Antipsychotics.Opioids.Other Flashcards
(157 cards)
1
Q
increased DA activity in limbic system
A
positive sxs
2
Q
decreased DA activity in frontal cortex
A
negative sxs
3
Q
what do classic vs atypical target?
A
c: positive sxs
a: negative sxs
4
Q
what other NT may be involved with schizophrenia?
A
5HT
5
Q
mesolimbic pathway
A
VTA to limbic system
positive sxs
6
Q
mesocortical pathway
A
VTA to frontal cortex
negative sxs
7
Q
nigrostriatal pathway
A
SN to caudate/putamen
EPs
8
Q
tuberoinfundibular pathway
A
hypothalamus to ant pit
prolactin release
9
Q
what do classic anatipsychotics block?
A
DA D2 receptor
positive sxs
10
Q
newer antipsychotics block what?
A
5HT2a receptors
negative sxs
11
Q
what other receptors do antipsychotics normally block?
A
muscarinic
alpha adrenergic
histamine
12
Q
why are there sometimes EPS?
A
D2 antagonists block DA in nigrostriatal system which have motor control
13
Q
EPS
A
anxiety restlessness pacing constant rocking (akathisia) mm spasms abnormal postures (dystonia)
14
Q
dystonia nad akathisia
A
EPS
15
Q
which drugs have a lower tendency to cause EPS?
A
clozapine
risperidone
16
Q
how might we treat EPS?
A
anticholinergics
17
Q
uncontrollable movements of mouth, tongue, face, eyelids, trunk, extremities
A
tardive dyskinesia
18
Q
endocrine SE of antipsychotics
A
weight gain
prolactin release
19
Q
autonomic SE of antipsychotics
A
anticholinergic
postural hypotension (alpha block)
sedation
20
Q
seizures and antipsychotics
A
decrease seizure threshold
21
Q
muscle rigidity
catatonia
hyperthermia
altered BP/HR
A
neuroleptic malignant syndrome
22
Q
how do we treat NMS?
A
dantrolene
23
Q
most common drug interactions with antipsychotics
A
antichoinergics
sedative-hypnotics
24
Q
chlorpromazine uses
A
sxhizophrenia
psychotic episode assoc. w/ mania
psychosis/hallucination due to SA
25
SE of chlropromazine
anticholinergic
postural hypotension
inhibition of ejaculation
retinal deposits
26
haloperidol use
injection-acute
27
haloperidol SE
EPS
28
atypical antipsychotics MOA
block 5HT2a and
| DA D2, D4
29
when do we use clozapine?
refractory
| EPS/TD
30
Se of clozapine
agranulcocytosis
31
how is olanzapine different from clozapine?
no agranulocytosis
| hyperglycemia, T2DM
32
quetiapine
similar to clozapine-no agranulocytosis
| very sedating
33
aripiprazole MOA
dopamine system stabilizer
| DA receptors activated when low and blocked if high
34
SE of aripiprazole
decreased motility of esophagus
| orthostatic hypotension
35
risperidone use
first line drug for psychosis
36
benefit of risperidone
no significant effect on DA receptors in basal ganglia= no EPS
37
DOC for psychosis
risperidone
38
SE of risperidone
increased prolactin
| anxiety
39
ziprasidoneMOA
blocks D2 and 5HT 2a
40
ziprasidone use
Tourette's
| acute mania
41
SE of ziprasidone
drug interactions
prolonged QT interval
sedation
42
relative CI for ziprasidone
hx of seizures
| with other drugs that decrease threshold
43
lurasidone
no histamine/muscarinic effects
| depression assoc. w/ bipolar
44
DOC for bipolar
lithium
45
kinetics of lithium
small therapeutic window
| excreted by kidney-competes with sodium for reabsorption
46
too much lithium given
hyponatremia
47
sodium decreased while on lithium
lithium toxicity
48
renal effects of lithium
nephrogenic diabetes insipidous
49
how do we treat nephrogenic DI?
amiloride
50
how do we treat lithium overdose?
dialysis
| saline
51
antidepressants and lithium
increase mania
52
antipsychotics or benzodiazepines and lithium
sage
53
diuretics and lithium
thiazides decrease clearance
| loops =little effect
54
NSAIDs and lithium
decrease lithium clearance
55
anticonvulsants with mood-stabilizing properties
valproic acid
carbamazepine
lamotrigine
56
lamotrigine use as an mood stabilizer
prevents depression that follows mania
57
Parkinson's pathophys
degerneration of DA neurons in pars compacta of SN leading to overactivity in indirect pathway and underactivity in direct pathway=decreased glutamat into cortex
58
DA synthesis
tyrosine--> l-dopa--> DA via dopa decarboxylase
59
how is DA metabolized?
MAO B in nerve terminal
| also MAO A and COMT
60
carbidopa MOA
dopa decarboxylase inhibitor
| does not cross BBB
61
why would you give carbidopa with l dopa?
inhibits synthesis of DA from l dopa in the periphery so more l dopa gets into the brain (dose can be decreased)
62
l dopa half life
short
| multiple doses/ day
63
GI SE of l dopa
N/V (decreases w/ carbidopa)
64
CV SE of l dopa
postural hypotension
| arrhythmias
65
l dopa and dyskinesias
dose-related
occurs w/ long-term therapy
more common with carbidopa combo
66
Parkinson's patient with psychosis, how do you treat that?
must be atypical antipsychotic-- clozapine, quetiapine, aripiprazole
67
on-off phenomenom
only when treated with l-dopa-->brain adaptation
| off=periods of dyskinesia
68
drug holiday for Parkinson's
not recommended anymore
69
l dopa and MAOI
hypertensive crisis
70
Vitamin B6 and l dopa
increases peripheral metabolism of l-dopa=decreased effectiveness
71
CI for l dopa
```
psychosis
closed-angle glaucoma
active PUD
malignant melanoma
cardiac dz-small risk
```
72
why MAOI for Parkinson's?
selective for MAOB which is predominant form in SN
73
effect of MAOI on Parkinson's
decreases formation of free radicals- may slow progression
| use in early stages
74
SE of MAOI
insomnia, anxiety
75
what can not be taken with MAOI?
meperidine
76
tacapone vs entacapone
tacapone crosses BBB, entacapone does not
| entacapone used as adjunct levodopa/carbidopa
77
issue with tolcapone
death from liver dz--pt consent
78
dopamine receptor agonist effect on prolactin
decreases release
79
dopamine agonist that is a patch
rotigotine
80
GI SE of DA agonists
anorexia
| N/V
81
CV SE of DA agonists
```
postural hypotension (esp at beginning)
cardiac arrhythmias
```
82
CNS SE of DA agonists
dyskinesia
| mental disturbances
83
SE of ergot derivatives
erythromelalgia-- disappears when discontinued
84
erythromelalgia
red, tender, swollen feet due to vasospasm
85
bromocriptine
ergot derivative
| rarely used
86
pramipexole/ropinirole use
Parkinson's
| Rop: restless leg syndrome
87
SE of pramipexole/ropinirole
nausea
fatigue
sudden sleep during the day
88
apomorphine use
Parkinson's "rescue"
89
apomorphine MOA
potent DA receptor agonist
90
apomorphine kinetics
injection
| quick effect
91
apomorphine SE
nausea
92
amantadine MOA
influenza antiviral used for Parkinson's
93
SE of amantadine
psychiatric
94
livedo reticularis
amantadine
| spotting of skin
95
CI caution with amantadine
hx of seizures
| CHF
96
why anticholinergics for Parkinson's?
decrease the effects of ACh to match loss of DA
| start low
97
what sxs do anticholinergics affect with Parkinson's?
not bradykinesia
| rigidty, tremor, drooling
98
neuritic plaques
| neurofibrillary tangles
Alzheimer's
99
ApoE4
Alzheimer's
100
RF for Alzheimers
age
FH
gender
educational level
101
pathophysiology of Alzheimers
degeneration of cholinergic neurons from nucleus basalis of Meynert which projects to cerebral cortex and hippocampus
102
SE of antichoinergics
N/D/V
103
memantine MOA
antagonist at NMDA receptors
104
memantine use
more severe Alzheimer's dz
105
CI caution for memantine
severe renal impairment
106
SE of memantine
```
agitaiton
urinary incontinence
UTI
insomnia
diarrhea
```
107
what drugs can not be given with memantine?
meperidine, dextromethorphan (also block NMDA)
108
how does memantine affect l dopa?
enhances adverse effects of l dopa
109
three opioid receptors
mu
kappa
delta
110
endogenous opioids
met-, leu- enkephalin
beta endorphin
dynorphins
111
opioid receptor activation
closes voltage-gated Ca2+ channels--decrease release of NT
| opens K+ channels-hyperpolarize--inhibition of postsynaptic neurons
112
which opioid receptor is most associated with dysphoria?
kappa
113
what components of pain are affected with opioids?
sensory
| affective (emotional)
114
neuropathic pain and opioids
not great
| use TCAs or gabapentin
115
GI effects of opioids
nausea
constipation
decreased gastric motility
116
which opioid does not suppress cough?
meperidine
117
what receptor does meperidine most affect?
mu
118
other general effects of opioids
```
respiratory depression
elevated ICP
miosis
decreased body temp
truncal rigidity
```
119
what opiod SE does not develop tolerence?
miosis
120
CV effects of opioids
bradycardia
meperidine-tachycardia
orthostatic hyopotension
121
why can there be orthostatic hypotension with opioids?
depression of central vasomotor systems and histamine release
122
GU effects of opioids
decrease urine output
increased sphincter tone
increased ureteral tone
123
what makes a histamine flush with opioids more common?
injected
124
what drugs might you give for opioid withdrawal?
clonidine
| another opioid-methadone
125
pin point pupils
opioid OD
126
sedative-hypnotics and opioids
CNS depression
| respiratory depression
127
antipsychotics and opioids
sedation
| increased CV effects
128
MOAIs and opioids
hyperpyrexic coma
129
which opioids are the worst to mix with MAOI?
meperidine
| dextromethorphan
130
opioids that must be demethylated
codeine
hydrocodone
oxycodone
131
opioid CI
```
pure agonist with partial
head injuries
during pregnancy
impaired respiratory function
impaired hepatic or renal function
Addison's
```
132
morphine unique
IV
| histamine flush
133
hydromorphone
less metabolite accumulation
| more potent than morphine
134
methadone
long duration
also blocks NMDA
less likely for addiction
135
meperidine
no antitussive activity
mydriasis
tachycardia
not for long term use
136
what pts do we have to caution with using meperidine?
renal failure--seizures
137
why is meperidine not good for long-term use?
short duration
metabolites accumulate
large dose=tremor, mm twtich, convulsions
138
why does meperidine cause mydriasis and tachycardia?
antimuscarinic activity
139
what drugs combined with meperidine can cause serotonin syndrome?
phenelzine
selegiline
linezolid
140
fentanyl
highly potent
short-acting
usually used with anesthesia/surgery
CYPs-drug interactions
141
hydrocodone and oxycodone
usually produced with acetaminophen
142
metabolism of hydrocodone and oxycodone
CYP2D6 (some of it)
143
opioids that have drug interactions with fluoxetine and paroxetine
codeine
hydrocodone
oxycodone
(CYP2D6)
144
pentazocaine/naloxone MOA
agonist at kappa
| partial agonist at mu
145
use of pentazocaine/naloxone
moderate pain
146
SE of pentazocaine/naloxone
less SE compared to others
| dysphoria
147
withdrawal with pentazocaine/naloxone
can precipitate in opioid addicts
148
buprenorphine MOA
partial agonist at mu/kappa receptors
149
use for buprenorphine
reduce drug cravings
| sublingual
150
what if buprenorphine is given with a full agonist?
acts as an antagonist
151
MOA of tramadol
weak mu agonist
| inhibits reuptake of norepi and serotonin
152
what happens with combo of tramadol and antidepressants?
seizures
153
what should be avoided with tramadol?
TCAs
SSRIs
MAOIs
*serotonin syndrome
154
tapentadol
similar to tramadol
N/V
sedation
155
what happens when mixing MAOIs and dextromethorphan?
serotonin syndrome
156
DOC for opioid overdose
naloxone--short-acting
157
naltrexone
oral, long-acting antagonist
