Week 11: psychotherapeutics, vaccines

Question 1

What are extrapyramidal symptoms (EPS)? Describe the four types.

Answer 1

Akinesias –restlessness, foot tapping, trouble standing still, pacing, feet in constant motion, rocking back and forth
Pseudoparkinsonism – stooped/shuffled gait, rigidity, bradykinesia, pill-rolling motion of the hands slight tremor at rest
Acute dystopia – facial grimacing, involuntary upward eye movement, muscle spasms of the tongue, face, neck and back (trunk arching forward)
Tardive dyskinesias – protrusion and rolling of tongue, chewing or sucking motion, facial dyskinesia, involuntary movements of the body and extremities

Question 2

s/s serotonin syndrome

Answer 2

hyperactive bowel activity, tremor, hyperreflexia, dilated pupils (hyperthermia, altered LOC, ANS instability too)

Question 3

tx serotonin syndrome

Answer 3

d/c med, supportive care, give serotonin receptor blockers

Question 4

Why do you think it’s so important to differentiate between the two prior to initiating pharmacologic treatment?

Answer 4

It is particularly important to differentiate between the two because the treatment for serotonin syndrome could worsen neuroleptic malignant syndrome if misdiagnosed.

Question 5

Contraindications for SGAs

Answer 5

avoid with other drugs that suppress bone marrow

Question 6

List some atypical antidepressants

Answer 6

Bupropion
Esketamine

Question 7

How does esketamine work

Answer 7

Esketamine – NMDA receptor antagonist, thus can increase glutamate (excitatory)

Question 8

How does bupropion work?

Answer 8

Bupropion – unclear, may be d/t DA/NE reuptake

Question 9

How does Na+ levels affect plasma drug levels of lithium?

Answer 9

Excretion is affected by Na+ concentration, the lithium goes where the sodium goes, so hyponatremia poses a risk for toxicity, while hypernatremia causes a risk for subtherapeutic drug levels

Question 10

AE of lithium at theraputic dosages

Answer 10

N/V/D
Thirst, polyuria (block of ADH)
Lethargy, slurred speech, fine hand tremor,
renal toxicity
Hypothyroidism and goiter
Teratogenesis (avoid in first trimester, unless benefits outweigh risks)

Question 11

Classes of drug interactions with lithium

Answer 11

Diuretics (na+ loss)
NSAIDs (increase renal artery vasoconstriction, increasing lithium levels)
anticholinergic (urinary hesitancy)
ACE inhibitors (Na+ loss)

Question 12

Who should receive RSV antibodies?

Answer 12

Preterm infants
Congenital heart disease less than 2 yrs
Bronchopulmonary dysplasia (less than 2 yrs)

Question 13

all vaccines pose a risk for anaphylaxis because

Answer 13

of preservatives, like neomycin, gelatin,

Question 14

Vaccines requiring only one dose

Answer 14

Hep A (2nd dose only if live in high risk areas)

Question 15

AE MMR

Answer 15

localized lymphadenopathy, joint stiffness, transient thrombocytopenia

Question 16

AE DTaP

Answer 16

high fever, febrile seizure, encephalopathy

Question 17

AE polio

Answer 17

polio-like syndrome only w/ oral (rare)

Question 18

AE varicella

Answer 18

mild rash

Question 19

Unique CI for MMR

Answer 19

pregnancy

Question 20

Unique CI for DTaP

Answer 20

after previous dose fever above 105, febrile seizure, encephalopathy

Question 21

unique CI for varicella

Answer 21

pregnancy, blood cancer

Question 22

Unique considerations for hep B

Answer 22

if mom is hep B+, give immunoglobulin with first dose

Question 23

unique CI for rotavirus

Answer 23

uncorrected GI malformation, severe vomiting or diarrhea (can’t keep in gut long enough to develop antibodies)

Question 24

Antidote for overdose of AChE inhibitors

Answer 24

Atropine

Question 25

Antidote for OD of Anticholinergic drugs

Answer 25

AchE inhibitor

Question 26

Antidote for heparin OD

Answer 26

protamine

Question 27

What are two FGA

Answer 27

haloperidol Chlorpromazine (phenothiazine)

Question 28

AE of SGA

Answer 28

DM Weight gain HLD agranulocytosis sz myocarditis EPS orthostatic hypotension higher risk mortality w/ dementia

Question 29

What is the difference between MAOIs (nonselective) and MAO-B inhibitors

Answer 29

MAOIs are used for depression, causing an increase in dopamine, serotonin and NE. MAO-B inhibitors cause an increase in dopamine and are used in PD

Question 30

Classes used to treat insomnia

Answer 30

benzos benzo-like drugs melatonin agonists orexin antagonist (both sleep onset and maintenance) barbs

Question 31

AE of zolpidem

Answer 31

similar to benzos little to no respiratory depression at therapeutic doses avoid in pregnancy rare: abnormal sleep related behaviors

Question 32

AE of suvorexant

Answer 32

somnolence, dizziness HA dry mouth, cough physical dependence/tolerance - schedule 4

Question 33

Cautions in suvorexant

Answer 33

Obstructive Sleep Apnea (OSA) and COPD

Question 34

Drug interactions with ramelteon

Answer 34

CNS depressants fluvoxamine (can increase drug levels 50x)

Question 35

Caution with Buspirone

Answer 35

hepatic metabolism, be careful with CYP450 inducers and inhibitors

Question 36

Considerations with Amphetamines

Answer 36

tolerance and dependence occurs so taper slowly

Question 37

Considerations with Methylxanthines

Answer 37

may lower birth weight in pregnancy ADH suppression causing diuresis

Question 38

What is Miralax especially good for decreasing absorption of

Answer 38

iron, lithium, lead