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17 Cards in this Set

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What can you use for anxiety?
SSRI's (especially for patient w/ substance abuse history). TCA's and MAOI's can be used, but have side effects.

BENZO's are better than SSRI's for GAD.
What receptors to BENZO's bind to?
BIND TO GABA RECEPTORS TO INCREASE AFFINITY FOR GABA.

Bind to two types:

BZ - 1: mediates sleep (ambien, lunesta act here)

BZ - 2: mediates anxiety, memory, motor control, cognition
What breaks down BENZO's?
HEPATIC! Elderly patients and others with hepatic hypometabolism can PROLONG BENZODIAZAPENE DURATION
Risk for benzo OD?
Alone, virtually none.

Only when mixed with other sedatives (like alcohol)
What are the 3 types of typical antipsychotics?
Separated by potency.

HIGH potency = D2 antagonist...also blocks alpha-1

MED potency = less potent D2 antagonist. Blocks alpha-1, H1, muscarinic.

LOW potency = least potent D2 antagonist. Has anticholinergic effects. Highest potency binding for muscarinics.
What are classical D2 blockage side-effects?
Tardive Dyskinesia (nigrostriatal), flattened affect (mesolimbic). slowed cognition (mesocortical), increased prolactin (tuberoinfundibular)
What is a BIG POTENTIAL PROBLEM for treating with antipsychotics
NMS.
What are side effects of Anticholinergics?
Blurred vision, dry mouth, constipation, confusion, difficulty urinating
Which of the 4 DA pathways has the fewest 5HT2 receptors?

How is this related to atypical antipsychotics?
Mesolimbic!

Atypicals also block 5HT2 receptors, which leads to increased DA secretion, can counteract the D2 antagonism in all the DA pathways EXCEPT mesolimbic.

This is good because BLOCKING MESOLIMBIC (limbic most affected in schizophrenia) reduces positive symptoms, while evening out of dopamine levels can reduce side-effects from the other three DA pathways (tardive, enhanced cognition, less prolactin release)
What binding properties affect tardive dyskinesia?
Depends on how tightly the D2 receptor is bound

Atypicals have rapid D2 dissociation. May reduce tardive dyskinesia.
What are some side-effects of the atypical antipsychotics?
Hyperglycemia, Diabetis, Obesity risks.

COST! Pharmacoeconomics would suggest that TYPICALS ARE PREFERIBLE BECAUSE THEY ARE MUCH CHEAPER!
What medications can you use for Bipolar?
MOOD STABILIZERS: LITHIUM

ANTIEPILECTICS

ATYPICAL ANTIPSYCHOTICS

COMBINATION THERAPY IS THE NORM.
What are side effects of lithium?
GI, sedation, weight gain, acne, psoriasis. HYPOTHYROIDISM

RENAL METABOLISM. SMALL THERAPEUTIC WINDOW. can lead to coma and death. Do not give to pregnant mothers.

Serotonin Syndrome (like with rapid removal of MAOI!)
Side effects of other mood stabilizers?
GI, dizziness, alopecia, weight gain, rashes (rare = steven johnson)
What are Valproate and Carbamazepines effects of p450?
Valproate is an inhibitor!

Carbamazepine is an activator!
What is the only medication approved for bipolar depression?
Olanzapine - Fluoxetine mix.

ANTIPSYCHOTIC + SSRI
What antidepressants are good for pain control?
TCA's and SNRI's