Antipsychotic Agents & Lithium Flashcards Preview

Pharm II Exam 4 > Antipsychotic Agents & Lithium > Flashcards

Flashcards in Antipsychotic Agents & Lithium Deck (34):
1

What are the essentials of dx for schizophrenia? (6)

Social withdrawal

Loose thought associations

Autistic absorption in inner thoughts

Auditory hallucinations

Delusions

Sx ≥ 6 months duration

2

What plays a role in schizophrenia?

Serotonin: 5-HT2A receptor blockade

Dopamine: blockade of postsynaptic D2 receptors

Glutamate: hypofunction of NMDA receptors

3

Out of all of the first generation antipsychotics (FGAs), which causes the most wt gain?

Chlorpromazine

4

Which FGA causes significant QT prolongation?

Thioridazine

5

Which 2nd-gen antipsychotics should be taken w/ food? How many calories are required?

Lurasidone: ≥ 350 calories

Ziprasidone: ≥ 500 calories

6

Which 2nd generation antipsychotics cause wt gain?

Olanzapine (avoid in 1st antipsychotic episode)

Quetiapine (dose related)

7

All antipsychotics should be tapered slowly before discontinuation to avoid cholinergic rebound.
Which drug is this especially important for?

Clozapine

8

What is the MOA of lithium?

Increase the volume of brain structures involved in emotional regulation

S/a the prefrontal cortex, hippocampus, & amygdala (reflecting its neuroprotective effects)

9

What does lithium do at a neuronal level?

Reduces excitatory (dopamine & glutamate) but increases inhibitory (GABA) neurotransmission

10

Which 2 drug classes cause decreased clearance of lithium?

Thiazides & NSAIDs

11

What are ADEs of lithium?

Tremor

Edema

Hypothyroidism*

Renal dysfunction

Pregnancy category D*

12

What are 3 newer drugs used for bipolar disorder?

Carbamazepine

Lamotrigine

Valproic acid

13

What is an ADE of lamotrigine (1 of the newer drugs for bipolar d/o)?

Rash*

14

How do you initially treat hypomania?

Initiate mood stabilizer: lithium, valproate, carbamazepine, or SGAs

15

If initial tx for hypomania fails, what is your next step?

Consider 2 drug combo:

Lithium + an anticonvulsant or SGA

Anticonvulsant + another anticonvulsant or SGA

16

How do you initially treat mania?

2 or 3 drug combos + a benzo &/or antipsychotic for short term adjunctive tx of agitation or insomnia

17

If initial tx for mania fails, what is your next step?

Consider 3 drug combo:

Lithium + anticonvulsant + antipsychotic

Anticonvulsant + another anticonvulsant + antipsychotic

18

If 3-drug therapy fails in the tx of mania, what is your next step?

Consider ECT or add clozapine

19

How do you initially treat a mild to moderate depressive episode?

Initiate mood-stabilizer: lithium, quetiapine, lurasidone

20

How do you initially treat a severe depressive episode?

Optimize current mood stabilizer or initiate: lithium, quetiapine, or lurasidone

21

If initial treatment for severe depressive episode fails, what is your next step?

Consider carbamazepine or adding antidepressant

22

If second form of tx fails for severe depressive episode, what is the 3rd step?

Consider 3-drug combo:

Lithium + lamotrigine + antidepressant

Lithium + quetiapine + antidepressant

23

If 3rd form of tx fails for severe depressive episode, what is the 4th step?

Consider ECT

24

What are the 4 dopaminergic pathways?

Mesolimbic: + sx

Mesocortical: - sx

Nigrostriatal: EPS & tardive dyskinesia

Tuberophypophyseal: hyperprolactinemia

25

What are overall characteristics of antipsychotics?

Well absorbed

Lipid soluble

Bound to plasma proteins

Metabolized by liver enzymes, renally eliminated

Long 1/2 lives

26

What are relative side effects of antipsychotics?

Sedation
EPS
Anticholinergic
Orthostasis
Wt gain
Prolactin

27

What agents are used to treat EPS?

Antimuscarinics
Antihistaminic
Dopamine agonist
Benzos
B-blockers

28

How long should you continue antipsychotic therapy after remission of the 1st episode?

At least 12 months

Many recommend tx for at least 5 yrs

29

How do you switch from 1 antipsychotic to another?

Taper & discontinue the 1st over at least 1-2 wks while the 2nd antipsychotic is initiated & tapered upward

30

What is lithium used for?

Manic phase of bipolar d/o

Prevents mood swings

31

What 2 classes of meds may need to be included during the initiation of lithium or valproic acid for bipolar d/o?

Antipsychotics & benzos due to slow onset of lithium & valproic acid

32

What can precipitate mania in bipolar pts?

Monotherapy w/ antidepressants

33

What are ADEs of carbamazepine (1 of the newer drugs for bipolar d/o)?

Hematotoxicity & induction of drug metabolism

34

What are ADEs of valproic acid (1 of the new drugs for bipolar d/o)?

Hepatic dysfunction
Wt gain
Inhibition of drug metabolism