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Pharmacology > Chapter 15: psych > Flashcards

Chapter 15: psych Flashcards

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1
Q

which receptors are blocked by antipsychotics

A

cholinergic

muscarinic

histamine

dopamine

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2
Q

antipsychotic action

A

comes from blocking of CNS dopamine receptors in the mesocorttical/mesolimbal systems in the brain

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3
Q

EPS is the result of

A

dopamine blocking in other parts of the body

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4
Q

EPS

A

parkinson-like syndrome usually occuring with both classes of antipsychotics as a result of years of exposure

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5
Q

symptoms of EPS

A

dystonia usually occurs within first 5-30 days

tardive dyskkinesia after 6 months (can be reversible)

rhythmic tongue protrusion, puffing cheeks, puckering of mouth

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6
Q

neuroleptic malignant syndrome (NMS)

A

life-threatening

starts months after therapy begins but rapidly progresses

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7
Q

treatment of NS

A

rapid d/cof agent and administration of dantrolene to relax muscles

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8
Q

how should antipsychotic therapy be discontinued

A

slowly reduce dose over 2-3 weeks

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9
Q

first generation antipsychotics (typical)

A

phenothiazines

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10
Q

examples of phenothiazines

A

haloperidol (Haldol)

trifluoperazine (Stelazine)

chlorpromazine (Thorazine)

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11
Q

second generation antipsychotics (atypicals)

A

aripiprazole (Abilify)

risperidone (Risperdal)

Olanzapine (Zyprexa)

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12
Q

largest group of psychotropic agents

A

phenothiazines

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13
Q

phenothiazine mechanism of action

A

unknown

theorized that it is a result of dopamine blockage in certain areas of CNS

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14
Q

effects of long term phenothiazine usage

A

cardiac arrythmia

hyperlexia (life-threatening)

HTN

rigidity

tardive dyskinesia

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15
Q

clinical uses of phenothiazines

A

acute, idiopathic psychotic illness marked by agitation

manic phase of bipolar disorder

schizophrenia

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16
Q

phenothiazines interactions

A
  • alcohol (CNS depression)
  • anticholinergics (increased anticholinergic effects)
  • amphetamines (decrease antipsychotic effect)
  • antiparkinson drugs (antagonize antipsychotic effect)
  • hypoglycemics (weaken control of diabetes)
  • lithium (decreases antisychotic effect)
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17
Q

phenothiazines contraindications

A

parkinsonism

blood dyscrasia

severe liver impairment, cardiac disease, or CNS depression

Reye’s syndrome

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18
Q

overdose of phenothiazines

A

fairly common but not fatal

symptoms: worsening CNS depression, hypotension, worsening of EPS

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19
Q

why are atypical antipsychotics considered atypical

A

hey do not cause EPS, tardive dyskinesia, or elevate prolactin levels

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20
Q

what is the only atypical antipsychotic with clear evidence of efficacy in treatment-resistant schizophrenia

A

clozapine (Clozaril)

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21
Q

black box warning for all antipsychotics

A

may increase mortality in elderly with dementia-related psychosis

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22
Q

Clozaril places at increased risk for

A

agranulocytosis, aeizures, and myocarditis

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23
Q

clinical uses for atypical antipsychotics

A

psychosis in patients with schizophrenia

depression or mania with psychotic features

bipolar disorder

severe agitation and delusions in dementia patients

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24
Q

when are antipsychotic medications used

A

psychotic episodes when tranquilizing effect is needed

Tourette’s (pimozide)

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25
examples of atypical antipsychotics
* aripiprazole (Abilify) * asenapine (Sapris) * clozapine (Clozaril) * iloperidone (Fanapt) * lurasidone (Latuda) * olanzpine (Zyprexa) * olanzapine/fluoxetine (Symbyax) * palpiperidone (Invega) * quetiapine (Seroquel) * risperidone (risperdal) * ziprasidone (Geodon)
26
atypical antipsychotic interactions
any drug requiring liver metabolism (including alcohol)
27
atypical antipsychotic contraindications
liver impairment
28
drug classes used for depression
MAOIs (Monoamine oxidase inhibitors) TCAs (tricyclic antidepressants) SSRIs (selective serotonin reuptake inhibitors) non-TCA Antidepressants
29
examples of third line MAOIs
tranylcypromine (parnate) selegiline (Emsam) phenylamine (Nardil) RARELY USED ANYMORE
30
MAOI mechanism of action
irreversible, non-selective inhibitors of MAO in its CNS storage sites depression relief immediately or within 1 week
31
HTN crisis with MAOIs can be precipitated by
foods rich in tyramine (alcohol, aged cheese) sympathomimetic drugs (cough meds containing ephedrin) tricyclic antidepressants
32
what herb can cause life-threatening serotonin syndrome when taken with MAOI
St. John's wort
33
MAOI contraindication
liver impairment
34
wash out period when witching from MAOI to SSRI
2 weeks
35
foods high in tyramine
aged cheese, beer, wine, pickled products, liver, raisins, bananas, figs, avocados, chocolate, yogurt, meat tenderizer
36
second line tricyclic antidepressants (TCAs) mechanism of action
blocks neuronal reuptake of norepinephrine and serotonin at presynaptic terminus has anticholinergic properties ability to increase mood poorly understood as they do not stimulate the CNS
37
how long to clinical effect of TCAs
2-8 weeks
38
clinical uses of TCAs
endogenous depression reactive depression depression r/t alcohol/cocaine withdrawal, anxiety, neuropathic pain, enuresis, OCD
39
examples of TCAs
* amitriptyline (Elavil) * clomipramine (Anafril) * doxepine (Silenor) * imipramine (Tofranil) * trimipramine (Surmontil) * amoxapine (Asendin) * desipramine (Norpramin) * nortriptyline (Pamelor) * protriptyline (Vivactil)
40
TCA interactions
any anticholinergic or barbituate, chlorpropamide, cimetidine, clinodine, epinephrine, ethanol, fluoxetine, neuroleptics, norepinephrine, propoxyphene, quinidine, and SSRIs
41
TCA contraindications
MAOI use recovery phase of MI doxepine is contraindicated with glaucoma or urinary retention
42
TCAs are most effective in which population
severe depression, especially with greater disturbances and melancholia
43
advantages of SSRI
act quicker and more reliabily than other antidepressants and have fewer side effects
44
SSRI mechanism of action
selectively inhibits 5-HT neuronal reuptake at selected nerve terminals in the CNS and inhibit CYP450
45
SSRI effect on norepinephrine and dopamine reuptake
little to no effect
46
clinical uses of SSRIs
major depression depression in patients with comorbidities panic disorder
47
examples of SSRIs
citalopram (Celexa) fluoxetine (Prozac) fluvoxamine (Luvox) paroxetine (Paxil) sertraline (Zoloft) escitaloprma (Lexapro
48
how long does it take SSRIs to relieve depression
up to 6 weeks
49
Luvox (SSRI) is used only for
OCD (produces no anticholinergic effects)
50
which SSRIs should be taken in the morning and why
Prozac, Paxil, Zoloft because they can induce insomnia
51
SSRIs and NSAIDs
concurrent use can increase GI bleeding risk
52
SSRI interactions
buspirone diazepam lithium MAOIs neuroleptics tricyclics
53
SSRI contraindications
MAOI use within 14 days pregnancy and lactation
54
Prozac dosage with liver problems
must be reduced because Prozac is a strong inhibitor of the CYP450 system
55
Prozac elevates the levels of which drugs
antiarrhythmics, other antidepressants, phenothiazine, risperidone, theophylline
56
antidepressant for a patient that presents with a flat affect and fatigue
Prozac because it one of the more stimulating SSRIs
57
most sedating SSRI
Paxil
58
depressed patient that presents with anxiety, agitation and severe insomnia
Paxil
59
which SSRI has a higher incidence of weight gain and side effects, requiring frequent monitoring
Paxil
60
symptom of abrupt d/c of Paxil
flu-like syndrome
61
middle of the road SSRI
Zoloft
62
newer SSRI that is highly bound to plasma protein
Celexa
63
SSRi with the most favorable drug-drug interaction profile
Celexa because it has the least effect on the CYP450 system
64
when did non-TCA antidepressants enter the market
1990's
65
classes of non-TCAs
SNRI (serotonin and norepinephrine reuptake inhibitors) NDRIs (norepinephrine and dopamine reuptake inhibitors) SRIs (serotonin reuptake inhibitors) TeCa (tetracycline antidepressant)
66
examples of SNRIs
Ymbalta Pristiq Effexor
67
aside from depression, SNRIs are approved to treat
anxiety panic disorder OCD bulimia
68
common off label uses for SNRIs
insomnia chronic pain (diabetic neuropathy)
69
SNRI contraindications
MAOI use within 14 days
70
example of NDRIs
bupropion (Wellbutrin)
71
wellbutrin adverse reactions
* CV: tachycardia * DERM: photosensitivity * ENDO: hyperglycemia, hypoglycemia * GI: anorexia, weight loss, nausea, constipation, dry mouth * META: weight loss * NEURO: tremors/seizures if not taken correctly (dose dependent)
72
wellbutrin interactions
common are phenobarbital and tegretal because they all undergo first pass metabolism
73
wellbutrin contraindications
history of seizure, anorexia, bulimia MAOI use within 14 days
74
example of SRI
trazadone (Desyrel)
75
clinical uses of trazadone
depression with insomnia, anxiety, and chronic pain
76
off label uses of trazadone
sedative, panic attacks, agoraphobia, cocaine withdrawal, aggressive behavior
77
trazadone interactions
digoxin and coumadin (take in divided doses)
78
trazadone contraindications
hypersensitivity
79
example of tetracyclic antidepressant (TeCA)
mirtazipine (Remeron)
80
clinical uses of remeron
depression PTSD
81
remeron interactions
* MAOIs (HTN, seizures, death from serotonin syndrome) * CNS depressants (increased CNS depression) * any drug affecting CYP450
82
remeron contraindications
hypersensitivity
83
agents used to treat bipolar mania
lithium valproates carbamazepine
84
itium mechanism of action
unknown
85
clinical uses of lithium
bipolar disorder with other antidepressants for major depression with antipsychotics for schizophrenia
86
what are lithium side effects related to
serum level
87
signs of lithium toxicity and serum levels at which they occur
2.0-2.5 mEq/L or greater * CV: severe hypotension, ARRYTHMIAS, ECG changes, circulatory failure * NEURO: ataxia, blurred vision, giddiness, tinnitus, SEIZURES * GU: oliguria, nephrogenic diabetes insipidus
88
lithium contraindications
significant renal impairment significant cardiovascular disease significant thyroid disease diabetes severe dehydration sodium depletion pregnancy
89
how often should lithium levels be drawn
biweekly until stable and then every 2-3 months
90
what can happen with abrupt withdrawal of depakote
status epilepticus
91
valproaes mechanism of action and uses
mechanism of action is unknown acts as an anticonvulsant, anti-manic, and antimigraine
92
Benzo pharmacokinetics
page 288
93
benzo interactions
alcohol, CNS depressants, opiod analgesics, anesthetics, TCAs can cause enhanced CNS depression
94
benzo contraindications
comotose uncontrolled severe pain severe hypotension angle-closure glaucoma sleep apnea
95
specific contraindications for Halcion and Xanax
taking ketoconazole and itraconazole
96
schedule of benzodiazepines
IV
97
Meprobamate (Equanil, Miltown)
schedule IV drug that is a carbamate derivative use today is almost non-existant
98
meprobamate mechanism of action
affects thalamus and limbic systems as well as inhibits multi-neuronal spinal reflexes
99
clinical use of meprobamate
relieve pain of muscle spasms and rigidity
100
implications for special populations
pages 289-290

Pharmacology (28 decks)

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