psych pharm 4-21-06
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- what is another name for antipsychotics
- neuroleptics
- name 4 antipsychotic drugs
- thioridazine, haloperidol, fluphenazine, chlorpromazine
- how do you keep benzos straight from antipsychotics
- Benzos help 3rd year Jon Kazam be less anxious around patients: Shazam Kazam! Without antipsychotics patients talk like a crazy 'zine (well, not perfect, but I'm working on it)
- what is the mechanism of most antipsychotics
- block dopamine D2 receptors
- what is the clinical application of antipsychotics
- schizophrenia, psychosis
- what are the side effects of antipsychotics
- extrapyramidal side effects (EPS), sedation, endocrine, muscarinic blockade, alpha blockade, histamine blockade
- what is a long-term effect of antipsychotic use
- tardive dyskinesia
- what is neuroleptic malignant syndrome
- a side effect of antipsychotics; rigidity, autonomic instability, hyperpyrexia
- how do you treat neuroleptic malignant syndrome
- dantrolene, dopamine agonists
- what is tardive dyskinesia
- side effect of neuroleptics; stereotypic oral-facial movements, may be due to dopamine receptor sensitization
- what is the "rule of 4" with EPS side effects from antipsychotic drugs
- evolution of EPS side effects: 4 hours -- acite dystonia, 4 days -- akinesia, 4 weeks -- akasthesia, 4 months -- tardvie dyskinesia
- is tardvie dyskinesia reversible
- often irreversible
- what is fluphenazine used for
- schizophrenia, psychosis
- name 3 atypical antipsychotics
- clozapine, olanzapine, risperidone
- what type of antipsychotic is clozapine
- atypical
- what type of antipsychotic is olanzapine
- atypical
- what type of antipsychotic is risperidone
- atypical
- what is the mechanism of atypical antipsychotics
- block 5-HT2 and dopamine receptors
- what is the mechanism of clozapine
- block 5-HT2 and dopamine receptors
- what is the mechanism of olanzapine
- block 5-HT2 and dopamine receptors
- what is the mechanism of risperidone
- block 5-HT2 and dopamine receptors
- what is the clinical application of clozapine
- schizophrenia positive and negative symptoms
- what is the clinical application of olanzapine
- schizophrenia positive and negative symptoms, OCD, anxiety disorder, depression
- what is the clinical application of risperidone
- schizophrenia positive and negative symptoms
- how are atypical antipsychotics different from classic ones
- atypicals treat positive and negative symptoms of schizophrenia, fewer extrapyramidal and anticholinergic side effects than classic antipsychotics
- which antipsychotics should be used to treat positive and negative symptoms of schizophrenia
- atypical ones -- clozapine, olanzapine, risperidone
- which antipsychotics should be used for fewer side effects
- atypical ones -- clozapine, olanzapine, risperidone
- what is a potential toxicity of clozapine
- agranulocytosis
- which antipsychotic drug can cause agranulocytosis
- clozapine
- what test must be done weekly on patients taking clozapine
- WBC count because of potential agranulocytosis
- 0
- 0
- what is the mechanism of action of lithium
- unknown; may be related to inhibition of phosphoinositol cascade
- what is the clinical application of lithium
- mood stabilizer for bipolar disorder
- how does lithium help people with bipolar disorder
- prevents relapse and acute manic episodes
- what are the side effects of lithium
- tremor, hypothyroidism, polyuria, teratogenic
- is it OK for women taking lithium to get pregnant
- NO -- teratogenic
- what does lithium cause polyuria
- ADH antagonist --> nephrogenic diabetes insipidus
- What do the following drugs inhibit: 1. MAO inhibitors, 2. Desipramine/maprotilline, 3. Mirtazapine and 4. Fluoxetine/trazodone?
- 1. MAO 2. NE reuptake 3. Alpha 2-R & 5HT2 R 4. 5HT reuptake
- 1. MAO inhibitors, 2. Desipramine/maprotilline, 3. Mirtazapine and 4. Fluoxetine/trazodone actions are ------synaptic
- PRE
- List the Tricyclic Antidepressants
- Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin
- What are the three C's of Tricyclic Antidepressant toxicity?
- Convulsions, Coma, Cardiotoxicity (arrythmias). Also respiratory depression, hypyrexia.
- How about tricyclic antidepressant toxicity in the eldery?
- confusion and hallucinations due to anticholinergic SE
- What is the mechanism of TCA?
- block reuptake of NE and 5HT
- What is the clinical uses of TCAs?
- Endogenous depresion. Bed wetting - imipramine. OCD- clomipramine.
- How are tertiary TCA's different than secondary in terms of side effects?
- Amitriptyline (tertiary) has more anti-cholinergic effects than do secondary (nortriptyline). Desipramine is the least sedating.
- what are the side effects of TCAs?
- sedation, alpha blocking effects, atropine-like anti cholinergic side effects (tachycardia, urinary retention)
- Fluoxetine, sertraline, paroxetine, citalopram are what class of drugs?
- SSRI's for endogenous depression
- How long does it take an anti-depressant to have an effect?
- 2-3weeks
- How does the toxicity of SSRI's differ from TCA's and what are they?
- Fewer than TCA's. CNS stimulation - anxiety, insomnia, tremor, anorexia, nausea, and vomiting.
- What toxicity happens with SSRI's and MAO inhibitors given together?
- Seratonin Syndrome! Hyperthermia, muscle rigidity, cardiovascular collapse
- What are heterocyclics?
- 2nd and 3rd generation antidepressants with varied and mixed mechanisms of action. Used major depression.
- Examples of heterocyclics?
- Buproprion, Venlafaxine, Mirtazapine, Maprotiline, Trazodone BUtane in your VEINs to MURder for a MAP of alcaTRAZ
- Which heterocyclic is used for smoking cessation?
- Buproprion. Mechanism not known. Toxicity - stimulant effects, dry mouth, aggrevation of pyschosis
- Which heterocyclic used in GAD?
- Venlafaxine - inhibits 5HT and DA reuptake. Toxicity - stimulant effects
- which heterocyclic blocks NE reuptake
- maprotiline
- Which heterocyclic increases release of NE and 5HT via alpha 2 antagonism?
- mirtazapine. Also potent 5HT Rantagonist. Toxicity - sedation, increase serum cholesterol, increase appetite
- What is trazodone and it' SE?
- primarily inhibits seratonin reuptake. Toxicity - sedation, nausea, priapism, postural hypotension
- Give 2 examples of MAO
- phenelzine. Tranylcypromine
- MAO Mechanism and Clinical Uses?
- non selevtive MAO inhibition. Atypical antidepressant, anxiety, hypochondriasis
- What is the toxicity of MAOs with tyramine ingestion (in foods) and meperidine?
- Hypertensive crisis
- Other MAO toxicities? (besides w/ tyramine)
- CNS stimulation, contraindicated with SSRI's or B-agonists
- What is the mechanims of selgiline (deprenyl)?
- Selectively inhibits MAO-B, increasing DA
- what is deprenyl's (selgiline) clinical use and toxicity?
- adjunctive agent to L-dopa for Parkinsons. May enhance adverse effects of L-dopa