schizophrenia Flashcards
how does blockage of dopamine receptors mesolimbic tract affect?
dopamine blockade prevents overactivity responsible for positive symptoms
how does blockage of dopamine receptors in mesocortical tract affect
hypofunction results in negative unwanted sx
how does blockage of dopamine receptors in nigrostriatal tract affect
blockade causes epse
how does blockage of dopamine receptors in tuberinfundibular tract affect
dopamine blockade leads to hyperprolactinemia
therapeutic effects of D2 antagonism
reduces positive sx
side effects of D2 antagonism
epse, hyperprolactinemia
therapeutic effects of 5HT1A agonism
anxiolytic properties
therapeutic effects of 5HT2A antagonism
antidepressant effects, improve negative sx
side effects of 5HT2C antagonism
weight gain
side effects of H1 antagonism
sedation / weight gain
side effects of alpha 1 antagonism
orthostasis
side effects of m1 antagonism
anticholinergic effects (acute urinary retention, delirium)
side effects of IKR antagonism
QTc interval prolongation
clozapine monitoring
weekly WBC and ANC count for first 18 weeks, then monthly
why avoid in elderly with dementia
increased risks for mortality and stroke
if patient is uncooperative during acute agitation
IM lorazepam, olanzapine, haloperidol, promethazine
if patient is cooperative during acute agitation
PO Lorazepam, PO risperidone
NMS symptoms (antipsychotics)
muscle rigidity, fever, autonomic dysfunction, altered consciousness, increased serum creatine kinase
ortho hypot: which drug has the lowest risk
aripripazole
ortho hypo t: does olan or quet have higher risk?
quet
ortho hypo t: does risp or pali have higher risk?
risp,pali, quet same
ortho hypo t: does cloz or risp have higher risk?
cloz
ortho hypot: which drug has the highest risk
chlorpromazine
what drugs have risk of vte
low potency fga
qtc prolong: which drug has higher risk (olan/quet)
quet.
olan has the lowest risk
qtc prolong: which drug has higher risk (halo/cpz)
cpz
qtc prolong: which drug has higher risk (quet/risp)
quet
qtc prolong: which drug has the highest risk
thioridazine
drugs causing neuroleptic malignant syndrome
high potency antipsychotics
antidote for nms
IV dantrolene, PO dopamine agonist
clozapine adverse effects
decrease in wbc count, agranulocytosis (blood dyscrasias)
what to monitor
BMI, fasting sugar, lipids, blood pressure, EPSE exam
elderly what to avoid
drugs causing alpha1 adrenergic blockade, anticholinergic side effects
2d6 inhibitors
fluoxetine, paroxetine, bupropion
3a4 inducers
simvastatin, lovastatin, nifedipine, amlodipine, diltiazem, phenytoin, cbz
fluvoxamine pd characteristics
1a2 inhibitor, 2c19 inhibitor
substrates of 2d6
metoprolol, codeine, hydrocodone, oxycodone, tramadol
substrates of 1a2
amiodarone, theophylline, warfarin
clozapine interactions
(1a2 inhibitors) fluvox, quionlones, macrolides, isoniaid, ketoconazole
(agranulocytosis) cbz
contraindication to antipsych
qtc prolongation
precautions of antipsychs
cvs
parkinson’s disease
prostatic hypertrophy
angle closure glaucoma
what to avoid with IM olanzapine
use of IM lorazepam
low potency antipsychs
clozapine, chlorpromazine, quetiapine
high potency antipsychs
haloperidol, olanzapine, risperidone
side effects of antipsychs
dystonia,
pseudo-parkinsonism, akathisia (restlessness),
tardive dyskinesia, hyperprolactinemia, metabolic
orthostatic hypoT
NMS (muscle rigidity, fever)
monitoring for sga
bmi,
fasting blood glucose,
lipid panel,
blood pressure,
epse exam
to reverse epse effects
IM benztropine (antichol)
to mitigate akathisia (restlessness)
clonazepam, propanolol
to reverse tardive dyskinesia
discontinue anticholinergics
drugs should be given IM or IV
IM, prevent bp crashing
sedation higher (cpz/cloz)
cpz. it has the highest risk of sedation.
sedation (risp/cloz)
cloz
sedation (risp/olan)
olan
sedation (quet/cloz)
cloz
sedation (quet/risp)
quet
sedation (pali/quet)
quet
seizure (cloz/sga/cpz)
cloz/cpz > sga
which drugs cause raised lfts
cpz and other fga, olan, quet
haloperidol/olanzapine a substrate of?
1a2, 2d6
risp a substrate of ?
2d6, 3a4
quetiapine a substrate of?
3a4
aripiprazole a substrate of?
2d6, 3a4
clozapine a substrate of?
1a2
side effect of blockage of post synaptic receptor
epse