Quiz 1 Psychotic and Mood Disorders Flashcards
First Generation APS typically end in what suffix
Zine
most common - chlophromazine, fluphenazine
include Haloperidol
Atypical APS with relative potency dose
Risperidone 1mg (2-6) Olanzapine 4mg (15-30) Ziprasidone 20mg (80-160) Clozapine 50mg (200-500) Quetiapine 80mg (300-800)
Typical APS with relative potency dose
Fluphenazine 1-2mg (2-20) Haloperidol 2mg (5-20) Mesoridazine 50mg (50-150) Chlorpromazine 100mg (100-600)
High potency dose - higher risk for?
EPS
Low potency dose - higher risk for
Metobolic disturbance
Second Generation APS typically end in what suffix?
PINE or IDONE or AZOLE
FGA preliminary diagnostics would consist of:
AIMS (abnormal involuntary scale)
VS
ECG
SGA - Metabolic syndrome diagnostics are:
Weight, BMI, blood glucose, lipid panel
Prolactin levels related to gynecomastia (dose-depemdent)
Side effects of APS D2 occupancy should be between what percentage?
60-80%
> 80% = EPS
Patient experiencing EPS should add what drugs?
Benztropine
Benadryl
Amantadine
Pseudoparkinsonism - presentation and drug
Muscle rigidity, masked facies, shuffling gait, tremor
Drugs: benztropine or amantadine
Benztropine used for what side effects
Pseudoparkinsonism
Dystonia or dyskinetic movements
Akathisia (beta blocker, lower dose)
Tardive Dyskinesia (TD) - drugs to use
Austedo
Vilbenazine
Drug to treat QTc prolongation
Beta Blocker
Hyperprolactinemia causes
Dopaminne inhibits prolactin
FGAs more risk due to potency and affinity
Neuroleptic Malignant Syndrome definition and treatment
Impaired body temp regulatio
Needs to be treated emergently - ER
Remove offending agent
Dantrolene
Clozapine indications
Diminish S/S of EPS, specifially TD
Common S/E - excessive salivation, metabolic syndrome, ileus, rediced seizure threshold, tachy
Mood Stablizer drugs
Divalproex, Valproate (Depakote)
Lithium
Caramazepine (Tegretol)
Latroigine
Lithium indication and SE
Considered gold standard for bipolar/suicide Ebstein anomaly (heart defect)
Drug/drug interactions - NSAIDS, ACE inhibitors, diurectics
Plasma trough level at 12hrs after last dose. >2 is considered toxic levels
Toxicity SE ataxia, N/V/D, vision changes, unsteadiness
Divalproex, Valproate (Depakote)
mood stabilizer depression (manic) and seizure disorder
drug/drug interactions - carbamazine & lamictal
assoc with PCOS
Carbamazepine indications and SE
Mood stabilizer/ bipolar (manic)
CYP induction -
Rash - Steven Johnsons Syndrome
Neural tube defects in pregnant woman
Lamotrigine indication and SE
Mood stabilizer/ bipolar depression
Steven Johnsons Syndrome (titrate slowly)
When given with Divalproex, start with half the Lamotrigine dose and titrate slowly
Weight neutral
what drugs treat both manic and depressive bipolar
olanzapine, quetiapine, cariprazine, lurasidone
SSRI
citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
fluvoxamine- not indicated for depression, ok for OCD and social anxiety disorder
sertaline- indicated for social anxiety, MDD, OCD, panic, PTSD, PMDD. Most lethal
paroxetine- short half life, discontinuation syndrome, PTSD, SAD, MDD, OCD, GAD
These drugs above are CYP450 inhibitors (increases drug concentration)
SNRI
Venlafaxine, devenlafaxine, duloxetine, milnacipran, levomilnacepran
May help to alleviate chronic pain
Venlafaxine short half life - produces discontinuation syndrome, hypertension
SARI
nefazodone, trazodone, vortioxetine
trazodone- more useful for sleep than depression, priaprism, orthostatic hypotens
vortioxetine- GI distress
nefazodone- Black box warning LIVER FAILURE (rarely used)
SPARI
vilazodone- must take with food
works as SSRI and a partial agonist. Meaning it doesn’t reach its full potential
NDRI
Bupropion- norepinephrine-dopamine reuptake inhibitor
Do not use with hx of seizures or eating disorder
Aids in smoking cessation
Lowest risk for sexual SE
Used as an augmenting agent to SSRI
Lowest risk for “switch” to mania in bipolar
TCA
Amitriptyline, amoxapine, dlomipramine, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline, trimipramine
Usually have suffix -triptyline or -ipramine
Desipramine - lethal in overdose (death by cardiac conduction, wide QRS)
SE- dry mouth, constipation, blurred vision, urinary retention, tachy
Amitriptyline- help alleviate chronic pain/migranes
MAOI
iscocarboxazid, moclobemide, phenelzine, trancylopromine, selegeline
MAO-A (advanced) inactivates serotonin, norepi, dopamine)
MAO-B (basic) can only inactivate dopamine
phenelzine, transcyclopromine, isocarboxazid = MAO-A & B
selegiline = MAO-B
Must have 4-5 week wash out period, dietary restrictions, foods high in tyramine can cause hypertension Risk of serotonin syndrome
Most effective antidepressants.
Phenelzine for depression with atypical features
Trancyclopromine for anxiety
Mirtazapine
Mirt-a-2-apine - is an a2 receptor antagonist, works as an antidepressant
Stimulates appetite, sedation at lower doses, can be useful in elderly population
