Somatic Therapies II Flashcards
What are the four major general classes of anxiolytics?
- Antidepressants
- benzos
- Buspirone
- Antihistamine
What are the antidepressants that are used to treat anxiety disorders? (3)
SSRIs
SNRIs
Mirtazapine
For treating OCD using SSRIs or clomipramine, what are the changes compared to treating depression?
- SSRIs need higher doses
- Need longer response time
What is the drug of choice for an acute panic attack? What is the major issue with this?
Alprazolam (xanax)
Fast onset, but short acting, and highly addictive because of that.
What is the only benzo that is absorbed IM?
Lorazepam
What are the side effects of benzos?
- Drowsiness
- Reduced motor coordination
- potential for tolerance
What are the withdrawal s/sx of benzos?
Like alcohol withdrawal
True or false: benzos have major adverse effects in pregnancy
False–generally safe PRN
True or false: benzos have adverse effects with breastfeeding
True
What is the MOA of buspirone? Use?
- 5HT1a agonism
- Anxiolytic w/o sedation
- No risk of tolerance
True or false: buspirone is effective for treating OCD, but not panic attacks or phobias
False–not effective for any of them. Only GAD.
What is buspirone used for now?
Augment antidepressants for anxiety disorders
What is the general treatment regimen for anxiety?
- SSRIs
- SNRIs if SSRIs fail
- Mirtazapine
What is the role of benzos in the treatment of anxiety disorders?
Short term, acute episodes PRN
Is buspirone used PRN or long term?
Long term
What are the four major typical antipsychotics? Which is a weak one?
- Haloperidol
- Chlorpromazine**
- Thioridazine**
- Fluphenazine
What are the atypical antipsychotics? (6)
- Olanzapine
- Clozapine
- Quetiapine
- Risperidone
- Aripiprazole
- Ziprasidone
What is the general MOA of antipsychotics?
Postsynaptic D2 receptor blockade in the mesolimbic and mesocortical pathway
What are the uses of FGAs?
- Schizophrenia
- Psychosis
- Agitation
- Tourette’s syndrome
What is the only antipsychotic that is not approved for use with schizophrenia? What is it used for?
Clozapine
Refractory schizophrenia
What is the use for risperidone that is unlike the other FGAs?
ASD
How fast are antipsychotics in treating agitation?
30-60 minutes
What organ metabolizes antipsychotics?
Liver
What is the duration of an adequate trial of antipsychotics?
4-6 weeks
What percent of pts taken off of antipsychotics for schizophrenia will relapse?
75%
True or false: prevention of relapse with schizophrenia is more important than side effects
True
What is the psychotic drug that causes agranulocytosis?
Clozapine
What is the psychotic drug that causes hyperprolactinemia? How?
Risperidone
Dopamine antagonism
What is neuroleptic malignant syndrome? S/sx?
Reaction to antipsychotics
- Fever
- Elevated CPK
- Vital sign instability
- Encephalopathy
- Rigidity
What is the treatment for NMS? (3)
- IVFs
- Dantrolene
- Bromocriptine or other dopamine agonist
Why do SGAs have a lower risk of movement disorders?
Blockade of 5HT2a receptors
What is acute dystonic reaction? Treatment?
- Reaction to FGAs or SGAs that causes painful muscle contractions
- Treat with antihistamine or benztropine
What are the s/sx of pseudoparkinsonism?
- Rigidity
- Coarse tremor
- Hypokinesia/ bradykinesia
What is the treatment for pseudoparkinsonism?
Anticholinergics
When does akathisia usually occur with antipsychotic use?
within the 1st few weeks of treatment
What are the subjective symptoms of akathisia
anxiety and tension
How do you differentiate between akathisia and anxiety?
Akathisia will point to extremities as source of symptoms, as opposed to chest
What is the treatment for tardive dyskinesia?
- Beta blockers such as propranolol
- Switch drugs
What is the early sign of tardive dyskinesia?
See tongue fasciculations
Which gender is at greater risk of tardive dyskinesia?
Women
What happens initially with decreasing dose of antipsychotic with TD?
Gets worse, but you should not increase
What is the most sedating antipsychotic?
Quetiapine
What is the antipsychotic with the most EPS?
Risperidone
What are the two antipsychotics that have weight gain as a major side effect?
Clozapine
Olanzapine
What are the two antipsychotics that do NOT have weight gain as a major side effect?
Aripiprazole
Ziprasidone
What atypical has the least EPS?
Clozapine
What are the disadvantages of SGAs?
-Metabolic syndrome and DM
Which generally is more effective for the positive symptoms of schizophrenia: FGAs or SGAs?
FGAs
What is the major advantage of SGAs?
Lower movement disorders
What is the major side effect of risperidone?
CVAs
What is paliperidone?
Risperidone active metabolite
What is the role of clozapine in the treatment of schizophrenia?
Second or third line treatment
Drooling is caused by what SGA?
Clozapine
What is the major side effect of clozapine?
Agranulocytosis
What must be followed with clozapine?
Weekly absolute neutrophil count for 6 months, then every other week for 6 months
What is the major side effect with ziprasidone?
-QT prolongation
What is asenapine?
SGA
True or false: SGAs are first line for psychosis
True
What should be done if there are significant side effects with SGAs or FGAs?
switch or lower dose
What are depot formulations?
IM injections q 2-4 weeks
Which type of antipsychotic has a risk of metabolic symptoms?
SGAs
