Pharm Flashcards
(30 cards)
How is antipsychotic-induced EPS toxicity treated?
benztropine or diphenhydramine
How is NMS treated?
dantrolene, D2 agonist: bromocriptine
What are the EPS side effects? how long are they expected to last?
- Acute dystonia (4 hr)
- Akathisia (restlessness) (4 d)
- bradykinesia (4 wk)
- tardive dyskinesia (4 mo)
What happens when D2 receptors are inhibited?
the normal block of adenylate cyclase is lifted leading to an increase in cAMP
What risk is increased with low potency drugs?
autonomic (hypoTN)
What risk is increased with high potency drugs?
EPS
Why is prolactin increased with D2 antagonists
Presence of dopamine in the hypothalamus inhibits the release of prolactin. When it’s blocked, prolactin release is less regulated
What is the difference in effectiveness based on potency?
No difference!! They have the same efficacy, but potency determines side effects
What is acute dystonia? How do you treat it?
Muscle Spasms: facial grimacing, torticollis (stiff neck), oculogyeric crisis
Tx: anticholinergic antiparkinsonian agent (benztropine) – block increase in DA turnover in BG–> reduce EPS
What is akathesia? How is it treated?
-Strong, subjective feelings of distress or discomfort: “ants in the pants”
Tx: decrease dose (most effective), can add antiparkinsonian or propranolol
What are the symptoms of parkinsonian syndrome? How is it treated?
akineasia, mask facies, decreased arm movement, rigidity, tremor
Tx: anticholinergic, amantadine
**don’t increase DA levels
What is NMS? How is it treated?
neuroleptic malignant syndrome
-RARE: fever, severe parkinsonian with catatonia
-fluctuations in coarse tremor intensity
-autonomic instability
-elevated CK, myoglobinemia
HIGH MORTALITY
Tx: immediate antipsych cessation, support, dantrolene or bromocriptine
What is perioral tremor?
- RARE
- rabbit syndrome
- treat with anticholinergics, stop neuroleptic
What is tardive dyskinesia? How is it treated?
stereotyped, repetitive, quick choeriform movements of face (eyelids), mouth, tonuge, extremities, trunk
NO adequate treatment, discontinue drug
–symptoms fade with time
What are some symptoms of metabolic syndrome?
abdominal obesity, dyslipidemia, high BP, insulin resistance, glucose intolerance, prothrombotic state (high fibrinogen), pro-inflam state (high CRP)
What receptor blockade causes EPS?
D2
What receptor blockade causes hyperprolatinemia?
D2
What receptor blockade causes hypotension?
alpha adrenergic
What receptor blockade causes sedation?
histamine
What receptor blockade causes weight gain?
histamine and 5-HT
What receptor blockade causes anticholinergic symptoms?
muscarinic
What receptor blockade causes sexual side effects?
5-HT, muscarinic, noradrenergic, D2
How are most antipsychotics given? why not oral?
IM
oral absorption is erratic
Do antipsychotic cross the placenta? Enter breast milk?
yes
