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psychopharm2 Flashcards

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1
Q

midpotency typical antipsychotics examples

A

Loxapine, thiothixene, trifluoperazine, perphenazine

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2
Q

loxapine

A

loxitane; higher risk of seizure; metabolite is an antidepressant

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3
Q

thiothixene

A

Navane; can cause ocular pigment changes

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4
Q

trifluoperazine

A

stelazine; can reduce anxiety

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5
Q

perphenazine

A

trilafon; mid potency typical antipsych

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6
Q

high potency typical antipsychotics

A

lower dose needed to achieve the effect; cause less sedation, orthostatic hypotension, and anticholinergic effects; greater risk for EPS and tardive dyskinesia

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7
Q

examples of high potency typical antipsychotics

A

heloperidol, fluphenazine (prolixin); pimozide (orap)

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8
Q

haloperidol

A

haldol; decanoate form availabe (long acting injectable)

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9
Q

fluphenazine

A

prolixin; decanoate form available

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10
Q

pimozide

A

orap; assoc with heart block, v tach and other cardiac effects

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11
Q

components of the mesolimbi pway

A

assoc with pos sx of schizophrenia; nuc accumbens, fornix, the amygdala, and the hippocampus

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12
Q

neg symptoms for schizophrenia

A

dopamine in the mesocortical pway; think cortex involved in personality so neg sx of schizo

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13
Q

EPS symptoms localized wheere

A

nigrostriatum; think parkinsons is involved in this

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14
Q

tuberoinfundibbular

A

prolactin

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15
Q

what are the EPS side effects associated with typical antipsychotics

A

parkinsonism, akathisia, dystonia (torticollis, contraction of the tongue, eyes)

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16
Q

what does hyperprolactinemia cause?

A

decreaed libido, galactorrhea, gynecomastia, impotence, amenorrhea, osteoporosis

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17
Q

what are the main categories of side effects of the typical antipsychotics?

A

Anti-dopaminergic, Anti-HAM, TD, and less commonly neuroleptic malignant syndrome; opthalmologic problems; derm problems; seizures

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18
Q

epi of TD

A

most often occurs in older women

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19
Q

epi of neuroleptic malig syndrome

A

young males early in treatment with both atypical and typical antipsychotics

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20
Q

characteristics of neuroleptic malignant syndrome

A

FALTERED; fever, autonomic instability, leukocytosis, tremor, elevated CPK, rigidity, excessive sweating, and delirium

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21
Q

treatment of neuroleptic malig syndrome

A

discontinue offending med and administrate supportive care

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22
Q

optho problems seen with typical antipyschotics

A

irreversible retinal pigmentation with high doses of thioridazine, deposits in lens and cornea with chlorpromazine

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23
Q

derm problems seen with typical antipsychotics

A

rashes and photosensitivity (blue-gray skin discoloration with chlorpromazine)

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24
Q

seizures and antipsychotics

A

low potency anti-psychotics are more likely to cause seizures than high potency

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25
how are atypical antipsychotics different from typical in terms of mecahnism of action?
atypical blocks both dopamine and seratonin; they are more effective in treating the negative sx of schizophrenia
26
side effects for atypicals
less likely to cause EPS, TD, or neuroleptic malig syndrome;
27
examples of atypical antipsychotics
clozapine (clozaril), risperidone (resperidal), quetiapine (seroquel), olanzipine (zyprexa), ziprasidone (geodon), aripiprazole (abilify), paliperidone (invega), asenapine (saphris), iloperidone (fanapt)
28
clozapine
clozaril, less likely to cause TD, assoc with tachycardia and hypersalivation, more anticholinergic SE, myocarditis can develop, risk of agranulocytosis and seizures
29
the only antipsychotic shown to decr the risk of suicide
clozapine
30
when to stop clozapine
if absolute neutrophil count drops below 1500
31
risperidone
can cause increased prolactin, some orthostatic hypotension and reflex tachycardia, has long acting injectable form called Consta
32
quetiapine
seroquel; common side effects incl seadation and orthostatic hypotension
33
olanzipine
zyprexa; common side effect is weight gain
34
ziprasidone
geodon; less likely to cause weight gain
35
aripiprazole
abilify; unique mecahnism of partial D2 agonism; can be more activating (akathisia) and less sedating; less potential for weight gain
36
newer expensive atypical antipsychotics
paliperidone, asenapine, iloperidone
37
side effects of atypical antipsychotics
metabolic syndrome, some anti-HAM side effects, weight gain, hyperlipidemia, hyperglycemia, liver function, QTc prolongation
38
what are mood stabilizers used for?
acute mania and to help prevent relapses of manic episodes in bipolar disorder and schizoaffective disorder
39
less commonly, mood stabilizers like lithium can be used for
potentiation of antidepressants, potentiation of antipsychotics, enhancement of abstinence in tx of alcoholism, tx of aggression and impulsivity
40
what are the mood stabilizers
lithium and anticonvulsants like valproic acid, lamotrigine, and carbamazepine
41
lithium
drug of choice for acute mania and as a prophylaxis for both manic and depressive episodes n bipolar and schizoaffective disorders; can also be used in cyclothymia and unipolar depression
42
how is lithium metabolized and what consequences does this have?
metabolized by the kidney, so you must adjust dose and monitor levels if patient has renal dysfunction
43
prior to initiating lithium, patients must have what?
ECG, basic chemistries, thyroid function test, a CBC, and a pregnancy test
44
onset of action for lithium
5-7 days
45
checking blood levels in patients on lithium
unlike SSRIs, blood levels of lithium correlate with clinical efficacy and should be checked after 5 days and then every 2-3 days until therapeautic
46
major downsides to lithium
side effects and narrow therapeutic range
47
side effects of lithium
toxic levels cause AMS, tremors, convulsions, and death; other side effects incl tremor, nephrogenic DI, GI disturbance, weight gain, sedation, thyroid enlargement, hypothyroidism, ECG changes, benign leukocytosis, Ebstein's anomaly
48
lithium can cause ebstein's anomaly. What is that?
cardiac defect in abbies born to mothers taking lithium
49
carbamazepine
tegretol; esp useful in treating mixed episodes and rapid-cycling bipolar disorder, and less effective for the depressed phase
50
carbamazepine also used in the treatment of what
trigeminal neuralgia
51
how does carbamazepine work
blocks sodium channels and inhibits action potential
52
onset of action of carbamazepine
5-7 day
53
side effects of carbamazepine
most common are GI and CNS (drowsiness, ataxia, sedation, confusion); possible skin rash (SJS), leukopenia, hyponatremia, aplastic anemia, thrombocytopenia, and agranulocytosis
54
other SE of carbamazepine
elev of liver enzymes, causing hepatitis; teratogenic effecs in pregnancy
55
drug interactions and carbamazepine
induces cyp 450; induces its own metabolism, requiring increasing dosages
56
carbamazepine toxicity
confusion, stupor, motor, restlessness, ataxia, tremor, nystagmus, twitching and vomitting
57
valproic acid
depakote and depakene; useful in treating mixed episodes of bipolar disorder as well as rapid cycling
58
valproic acid levels
usually checked after 3-5 days
59
lamotrigine
lamictal: an anticonvulsant; effective for bipolar depression but not for acute mania or prevention of mania
60
lamotrigine mech of action
works on sodium channels that modulate glutamate and aspartate
61
most common side effects of lamotrigine
dizziness, sedation, etc; but most serious side effect is Stevens-johnson syndrome
62
how is SJS with lamotrigine minimized
start with low doses and increase them slowly
63
valproate will increase lamotrigine levels and lamotrigine with decrease valproate levels
right
64
oxcarbazepine
trileptal; as effective in mood disorders as carbamazepine, but better tolerated and less risk of rash and hepatotoxicity
65
gabapentin
neurontin; often used adjunctively to help with anxiety and sleep; little efficacy in bipolar
66
pregabalin
lyrica; used in general anxiety disroder and fibromyalgia; little efficacy in bipolar
67
tiagabine
gabitril; may be helpful with anxiety
68
topiramate
topamax; helpful with impulse control disorder and anxiety; beneficial side effect is weightloss; can cause hypochloremic, non-anion gap met acidosis and kidney stones
69
most limiting side effect of topiramate
cognitive slowing
70
anxiolytics/hypnotics include which drugs
benzos, barbiturates, and buspirone
71
benzos
potentiate the effects of GABA; relatively safer in overdose than barbiturates
72
long acting benzos
half life greater than 20 hours; diazepam (valium), clonazepam (klonopin)
73
intermediate acting benzos
half life 6-20 hours; alprazolam (xanax), lorazepam (ativan), oxazepam (serax), temazepam (restoril)
74
short acting benzos
less than 6 hours; triazolam (halcion), midazolam (Versed)
75
diazepam
valium; used during detox from alc or sedative-hypnotic-anxiolytics and for seizures
76
clonazepam
Klonopin; treatment of anxiety, incl panic attacks; avoid with renal dysfunction; longer half life allows for once daily dosing
77
alprazolam
xanax; tx of anxiety, incl panic attacks; short onset, so high abuse potential
78
lorazepam
ativan; tx of panic attacks, alc and sedative hypnotic anxiolytic detox; not metabolized by the liver
79
oxazepam
serax; alcohol ad sedative-hypnotic-anxiolytic detox; not metabolized by the liver
80
benzos notmetabolized by the lier
LOT; lorazepam, oxazepam, temazepam
81
temazepam
restoril;decreasingly used for tx of insomnia due to dependence; not metabolized by the liver
82
triazolam
halcion; short-acting benzo; treatment of insomnia
83
midazolam
versed; short acting benzos; primarily used in med and surgical settings
84
side effects of benzos
drowsiness, impairment of intellectual function; anterograde amnesia
85
toxicity of benzos
resp depression, esp when combined with alcohol
86
examples of non-benzo hypnotics
zolpidem (ambien); dephenhydramine (benadryl); chloral hydrate (noctec, somnote); ramelteon (rozerem)
87
zolpidem
ambien, just like zaleplon (sonata), and eszopiclone (Lunesta); selective bindng to benzo receptor 1, which is responsible for sedation
88
diphenhydramine
benadryl; antihistamine; side effects are sedation, dry mouth, constip, urinary retention, and blurry vision
89
chloral hydrate
Noctec, Somnotec; not commonly prescribed due to tolerance and dependence; lethal in overdose, causing hepatic and liver failure
90
Ramelteon (Rozerem)
non benzo hypnotic; Selective melatonin MT1 and MT2 agonist; no tolderance or dependence
91
examples of non-benzo anxiolytics
buspirone (BuSpar); hydroxyzine (Atarax); Barbiturates; propranolol
92
buspirone
buSpar; partial agonist of the 5HT-1A receptor; has slow onset than benzos (takes 1-2 weeks for effect); not that effective, so often used in combo with another agent like SSRI for treatment of anxiety
93
in what population is buspirone good and why?
good in alcoholics because it does not potentiate the CNS depression of alcohol; also has a low potential for abuse/addiction
94
Hydroxyzine
atarax; antihistamine; quick acting short term med
95
barbiturates
eg. Butalbitol, phenobarbitol, amobarbitol, pentobarbitol; rarely used now because lethality of overdose and side effect profile
96
propranolol
beta blocker; useful for treating the autonomic side effects of panic attacks; can also be used to treat akathisia (side effect of typical antipsychotics)
97
examples of psychostimulants
dextroamphetamine and amphetamines; methylphenidate; atomoxetine; modafinil
98
dextroamphetamine and amphetamines
dexedrine, adderall
99
methylphenidate
ritalin, Concerta; watch for leukopenia, anemia, incr LFTs
100
atomoxetine (strattera)
presynaptic norepi transport inhib; less appetite suppression and insomnia
101
modafinil
Provigil; used in narcolepsy
102
acetylcholinesterase inhib
donepezil (Aricept); galantamine (Reminyl); Rivastigmine (Excelen); Tacrine (Cognex); Memantine (Namenda)
103
acetylcholinesterase inhib patch
less side effects; rivastigmine (Excelon)

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