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Pharmacology > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Reasons to use Psychopharmacology Medications

A

Symptom control, May increase compliance with other therapy

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2
Q

Major Drug Classifications

A

Antipsychotics (neuroleptics)
— Antianxiety agents
— Antidepressants (mood elevators) — Tricyclic antidepressants
— Serotonin norepinephrine reuptake inhibitors (SNRIs)
— Monoamine oxidase inhibitors (MAOIs)
— Antimanic agents
— Stimulants
— Anticholinergics (antiparkinson agents)
— Herbs and naturopathic remedies

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3
Q

Antipsychotics

A

Target symptoms: psychosis – group of mental disorders classified by a marked thought disturbance and an impaired perception of reality
Ex: schizophrenia, psychotic depression, paranoid disorders

Types:

  • Conventional
  • Atypical
Absorption:  variable
Metabolism:  liver
Excretion:  slow
accumulates in fatty tissues
1/2 life of 24 hours or more
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4
Q

Schizophrenia Background

A

It is believed that Schizophrenia must be treated in a multifaceted fashion

While medication is the first line treatment counseling, social and family services should be provided for proper treatment of patients

Further developments in pharmacological treatments should increase functioning of patients in society by reducing side effects with more selective drugs

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5
Q

Schizophrenia Etiology

A

Schizophrenia is a misregulation of information in the brain

Many different NT pathways are hypothesized to be involved in the biological basis of the disorder

Genetics may be an important role
The environment may trigger a possible genetic predisposition

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6
Q

Schizophrenia Symptoms

A

Schizophrenia has been broken down into two sets of symptoms

Positive and Negative

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7
Q

Positive symptoms for Schizo

A 
On the test
Positive Symptoms:
Hallucinations
Delusions
Disorganized Speech, Behavior and Movements
Increase in goal directed activity
Illogical thoughts
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8
Q

Negative symptoms for Schizo

A 
On the test
Blunted affect
Impaired emotional responsiveness
Apathy
Loss of motivation and interest
Social withdrawal
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9
Q

Antipsychotics Preparations

A

Oral, IM, Depot: haloperidol and fluphenazine

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10
Q

Antipsychotics Side effects

A

Cardiovascular - orthostatic hypotension, arrhythmias, prolonged QTc interval on electrocardiogram (ECG)

Weight-gain: blocking histamine receptor

Endocrine and sexual: block dopamine, interfere with prolactin

Blood Dyscrasias - agranulocytosis

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11
Q

Antipsychotic Medication Categories

A

Conventional antipsychotics primarily treat the positive symptoms associated with schizophrenia
block all dopamine receptors as well as cholinergic, norepinephrine, and histamine receptors

Atypical antipsychotics have a much more tolerable adverse effect profile and target both the positive and negative symptoms of schizophrenia
more specific for dopamine2 receptors, serotonin, and norepinephrine receptors

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12
Q

Antipsychotic Meds Conventional

A 
Chlorpromazine (Thorazine),
Thioridazine (Mellaril)
Fluphenazine (Prolixin)
Trifluoperazine (Stelazine) 
Perphenazine (Navane)
Thiothixene (Navane)
Haloperidol (Haldol)
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13
Q

Antipsychotic Meds Atypical/Novel

A 
Atypical or Novel
Clozapine (Clozaril)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
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14
Q

Risperidone/Risperdal

A

Available in regular tabs, IM depot form and rapidly dissolving tablet

  • Functions more like a typical antipsychotic at doses greater than 6mg
  • Increased extrapyramidal side effects (dose dependent)
  • Most likely atypical to induce hyperprolactinemia
  • Weight gain and sedation (dosage dependent)
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15
Q

Olanzapine (Zyprexa)

A
  • Available in regular tabs, immediate release IM, rapidly dissolving tab
  • Weight gain (can be as much as 30-50lbs with even short term use)
  • May cause hypertriglyceridemia, hypercholesterolemia, hyperglycemia (even without weight gain)
  • May cause hyperprolactinemia (< risperidone)
  • May cause transaminitis (2% of all patients)
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16
Q

Quetiapine (Seroquel)

A
  • Available in a regular tablet form only
  • May cause transaminitis (6% of all patients)
  • May be associated with weight gain, though less than seen with olanzapine
  • May cause hypertriglyceridemia, hypercholesterolemia, hyperglycemia (even without weight gain), however less than olanzapine
  • Most likely to cause orthostatic hypotension
17
Q

Ziprasidone (Geodon)

A
  • Available regular tabs and IM immediate release form
  • Clinically significant QT prolongation in susceptible patients
  • May cause hyperprolactinemia (< risperidone)
  • No associated weight gain
  • Absorption is increased (up to 100%) with food
18
Q

Aripiprazole (Abilify)

A
  • Unique mechanism of action as a D2 partial agonist
  • Available in regular tabs and immediate release IM formulation
  • Early data indicates low EPS, no QT prolongation, low sedation
  • CYP2D6 (fluoxetine and paroxetine), 3A4 (carbamazepine and ketoconazole) interactions that the manufacturer recommends adjusted dosing. Could cause potential intolerability due to akathisia/activation.
  • Not associated with weight gain
19
Q

Clozapine (Clozaril)

A
  • Available in 1 form- a regular tablet
  • Is reserved for treatment resistant patients because of side effect profile
  • Associated with agranulocytosis (0.5-2%) and therefore requires weekly blood draws x 6 months, then Q- 2weeks x 6 months)
  • Increased risk of seizures (especially if lithium is also on board)
  • Associated with the most sedation, weight gain and transaminitis
  • Increased risk of hypertriglyceridemia, hypercholesterolemia, hyperglycemia, including nonketotic hyperosmolar coma and death with and/or without weight gain
20
Q

Antipsychotics: Side Effects

A 
Neurological (Extrapyr-amidal) DA-block
-Non-Neurological (Low Potency)
Histaminergic: Sedation, Wt gain
Anticholinergic: Perypheral & Central
Alpha-Adrenergic: Orthostasis, EKG
Endocrine-Sexual: PRL, 5-HT
Hematologic: Agranulocytosis
Eye & Skin: retinopathy, photosensitivity
Seizure threshold: lowered
Liver: cholestatic jaundice CPZ
21
Q

Antipsychotic Adverse Effects

A
  • Tardive Dyskinesia (TD)-involuntary muscle movements that may not resolve with drug discontinuation- risk approx. 5% per year
  • Neuroleptic Malignant Syndrome (NMS): Characterized by severe muscle rigidity, fever, altered mental status, autonomic instability, elevated WBC, CPK and LFTs. Potentially fatal.
  • Extrapyramidal side effects (EPS): Acute dystonia, Parkinson syndrome, Akathisia
22
Q

Agents for Extrapyramidal Side effects

A
  • Anticholinergics such as benztropine, trihexyphenidyl, diphenhydramine
  • Dopamine facilitators such as Amantadine
  • Beta-blockers such as propranolol
  • Need to watch for anticholinergic SE particularly if taken with other meds with anticholinergic activity, i.e. TCAs
23
Q

Psychiatric Uses Of Antipsychotic Drugs

A
  • Schizophrenia: Acute and Chronic Maintenance
  • Psychotic Depression (With Antidepressants)
  • Acute Mania (With Lithium)
  • Autism (For Control of Aggressive Behaviors)
  • Gilles de la Tourette’s Syndrome – Chronic Tics
  • Severe Agitation In Intellectually Disabled and In Alzheimer’s Patients

Pharmacology (12 decks)

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