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Flashcards in antipsychotics Deck (36):
1

Essentials in diagnosing schizophrenia

social withdrawal
lose thought associations (shift topic to topic)
Autistic absorption in inner thoughts
Auditory hallucinations
Delusions
Sx at least 6 months

2

What are the different types of schizo

Schizophrenic d/o
Delusional d/o
Schizoaffective d/o
Schizophreniform d/o
Brief psychotic d/o

3

What are the dopaminergic pathways

Mesolimbic: + Sx
Mesocortical: - Sx
Nigrostriatal: EPS, tardive dyskinesia
Tuberophypophyseal: hyperPRL

4

What are + Sx

suspicious
delusions
hallucinations
conceptual disorganization

5

What are - Sx

flat affect
alogia (aphasia)
anhedonia
avolition

6

What are cognitive Sx

impaired attention
impaired memory
impaired executive function

7

What is the hypothesis behind schizophrenia Tx

5-HT2a receptor block; modulate release of dopamine, NE, glutamate, GABA, and ACh
Block post-synaptic D2 receptors in CNS, mesolimbic (+), and striatal (EPS)

8

What can hypofunction of NMDA receptors on GABA neurons lead to

Diminished inhibitory influences on neuronal function
Glutamate can lead to hypertsimulation of cortical neurons
(idk what any of this means- slide 9)

9

What other receptors are involved in PD of antipsychotics

A-adrenergic blocking action
5-HT2/2a antagonists
5-HT1d agonists
D2 and 5-HT1a partial agonists

10

What are first gen antipsychotics

Chlorpromazine
Fluphenazine
Haloperidol
Loxapine
Perphenazine
Thioridazine
Thiothixene
Trifluperazine

11

What are second gen antipsychotics

Aripiprazole
Clozapine
Lurasidone
Olanzipine
Risperidone
(not all inclusive)

12

What are the overall PK of antipsychotics

Well absorbed
Lipid soluble
Bound to plasma proteins
Metabolized by liver enzymes
Renally eliminated
Long half lives

13

What ADE should you monitor on someone taking antipsychotics

Akathisia (inner restlessness)
Anticholinergic ADE
Glucose intolerance
HLD
Orthostatic hypotension
HyperPRL
Sedation
Sexual dysfunction
Tardive dyskinesia
Weight gain

14

Monitor for these ADE in specific antipsychotics

Clozipine (2): Agranulocytosis (WBC), Sialorrhea (excess drooling
Inhaled Loxapine (1): Bronchospasm, respiratory distress/depression/arrest
Long acting Olanzapine (2): post-injection sedation, delirium syndrome

15

Antipsychotic toxicity can lead to

Dose dependent EPS: bradykinesia, rigidity, tremoe, akathisia, dystonias
Tardive dyskinesia: choreathetoid movements of lips and buccal muscle (appear at 6 months-yrs later)

16

How do you treat toxicities associated with antipsychotics

Dose dependent EPS (parkinson like Sx): muscarinic blockers and Diphenhydramine
Tardive dyskinesia: No Tx

17

What specific drugs treat EPS 2/2 antipsychotics

Benztropine, Trihexyphenidyl (antimuscarinic)
Diphenhydramine (antihistamine)
Amantadine (D agonist)
Lorazepam, Diazepam, Clonazepan (benzos)
Propranolol (BB)

18

Haloperidol is usually automatically paired with

Benztropine (anti-muscarinic)

19

Schizophrenia Tx addresses

Psychosocial component
Psychiatric pharm
co-occurring mental d/o
Tx adherence
Medical problems

20

Goal for schizo Tx is

First 7 days: decrease agitation, hostility, anxiety, aggression. Normalize sleep and eating
Wk 2-3: improve socialization, self-care, mood
Wk 6-8: Improve formal thought disorder

21

How do you maintain therapy (avoid relapses) in schizo

Continue meds for 12 mo. after remission of first episode, but most recommend 5 years
Lifetime lowest dose of pharm therapy
Taper Clozapine and other 1st gens slowly to avoid cholinergic rebound

22

How do you switch someone to a different antipsychotic

Taper the first down slowly and d/c over 1-2 weeks
At the same time, initiate the new antipsychotic and taper upward

23

What agents are used to treat Bipolar disorder

Lithium*: Tx manic phase, and prevent recurrent manic and depressive episodes
Valproic acid, Carbamazepine, Lamotrigine, Quetiapine, Olanzapine

24

What do you need to do when treating bipolar disorder (with meds)

Include antipsychotics and benzos during initiation to slow the onset of lithium or valproic acid

25

What can monotherapy with antidepressants do to bipolar patients

Precipitate mania!
Diagnosis needs to be correct w/ bipolar b/c SSRI's expose mania

26

How does lithium work

Increase volume of brain structures that regulate emotions (pre-frontal cortex, hippocampus, amygdala)= Neuroprotective
Reduces excitatory NT (dopamine, glutamate) and increases inhibitory NT (GABA)
-Suppresses IP3 and DAG signaling

27

What are the PK of lithium

Absorption: complete in 6-8 hrs, peak plasma in 30min-2hr
Distribution: no protein binding. some sequestered in bone
Metabolism: none
Excretion: Urine (renally)! half life is 20 hrs

28

What are the effects of Lithium

No sedation! no specific ANS or CNS receptors

29

Lithium clearance is decreased by

Thiazides
NSAIDs

30

Toxic ADE of lithium are

tremor
edema
Hypothyroid*
renal dysfunction
*Pregnancy category D

31

What are newer drugs used for manic component of bipolar disorder and their ADE

Carbamazeoine: ataxia, diplopia
Lamotrigine: nausea, dizziness, HA
Valproic acid: GI distress, weight gain, alopecia
-unclear mechanism

32

What are toxicities of new manic Tx drugs

Carbamazepine: hematotoxicity
Lamotrigine: Rash
Valproic acid: hepatic dysfunction, weight gain

33

First line for hypomania

Lithium, valproate, carbamazepine, Second gen antipsychotics
Consider + Benzo to combat initial insomnia

34

First line for mania

2-3 drugs: lithium, valproate, second gen antipsychotic + a benzo short term for insomnia, or lorazepam for catatonia

35

First line for mild-moderate depressive episode

Optimize or initiate: Lithium, Quetipine, Lurasidone

36

First line for severe depressive episode

Optimize or initiate: lithium, Quetipine, Lurasidone
Add fluoxetine ot olanzapine if also w/ psychosis