Week 11: psychotherapeutics, vaccines Flashcards
What are extrapyramidal symptoms (EPS)? Describe the four types.
Akinesias –restlessness, foot tapping, trouble standing still, pacing, feet in constant motion, rocking back and forth
Pseudoparkinsonism – stooped/shuffled gait, rigidity, bradykinesia, pill-rolling motion of the hands slight tremor at rest
Acute dystopia – facial grimacing, involuntary upward eye movement, muscle spasms of the tongue, face, neck and back (trunk arching forward)
Tardive dyskinesias – protrusion and rolling of tongue, chewing or sucking motion, facial dyskinesia, involuntary movements of the body and extremities
s/s serotonin syndrome
hyperactive bowel activity, tremor, hyperreflexia, dilated pupils (hyperthermia, altered LOC, ANS instability too)
tx serotonin syndrome
d/c med, supportive care, give serotonin receptor blockers
Why do you think it’s so important to differentiate between the two prior to initiating pharmacologic treatment?
It is particularly important to differentiate between the two because the treatment for serotonin syndrome could worsen neuroleptic malignant syndrome if misdiagnosed.
Contraindications for SGAs
avoid with other drugs that suppress bone marrow
List some atypical antidepressants
Bupropion
Esketamine
How does esketamine work
Esketamine – NMDA receptor antagonist, thus can increase glutamate (excitatory)
How does bupropion work?
Bupropion – unclear, may be d/t DA/NE reuptake
How does Na+ levels affect plasma drug levels of lithium?
Excretion is affected by Na+ concentration, the lithium goes where the sodium goes, so hyponatremia poses a risk for toxicity, while hypernatremia causes a risk for subtherapeutic drug levels
AE of lithium at theraputic dosages
N/V/D
Thirst, polyuria (block of ADH)
Lethargy, slurred speech, fine hand tremor,
renal toxicity
Hypothyroidism and goiter
Teratogenesis (avoid in first trimester, unless benefits outweigh risks)
Classes of drug interactions with lithium
Diuretics (na+ loss)
NSAIDs (increase renal artery vasoconstriction, increasing lithium levels)
anticholinergic (urinary hesitancy)
ACE inhibitors (Na+ loss)
Who should receive RSV antibodies?
Preterm infants
Congenital heart disease less than 2 yrs
Bronchopulmonary dysplasia (less than 2 yrs)
all vaccines pose a risk for anaphylaxis because
of preservatives, like neomycin, gelatin,
Vaccines requiring only one dose
Hep A (2nd dose only if live in high risk areas)
AE MMR
localized lymphadenopathy, joint stiffness, transient thrombocytopenia
AE DTaP
high fever, febrile seizure, encephalopathy
AE polio
polio-like syndrome only w/ oral (rare)
AE varicella
mild rash
Unique CI for MMR
pregnancy
Unique CI for DTaP
after previous dose fever above 105, febrile seizure, encephalopathy
unique CI for varicella
pregnancy, blood cancer
Unique considerations for hep B
if mom is hep B+, give immunoglobulin with first dose
unique CI for rotavirus
uncorrected GI malformation, severe vomiting or diarrhea (can’t keep in gut long enough to develop antibodies)
Antidote for overdose of AChE inhibitors
Atropine
Antidote for OD of Anticholinergic drugs
AchE inhibitor
Antidote for heparin OD
protamine
What are two FGA
haloperidol
Chlorpromazine (phenothiazine)
AE of SGA
DM
Weight gain
HLD
agranulocytosis
sz
myocarditis
EPS
orthostatic hypotension
higher risk mortality w/ dementia
What is the difference between MAOIs (nonselective) and MAO-B inhibitors
MAOIs are used for depression, causing an increase in dopamine, serotonin and NE.
MAO-B inhibitors cause an increase in dopamine and are used in PD
Classes used to treat insomnia
benzos
benzo-like drugs
melatonin agonists
orexin antagonist (both sleep onset and maintenance)
barbs
AE of zolpidem
similar to benzos
little to no respiratory depression at therapeutic doses
avoid in pregnancy
rare: abnormal sleep related behaviors
AE of suvorexant
somnolence, dizziness
HA
dry mouth, cough
physical dependence/tolerance - schedule 4
Cautions in suvorexant
Obstructive Sleep Apnea (OSA) and COPD
Drug interactions with ramelteon
CNS depressants
fluvoxamine (can increase drug levels 50x)
Caution with Buspirone
hepatic metabolism, be careful with CYP450 inducers and inhibitors
Considerations with Amphetamines
tolerance and dependence occurs so taper slowly
Considerations with Methylxanthines
may lower birth weight in pregnancy
ADH suppression causing diuresis
What is Miralax especially good for decreasing absorption of
iron, lithium, lead
