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28 Cards in this Set
- Front
- Back
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neuroleptic malignant syndrom
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too much high-potency DA2 block by typical neuroleptics; autonomic instability, parkinsonism, stiffness, wax/wane LoC; up to 30% fatal
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"dystonic rabbit can't sit still"
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EPS FX of typical neuroleptics (acute dystonic rxn, perioral tremor, akasthesia)
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treatment for dyskinesias, dystonias, EPS FX, tardive or otherwise
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Anti-ACh drugs
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hi potency typical neuroleptics (2)
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haloperidol, fluphenazine
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low potency typical neuroleptics (2)
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thoridazine, chloropromazine
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atypical neuroleptics
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clozapine, risperidone, olanzapine, quetiapine, ziprasidone, ariprazole
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name the SE associated with each atypical neuroleptic: clozapine, risperidone, olanzapine, ziprasidone, ariprazole
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clozapine (agranulocytosis, seizure), risperidone (EPS FX @ high doses), olanzapine (heavy weight gain), ziprasidone (QT elongation)
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3 DA pathways
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1. mesostriatal, 2. mesolimbic (includes reward system, accumbens), 3. mesocortical (lacks 5-HT2 receptors)
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this atypical neuroleptic has a completely active metabolic, making the drug's active concentration independent of changes in clearance
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risperidone
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(2) people at risk for dev'ping tardive dyskinesias within months (instead of years) of DA2 blocker use
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elderly w/ dementia + people w/ brain injuries
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main side FX of low potency typical neuroleptics (3)
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Anti-ACh FX, sedation, orthostasis
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main side FX of atypical neuroleptics (3)
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weight gain, metabolic syndrome/glucose intolerance, seizures (Clozapine)
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why 3' TCAs shouldn't be given to alzheimer's patients
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3' amines have worse side FX; anti-ACh FX really hurt alzheimer's patients
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side FX of TCAs (4)
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anti-ACh FX, sedation (Histamine), orthostasis (alpha1 blockade), cardiac toxicity
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issues that can become synergized with TCAs (3)
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Parkinsonism (anti-ACh), hypotension (alpha1 block), cardiac function (anti-arryhthmics)
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2' amines more selectively inhibit the reuptake of (NE or 5-HT) ?
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NE (hence 2' TCA named NORtriptyline)
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3 MAOi's
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phenelzine, tranylcypramine, selegline
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the two chemicals that, if in the system, are bad news when taking a MAOi
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SSRI (serotonin syndrome) and tyramine (processed meats, aged cheese, animal liver, banana peels)
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which SSRI inhibits P450 _____ leading to extended HL of warfarin
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fluoxetine, 2D6 inhibition
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3 SSRIs with lots of P450 FX
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fluoxetine, fluvoxamine, paroxetine
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what's special about paroxetine (2, one about potency, one about metabolism)
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strongest inhibition of 5-HT reuptake AND zero order kinetics
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the story of 5-HT2 blockers (which also block 5-HT reuptake)
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trazodone (sedative) and Nefazodone (liver failure)
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mech of action of SSRIs
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block reuptake of 5-HT and NE
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General side FX of SSRIs (4)
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insomnia, sexual dysfunction, fatigue, GI issues; + initial inc. in anxiety
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mirtazapine
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blocks a2 receptors, leading to increased NE/5-HT release (shunts to 5-HT1R); longer HL in women
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SNRIs (2)
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venlafaxine and duloxetine (pure TCAs with less side FX)
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problem with bupropion
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can't use with anorexia/bulimia (seizures)
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SSRI with crazy long HL
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fluoxetine (prozac) + active metabolite
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