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Pharm 2 Exam 2 > Psych 1 > Flashcards

Psych 1 Flashcards

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1
Q

What are the 2 categories of antipsychotics?

A

Typical antipsychotics (first generation antipsychotics; FGA)
Atypical antipsychotics (second-generation antipsychotics; SGA)

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2
Q

Uses for antipsychotics

A

delusions, hallucinations, paranoid behavior, non-psychiatric disorders (nausea and intractable hiccups)

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3
Q

What causes the antipsychotic action in meds?

A

antipsychotic action comes from their blocking of CNS dopamine receptors in the mesocortical/mesolimbic dopamine tracts of the brain

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4
Q

Blocking of dopamine can lead to?

A

Extrapyramidal effects
Hypersecretion of prolactin
Antiemetic action
Sedation and weight gain
High doses - confusion, memory loss, delirium, tachycardia, and dry skin

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5
Q

Which antipsychotics block histamine receptors and cause sedation/ weight gain?

A

quietiapine and olanzapine

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6
Q

EPS is caused by?

A

Result of accumulated use of antipsychotics over several years of exposure

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7
Q

Akathisia

A

Inability to sit still, tapping of feet, restlessness

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8
Q

Dystonia

A

A state of muscle spasms of face, tongue, back, and neck

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9
Q

When can dystonia occur w/ antipsychotics?

A

first 5-30 days of use of the medication

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10
Q

Parkinson-like symptoms

A

Mask-like face, tremors, shuffling gait, and hypersalivation, which mimic the four classic signs of Parkinson’s disease

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11
Q

Tardive dyskinesia (TD)

A

characterized by rhythmic tongue protrusion, puffing of cheeks, and puckering of mouth

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12
Q

When can TD occur with antipsychotic use?

A

may occur after 3 months of exposure to an antipsychotic, but usually occurs after several years

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13
Q

Neuroleptic malignant syndrome (NMS)

A

emergency (can be fatal) that includes a combination of hyperthermia, rigidity (extrapyramidal effect), and autonomic dysregulation

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14
Q

NMS characteristics

A

Characterized by body temperature exceeding 100.4°F (may go as high as 107°F), altered level of consciousness, tachycardia, labile BP, diaphoresis, tachypnea, urinary or fecal incontinence, rigidity, stupor, coma, and acute renal failure

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15
Q

Tx of NMS

A

Stop offending drug
Supportive tx - hyperthermia and ventilation
Dantrolene, bromocriptine or amantadine - can be used to reverse dopamine blockage and free up the rigidity

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16
Q

Long term affects of antipsychotics

A

Other long-term use can affect weight, cholesterol, and glucose metabolism (exacerbate metabolic syndrome)

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17
Q

Why should antipsychotics be tapered off in most cases?

A

may experience nausea, vomiting, dizziness, tremors, and withdrawal dyskinesia if stopped cold turkey

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18
Q

Which antipsychotic drugs produce the greatest EPS?

A

haloperidol, fluphenazine

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19
Q

Which antipsychotics cause the greatest anti-cholinergic and antihistamine effects?

A

thioridazine, chlorpromazine

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20
Q

Antipsychotic Black Box warning

A

elderly patients with dementia-related psychosis may have an increased risk of mortality

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21
Q

Phenothiazines examples

A

1st gen
haloperidol
chlorpromazine
fluphenazine
prochlorperazine

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22
Q

Phenothiazines MOA

A

Block dopamine at the chemoreceptor trigger zone, and peripherally inhibit the vagus nerve in the GI tract

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23
Q

Phenothiazines use

A

Acute, idiopathic psychotic illnesses marked by agitation
Bipolar disorder
Schizophrenia
Management of nausea and vomiting
Migraines
Intractable hiccups (Chrlorpromazine)

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24
Q

Phenothiazines SE

A

orthostatic hypotension, QT prolongation
Hyperglycemia, weight gain
Dry mouth, constipation, increased appetite
Decreased libido, inhibited ejaculation, urinary retention
Extrapyramidal syndrome (EPS), drowsiness, neuroleptic malignant syndrome

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25
Amphetamines + phenothiazides result in what?
Decrease antipsychotic effect of the phenothiazides
26
Phenothiazides can do what to DM?
Increase BS thus result in weaker control of DM
27
Dopaminergic antiparkinson drugs (Levodopa) + phenothiazides?
Antagonize the antipsychotic effect of the phenothiazides
28
Phenothiazines contraindications
Parkinsonism Blood dyscrasias Severe liver impairment Severe cardiac disease - Avoid use with other drugs that cause QT prolongation Severe CNS depression
29
Why are Atypical Antipsychotics atypical?
Considered atypical because of their superior ability to not induce extrapyramidal side effects (EPSE) or elevation of prolactin levels
30
What is special about clozapine?
Clozapine is the only atypical antipsychotic with clear evidence of efficacy in treatment-resistant schizophrenia.
31
Clozapine increases risk of what?
increased risk of agranulocytosis, seizures, and myocarditis
32
Atypical Antipsychotics examples
aripiprazole clozapine lurasidone olanzapine paliperidone quetiapine risperidone ziprasidone
33
Atypical Antipsychotics MOA
Partially interfere with the binding of serotonin at its receptor sites in the cortex, blocking serotonin, which inhibits the release of dopamine
34
Atypical Antipsychotics use
Psychosis in patients with schizophrenia Depression or mania with psychotic features Bipolar disorder Severe agitation and delusions in patients with dementia
35
Atypical Antipsychotics SE
QT prolongation, orthostatic hypotension, reflux tachycardia Clozapine can cause agranulocytosis Weight gain
36
Atypical Antipsychotics Black Box warning
Clozapine - agranulocytosis, orthostatic hypotension, bradycardia, syncope, and increased mortality in demented geriatrics
37
Atypical Antipsychotics contraindications
Liver impairment
38
When switching antipsychotic meds, what methods are available?
“wash out” or a “cross-titration.”
39
Miscellaneous Antipsychotics examples
pimozide loxapine molindone thiothixene
40
Miscellaneous Antipsychotics MOA
Competitively block postsynaptic dopamine receptors and increase turnover of dopamine in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla
41
Miscellaneous Antipsychotics use
Psychotic episodes when a tranquilizing effect also needed (good for agitated pts) Tourette’s syndrome (pimozide)
42
Miscellaneous Antipsychotics SE
Orthostatic hypotension Weight gain decreased sexual functioning
43
barbiturates, hypnotics, narcotics, alcohol, or antihistamines + Miscellaneous Antipsychotics can cause?
CNS depressants (barbiturates, hypnotics, narcotics, alcohol, or antihistamines) taken with a typical antipsychotic further increase CNS depression.
44
Miscellaneous Antipsychotics contraindications
Parkinsonism Blood dyscrasias Severe liver impairment Severe cardiac disease Severe CNS depression
45
What is the Abnormal Involuntary Movement Scale (AIMS)?
Scale used to monitor motor function in pts taking antipsychotics to monitor for early signs of EPS
46
How is acute psychosis tx?
In cases of acute psychoses, rapid and effective sedation is usually achieved by combining an antipsychotic with a benzodiazepine (IM or IV) - Haldol + lorazepam
47
Atypical antipsychotics are better because?
Fewer anticholinergic effects Less dystonia and parkinsonism Lower risk of tardive dyskinesia Potential minimization of other adverse effects (orthostatic hypotension)
48
In addition to medication tx, what is another important factor in schizophrenia tx?
A support structure is important
49
How long do antidepressants need to start working?
Therapeutic effects may take 4-8 weeks to manifest.
50
Third-line agents to tx depression?
MAOIs
51
MAOIs must be stopped for 14 days before switching meds, why?
Irreversibly inhibit monoamine oxidase; before any other drugs are administered for depression, the MAOIs must be stopped for 14 days
52
MAOI examples
tranylcypromine Phenelzine isocarboxazid
53
MOAI MOA
Irreversible, nonselective inhibitors of the enzyme monoamine oxidase in its CNS storage sites
54
MAOIs use
Refractory unipolar depression
55
MAOI SE
Orthostatic hypotension Constipation, nausea dizziness, headache, insomnia
56
MAOI interactions
Amphetamines, antidiabetic drugs, SSRIs
57
SSRI + MAOI can lead to what?
SSRIs, tricyclic antidepressants, and other drugs/alcohol with CNS effects when interacting with MAOIs can cause serotonin syndrome and increased risk of hypertensive crisis.
58
MAOI contraindications
Liver impairment Renal impairment Cardiovascular disorders
59
Foods high in Tyramine
aged cheese, beer, wine, pickled products, liver, raisins, bananas, figs, avocados, chocolate, yogurt, and meat tenderizer
60
TCAs are considered _____ line agents
2nd
61
TCA examples
amitriptyline doxepin nortriptyline
62
TCA MOA
increasing levels of norepinephrine and serotonin in the synaptic cleft
63
TCA uses
Depression Neuropathic pain (amitriptyline) Enuresis Obsessive compulsive disorder Panic disorder Fibromyalgia Headache Irritable bowel syndrome
64
TCA SE
dry mouth, urinary retention Orthostatic hypotension, prolonged QT weight gain Sedation, engaging in unusual or dangerous activities
65
TCA black box warning
increased suicidality in adolescents (up to age 24)
66
In which pts is Doxepin contraindicated in?
Glaucoma or urinary retention
67
How long does it take TCAs to work?
Therapeutic/beneficial effects may take 2 to 3 weeks.
68
Abrupt TCA d/c can cause what?
Abrupt discontinuation after long-term use may lead to withdrawal syndrome in 36-72 hours, including dizziness, nausea, paresthesias, anxiety/insomnia lasting for 3-7 days.
69
Which TCA is the least sedating?
Nortriptyline
70
Which TCAs are the most sedating?
amitriptyline, and doxepin

Pharm 2 Exam 2 (8 decks)

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