Psych Pharm 2 Flashcards
Clinical use for atypical neuroleptics
Schizophrenia, Bipolar (quetiapine or olanzapine) Quetiapine also for depressive; Psychosis caused by DA agoinst in pts with parkinsonism
Major SE atypical neuroleptics
EPS - neuroleptic malignant syndrome; Hyperglycemia/diabetes
SE Clozapine
“a CLOSE WATCCHH for:” Weight gain, agranulocytosis, tachycardia, CNS (seizures, sedation) Constipation, Hyperglycemia, Hypotension
MOA Lithium
Signal transduction blockade - Inhibits inositol formation reducing PIP2, precursor of IP3 and DAG, reducing cAMP and inhibiting AC; uncouples a receptor and its G protein
Major clinical uses for lithium
MAD - Manic-depressive (bipolar affective) disorder, rx, prevention of mania; SchizoAffective disorders or schizophrenia (adjunct); Depression (adjunct)
SE Lithium
“BATTERY” - Bradycardia, Ataxia, Acne, Tremor, Thyroid enlargement or hypothyroidism; Edema and weight gain; Renal toxicity (nephorgenic diabetes insipidus responsive to amiloride), LeukocYtosis, infantile toxicitY.
Mood stabilizing drugs
“A Quiet LOVE” Aripiprazole, Quetiapine, Lithium, Lamotrigine, Olanzapine, Valproate, CarbamazEpine
Antidopaminergic effects
EPS: Parkinsonism, Akathisia, Dystonia
Parkinsoinism
Bradykinesia, masklike face, cogwheel rigidity, pillrolling tremor
Akathisia
Subjective anxiety and restlessness, objective fidgetiness. Can’t sit still
Dystonia
Sustained painful contraction of muscles of neck (torticollis), tongue, eyes (oculogyric crisis). Life threatening if airway
TD
Tardive dyskinesia - Choreathetoid (writhing) movements of mouth and tongue that occur in patients who have used neuroleptics for >6 months, most often older women
Whom does NLMS occur in?
Less common - young males early in treatment with both atypical and typical antipsychotics
NMS characteristics
“FALTERED” Fever (most common symptom); Autonomic instability (tachycardia, labile hypertension, diaphoresis); Leukocytosis; Tremor, Elevated CPK, Rigidity (lead pipe); Excessive sweating; Delerium
MOA of NMS
Central dopamine receptor blockade in hypothalamus causes hyperthermia, dysautonomia; Interference with dopamine nigrostriatal pathways;
MOA of Tardive dyskinesia
Old - dopamine hypersensitivity; New - imbalance of D1 and D2 in basal ganglia, preferential blocking of D2 resulting in XS D1 striatopallidal output. This is why clozapine produces less TD as it is primarily a D1 blocker.
