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Pharm 585 > MCP CNS Meds Part 2 > Flashcards

MCP CNS Meds Part 2 Flashcards

1
Q

What is psychosis?

A
  • Psychosis is a symptom not a disease
  • ​​A disturbance in perception of reality
    • halluctionation: think something is there that isn’t
    • delusions: False sense of belief
    • thought disorganization
  • Seen in a variety of disorders:
    • schizophrenia
    • bipolar disorder
    • subtance-induced psychotic disorders
    • and many others
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2
Q

Schizophrenia: Epidemiology

A
  • Typically manifests in late teens and early twenties
  • Roughly affects equal numbers of men and women
    • occurs earlier in men
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3
Q

Schizophrenia: Symptoms

A
  • Positive symptoms: something is there that shouldn’t be
    • hallucinations, delusions, though disorganization, bizarre behavior
    • Dopamine receptor lackade helps resolve these symptoms
  • Negative symptoms: something isn’t there but should be
    • Social withdrawl, lack of emotional response, loss of motivation
    • Serotonin receptor blockade helps resolve these symptoms
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4
Q

Typical/First Generation Antipsychotics: MOA, Uses, Onset, Admin

A
  • MOA: Dopamine antagonist
  • Uses: Schizophrenia, bipolar disorder
  • Onset: 6-8 wks
  • Admin: with or w/o food
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5
Q

Typical/First Generation Antipsychotics: SE

A
  • ​Sedation
  • Hypotension
  • Anticholinergic effects
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6
Q

Typical/First Generation Antipsychotics: Important Pearls

A
  • ​**Highest **incidence of movement disorders
  • Poor adherance (50%)
  • Injectable forms available
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7
Q

Typical/First Generation Antipsychotics: Drugs

A
  • Chlorpromazine (Thorazine)
  • Perphenazine (Trilafon)
  • Trifluoperazine (Stelazine)
  • Thiothixene (Navane)
  • Haloperidol (Haldol)
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8
Q

Generic: Chlorpromazine

A

Thorazine

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9
Q

Generic: Perphenazine

A

Trilafon

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10
Q

Generic: Trifluoperazine

A

Stelazine

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11
Q

Generic: Thiothixene

A

Navane

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12
Q

Generic: Haloperidol

A

Haldol

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13
Q

Brand: Thorazine

A

Chlopromazine

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14
Q

Brand: Trilafon

A

Perphenazine

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15
Q

Brand: Navane

A

Thiothixene

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16
Q

Brand: Haldol

A

Haloperidol

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17
Q

Haloperidol: MOA, Dosage forms, Important Pearls

A
  • MOA: Blocks dopamine receptor
  • Dosage Form: Tab, IM Injection, syrup
  • Important Pearls:
    • Most potent typical antipsychotic
    • Highest incidence of EPS of all antipsychotics
      • table>>injection
    • Also called “vitamin H” when used for acute agitation
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18
Q

EPS

A
  • Extrapyramidal Symptoms
    • Akathisia: inability to remain motionless
    • **Dystonia: **involuntary muscle contractions
    • Onset: within weeks of starting antipsychotics
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19
Q

TD

A
  • Tardive dyskinesia
    • Syndrome consisting of involuntary movements
      • Lip smacking, tounge and jaw movements
    • Onset= YEARS of antipsychotic use
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20
Q

Atypical/Second Generation Antipsychotics: MOA, Uses, Onset, Admin

A
  • MOA: antagonize dopamine and serotonin receptors
  • Uses: Schizophrenia, bipolar disorder, and others
  • Onset: 3-6 wks
  • With or w/o food
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21
Q

Atypical/Second generation Antipsychotics: SE

A
  • Sedation, hypotension, anticholinergic effects, metabolic effects
    • More orthostatic hypotension, QT prolongation, and weight gain/diabetes risk
    • Less movement disorders than typical antipsychotics
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22
Q

Quetiapine: SE, Alternative use

A
  • Seroquel
  • SE:
    • somnolence, HA, sedation​
  • Alternative Use:
    • acute agitation
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23
Q

Risperidone: S/E

A
  • ​Risperdol
  • SE:
    • QT prolongation, EPS
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24
Q

Olanzapine: SE, Alternative Use

A
  • Zyprexa
  • ​SE:
    • somnolence, HA, weight gain
  • Alternative Use:
    • Acute agitation
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25
Q

Ziprasidone: SE, Alternative Use

A
  • Geodon
  • SE:
    • OT prolongation, somnolence
  • Alternative Use:
    • Acute agitation
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26
Q

Aripiprazole: SE, Alternative Use

A
  • Abilify
  • SE:
    • Agitation, insomnia, HA
    • More “stimulating” than other antipsychotics
    • Well tolerated
  • Alternative Use:
    • depression
27
Q

Clozapine: SE

A
  • Clozaril
  • SE
    • Agranulocytosis risk, REMS program, black box with elderly w/ dementia, increased risk seizure
    • Usually not a first line, main use is in refactory schizophrenia
28
Q

Brand: Seroquel

A

Quetiapine

29
Q

Brand: Risperdol

A

Risperidone

30
Q

Brand: Zyprexa

A

Olanzapine

31
Q

Brand: Geodon

A

Ziprasidone

32
Q

Brand: Abilify

A

Aripiprazole

33
Q

Brand: Clozaril

A

Clozapine

34
Q

3 most common side effects of all anti-psychotics

A

anticholinergic, hypotension, sedation

35
Q

Side effects more commonly seen in atypical antipsychotics

A

orthostatic hypotension, QT prolongation, metabolic effects

36
Q

Which antipsychotic class has the faster onset?

A

Atypical antipsychotics

37
Q

What is a seizure?

A

Abnormal, excessive electrical discharges of the brain

38
Q

What is epilepsy?

A

Chronic, recurrent seizures

39
Q

When do we treat epilepsy?

A
  • When a seizure won’t stop, status epilepticus
  • Maintenance therapy usually started after the second seizure episode
40
Q

How do antiepileptics works?

A
  • Stabilizing neuronal membranes, decreasing the release of excitatory neurotransmitters (NT) and increasing inhibitory NT release through several mechansims of action
  • Sodium Channels
    • Phenytonin, Carbamezepine, Oxcarbazepine, Zonisamide, Lacosamide, Lamotrigine​
  • Calcium Channels:
    • Ethosuximide
  • Inihibitory Transmission:
    • Benzodiazepine, Phenobarbital
  • Multiple Mechanisms:
    • Gabapentin, Levetiracetam, Topiramate, Valproate, Zonisamide
41
Q

Antiepileptics (AED): Onset, Admin, SE

A
  • Onset: Work within hourse but need to up-titrate to acheive therapeutic doses
  • Admin: Take w/ good if GI upset occurs
  • SE: drowsiness, fatique, solmnolence
42
Q

AED: Important Pearls

A
  • Take regularly, as non-adherance can result in seizures
  • Many DDI
    • Phenotyoin, Carbmazepine are enzyme inducers
    • Valoproic Acid can inhibit some drugs’ metabolism
  • Often have narrow therapeutic index (NTI)
43
Q

Phenytoin: Brand Name, MOA, Dosage Form, Important Pearls

A
  • Dilantin
  • MOA: Inhibts excitatory NT and stabalizes neuronal membrane
  • Dosage Form: tablet, capsule, chewable tablet, suspension, ER, injection
  • Important Pearls
    • Good oral hygiene is essential due to the risk of gingiival hyperplasia
    • Hair growth can occur (Hirsutism)
    • Drug Interaction
44
Q

Topiramate: Brand Name, MOA, Dosage Froms, Important Pearls

A
  • Topamax
  • MOA: Drecreases release of excitatory NT and potentiates inhibitory NT
  • Dosage Forms: Tablet, Capsul
  • Important Pearls:
    • Also used for migraines and for weightloss
    • Decreased work finding abilityabnormal thinking occurs in 31% of patients
45
Q

Lamotrigine: Brand name, MOA, Dosage Forms, Important Pearls

A
  • Lamictal
  • MOA: Decreases relase of excitatory NT
  • Dosage Forms: Tabs, chewable tabs, ODT, ER
  • Important Pearls
    • Start at a low dose then titrate due to risk of SJS (Stevens-Johnson Syndrome) and toxic epidermal necrolysis (TEN)
    • Patients should be monitored for rash when starting therapy
46
Q

Lamictal: SE, Alternative Use

A
  • Lamotrigine
  • SE: well tolerated, rash, requires slow uptitration
  • AU: Biolar disorder
47
Q

Depakote: SE, AU

A
  • Valproic Acid
  • SE: tremor, weight gain, GI issues, pregnancy category X
  • AU: Migraine prophylaxis
48
Q

Tegretol: SE, AU

A
  • Carbamezapine
  • SE: hyponatremia, rash
  • AU: Bipolar
49
Q

Topamax: SE, AU

A
  • Topiramate
  • SE: word finding, weight loss
  • AU: migraine prophylaxis
50
Q

Keppra: SE

A
  • ​Levetiracetam
  • SE: well tolerated, caution in patients with psychiatric history
51
Q

Dilantin: SE

A
  • Phenytoin
  • SE: gingival hyperplasia, hirsutism, bone density loss, rash
52
Q

Vimpat: SE, Othe info

A
  • Lacosamide
  • SE: PR prolongation
  • Expensive, Controlled Substance (V)
53
Q

Neurontin/Lyrica: SE, AU

A
  • Gabapentin/Pregabalin
  • SE: somnolence
  • AU: neuropathic pain
54
Q

Skeletal Muscle Relaxant: MOA, Onset, Admin, SE, Important Pearls

A
  • MOA: Cause CNS depression which leads to skeletal muscle relazaxation
  • Onset: 30-60 min
  • Admin: with or w/o food
  • S/E: Drowsiness, dizziness, anticholinergic effects
  • Important Pearls:
    • Alcohol intensifies effects
    • Duration of therapy should not exceed 2-3 weeks
      • No benefit for longer, pain may be from something else
55
Q

Cyclobenzaprine: Dosage Forms, Important Pearl

A
  • Flexeril
  • Dosage Form: Tablet, ER capsule
  • Important Pearl
    • Structurally similar to TCAs. Avoid concurrent use
56
Q

Carisoprodol: Dosage Form, Important Pearl

A
  • Soma
  • Metabolized to meprobamate which has anxiolytic and sedative effects
  • Dosage Form: Tablets
  • Important Pearl
    • Schedule IV, because of UW pharmacy!
57
Q

ADHD: Clinical Presentation, Treatment Options

A
  • Attention Deficit Hyperactivity Disorder
  • Clinical Presentation:
    • Inattention–>forgetful, easily distracted
    • Hyperactivity–>excessive fidgeting, talking
    • Impulsivity–>difficulty waiting turns, interrupts often, risky behavior
  • Treament Options:
    • Non-pharmacologic options
    • Pharmacologic options: Stimulants 1st line
58
Q

Stimulants: MOA, Use, Onset, Admin

A
  • MOA: Mediate CNS stimulation thoguh blocking the reuptake of norepinephrine (NE) and dopamine or stimulating NE and dopamine release
  • Use: Treat ADHD, narcolepsy and excessive daytime sleepiness
  • Onset: 1-2 hours
  • Admin: With or without food
59
Q

Stimulants: SE, Important Pearls

A
  • ​SE: Insomnia, Loss of appetit, weight loss, growth supression, cardiac effects
  • Imporant Pearls
    • Amphetamines and methylphenidate contraindicated in those with cardiovascular disease such as HTN and arteriosclerosis
    • Avoid alcohol and caffeine
    • Abuse potential
60
Q

Vyvanse

A

Lisdexamfetamine

Less abuse potential?

61
Q

Methylphenidate: MOA, Important Pearls

A
  • Concerta, Ritalin, Daytrana, Metadate
  • MOA: Blocks reuptake of NE and dopamin
  • Important Pearls
    • Immediate release form has the highest potential for abuse
    • C-II
    • Take IR tabs 30-45 min before meals (food affects absorbtion)
62
Q

Amphetamine/Dextroamphetamine: MOA, Important Pearls

A
  • ​Adderal, Adderall XL
  • MOA: Stimulating NE and dopamine release
  • Important Pearls:
    • Do not crush/chew extended release formulations
    • C-II
63
Q

Atomoxetine: MOA, Onset, Important Pearls

A
  • Strattera
  • MOA: Inhibts reuptake of NE
  • Onset: 2-4 wks
  • Important Pearls:
    • Only stimulant that is non-controlled
    • Typically reserved for those who fail convential stimulants/high abuse potential

Pharm 585 (13 decks)

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