulants and Atomoxetine
  5. Suicidality
  6. Increased risk of suicidal thoughts – Anticonvulsant hypersensitivity syndrome‐fever, rash, eosinophilia, lymphadenopathy, organ failure, hepatoxicity
  7. Stevens‐Johnson syndrome
  8. Aseptic meningitis – Increased risk of suicidal thoughts
  9. Cardiovascular events – Monitor BP and heart rate
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11
Q

Antipsychotic indications

A

Approved for treatment of schizophrenia, mood stabilization, and autism in children

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12
Q

Antipsychotic side effects (6)

A
  1. Extrapyramidal side effects
  2. Dystonia
  3. Tardive dyskinesia
    i. Look for these and other side effects at every single visit
    ii. Do AIMS on every patient on anti-psychotic that comes to office every 3 months to get evaluated
  4. Akathisia
  5. Brady/kinesia/drug induced parkinsonism
  6. Metabolic syndrome
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13
Q

Evaluation of Tardive Dyskinesia (3)

A
  1. Abnormal Involuntary Movement Scale (AIMS)
  2. Occurrence of tardive dyskinesia (TD) in patients receiving neuroleptic medications.
  3. Detection and following the severity of patient’s TD over time
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14
Q

Abnormal Involuntary Movement Scale (AIMS) (9)

A
  1. Assessment of denture and teeth
  2. Ask the patient whether there is anything in his or her mouth (such as gum or candy) and, if so, to remove it.
  3. Ask about the current condition of the patient’s teeth. Ask if he or she wears dentures.
  4. Ask whether teeth or dentures bother the patient now.
  5. Extremity and truncal dyskinesia
    a. Have the patient sit in chair with hands on knees, legs slightly apart, and feet flat on floor. (Look at the entire body for movements while the patient is in this position.)
    b. Ask the patient to sit with hands hanging unsupported ‐‐ if male, between his legs, if female and wearing a dress, hanging over her knees. (Observe hands and other body areas).
    c. Ask the patient to tap his or her thumb with each finger as rapidly as possible for 10 to 15 seconds, first with right hand, then with left hand. (Observe facial and leg movements.)
    d. Flex and extend the patient’s left and right arms, one at a time.
  6. Ask whether the patient notices any movements in his or her mouth, face, hands, or feet.
  7. If yes, ask the patient to describe them and to indicate to what extent they currently bother the patient or interfere with activities.

8 Ask the patient to open his or her mouth. (Observe the tongue at rest within the mouth.) Do this twice.

  1. Ask the patient to protrude his or her tongue. (Observe abnormalities of tongue movement.) Do this twice.
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15
Q

General overview of AIMS (3)

A
  1. Ask the patient to stand up. (Observe the patient in profile. Observe all body areas again, hips included.)
  2. Ask the patient to extend both arms out in front, palms down. (Observe trunk, legs, and mouth.)
  3. Have the patient walk a few paces, turn, and walk back to the chair. (Observe hands and gait.) Do this twice.
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16
Q

Tourette’s: Nonpharmacological tx (3)

A
  1. Psychoeducation
  2. Habit reversal therapy
    i. Most common management because most of the drugs are not preferable
    ii. Psychoeducation and behavioral therapy is preferred over drugs
  3. Individual and family therapy – Educational consultation
17
Q

Tourette’s Disorder: Pharm Management (8)

A

Level A evidence:

  1. Haloperidol
  2. Pimozide (Orap) – Risperidone

Level B

  1. Tiapride
  2. Ziprsidone

Level C

  1. Quetiapine
  2. Aripiprazole
  3. Olanzapine
  4. Sulpiride
18
Q

Tourette’s Disorder: Pharmacological - Non Antipsychotics (8)

A

Level B/Level II –tend to be used more than antipsychotics because of side effect profile

  1. Clonidine
  2. Guanfacine
  3. Pergolide (Permax, Prascend)

Level C

  1. Tetrabenazine
  2. Baclofen
  3. Nicotine Patch
  4. Flutamide
  5. Mecamylamine
19
Q

Lithium chief side effects (5)

A
  1. Renal damage
  2. Hypothyroidism
  3. Nephrogenic diabetes insipidus
  4. Hyperparathyroidism; Calcium will be high
  5. Weight Gain
20
Q

Genesights (3)

A
  1. A procedure where polymorphisms are measured among five genes that have to do with the drug metabolism and response of antidepressants and antipsychotics
  2. By assessing the genotype, the test can then determine which drugs will work well on the patient, which drugs should be used with caution, and which should be avoided due to inefficacy or the likelihood of adverse effects.
  3. TEST is controversial as there are not enough studies that prove it efficacy.

PPC3 Exam 3 (10 decks)

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