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63 Cards in this Set
- Front
- Back
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what is another name for antipsychotics
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neuroleptics
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name 4 antipsychotic drugs
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thioridazine, haloperidol, fluphenazine, chlorpromazine
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how do you keep benzos straight from antipsychotics
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Benzos help 3rd year Jon Kazam be less anxious around patients: Shazam Kazam! Without antipsychotics patients talk like a crazy 'zine (well, not perfect, but I'm working on it)
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what is the mechanism of most antipsychotics
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block dopamine D2 receptors
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what is the clinical application of antipsychotics
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schizophrenia, psychosis
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what are the side effects of antipsychotics
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extrapyramidal side effects (EPS), sedation, endocrine, muscarinic blockade, alpha blockade, histamine blockade
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what is a long-term effect of antipsychotic use
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tardive dyskinesia
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what is neuroleptic malignant syndrome
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a side effect of antipsychotics; rigidity, autonomic instability, hyperpyrexia
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how do you treat neuroleptic malignant syndrome
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dantrolene, dopamine agonists
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what is tardive dyskinesia
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side effect of neuroleptics; stereotypic oral-facial movements, may be due to dopamine receptor sensitization
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what is the "rule of 4" with EPS side effects from antipsychotic drugs
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evolution of EPS side effects: 4 hours -- acite dystonia, 4 days -- akinesia, 4 weeks -- akasthesia, 4 months -- tardvie dyskinesia
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is tardvie dyskinesia reversible
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often irreversible
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what is fluphenazine used for
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schizophrenia, psychosis
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name 3 atypical antipsychotics
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clozapine, olanzapine, risperidone
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what type of antipsychotic is clozapine
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atypical
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what type of antipsychotic is olanzapine
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atypical
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what type of antipsychotic is risperidone
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atypical
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what is the mechanism of atypical antipsychotics
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block 5-HT2 and dopamine receptors
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what is the mechanism of clozapine
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block 5-HT2 and dopamine receptors
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what is the mechanism of olanzapine
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block 5-HT2 and dopamine receptors
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what is the mechanism of risperidone
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block 5-HT2 and dopamine receptors
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what is the clinical application of clozapine
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schizophrenia positive and negative symptoms
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what is the clinical application of olanzapine
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schizophrenia positive and negative symptoms, OCD, anxiety disorder, depression
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what is the clinical application of risperidone
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schizophrenia positive and negative symptoms
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how are atypical antipsychotics different from classic ones
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atypicals treat positive and negative symptoms of schizophrenia, fewer extrapyramidal and anticholinergic side effects than classic antipsychotics
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which antipsychotics should be used to treat positive and negative symptoms of schizophrenia
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atypical ones -- clozapine, olanzapine, risperidone
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which antipsychotics should be used for fewer side effects
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atypical ones -- clozapine, olanzapine, risperidone
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what is a potential toxicity of clozapine
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agranulocytosis
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which antipsychotic drug can cause agranulocytosis
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clozapine
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what test must be done weekly on patients taking clozapine
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WBC count because of potential agranulocytosis
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0
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0
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what is the mechanism of action of lithium
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unknown; may be related to inhibition of phosphoinositol cascade
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what is the clinical application of lithium
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mood stabilizer for bipolar disorder
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how does lithium help people with bipolar disorder
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prevents relapse and acute manic episodes
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what are the side effects of lithium
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tremor, hypothyroidism, polyuria, teratogenic
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is it OK for women taking lithium to get pregnant
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NO -- teratogenic
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what does lithium cause polyuria
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ADH antagonist --> nephrogenic diabetes insipidus
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What do the following drugs inhibit: 1. MAO inhibitors, 2. Desipramine/maprotilline, 3. Mirtazapine and 4. Fluoxetine/trazodone?
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1. MAO 2. NE reuptake 3. Alpha 2-R & 5HT2 R 4. 5HT reuptake
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1. MAO inhibitors, 2. Desipramine/maprotilline, 3. Mirtazapine and 4. Fluoxetine/trazodone actions are ------synaptic
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PRE
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List the Tricyclic Antidepressants
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Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin
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What are the three C's of Tricyclic Antidepressant toxicity?
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Convulsions, Coma, Cardiotoxicity (arrythmias). Also respiratory depression, hypyrexia.
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How about tricyclic antidepressant toxicity in the eldery?
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confusion and hallucinations due to anticholinergic SE
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What is the mechanism of TCA?
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block reuptake of NE and 5HT
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What is the clinical uses of TCAs?
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Endogenous depresion. Bed wetting - imipramine. OCD- clomipramine.
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How are tertiary TCA's different than secondary in terms of side effects?
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Amitriptyline (tertiary) has more anti-cholinergic effects than do secondary (nortriptyline). Desipramine is the least sedating.
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what are the side effects of TCAs?
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sedation, alpha blocking effects, atropine-like anti cholinergic side effects (tachycardia, urinary retention)
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Fluoxetine, sertraline, paroxetine, citalopram are what class of drugs?
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SSRI's for endogenous depression
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How long does it take an anti-depressant to have an effect?
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2-3weeks
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How does the toxicity of SSRI's differ from TCA's and what are they?
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Fewer than TCA's. CNS stimulation - anxiety, insomnia, tremor, anorexia, nausea, and vomiting.
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What toxicity happens with SSRI's and MAO inhibitors given together?
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Seratonin Syndrome! Hyperthermia, muscle rigidity, cardiovascular collapse
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What are heterocyclics?
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2nd and 3rd generation antidepressants with varied and mixed mechanisms of action. Used major depression.
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Examples of heterocyclics?
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Buproprion, Venlafaxine, Mirtazapine, Maprotiline, Trazodone BUtane in your VEINs to MURder for a MAP of alcaTRAZ
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Which heterocyclic is used for smoking cessation?
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Buproprion. Mechanism not known. Toxicity - stimulant effects, dry mouth, aggrevation of pyschosis
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Which heterocyclic used in GAD?
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Venlafaxine - inhibits 5HT and DA reuptake. Toxicity - stimulant effects
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which heterocyclic blocks NE reuptake
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maprotiline
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Which heterocyclic increases release of NE and 5HT via alpha 2 antagonism?
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mirtazapine. Also potent 5HT Rantagonist. Toxicity - sedation, increase serum cholesterol, increase appetite
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What is trazodone and it' SE?
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primarily inhibits seratonin reuptake. Toxicity - sedation, nausea, priapism, postural hypotension
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Give 2 examples of MAO
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phenelzine. Tranylcypromine
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MAO Mechanism and Clinical Uses?
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non selevtive MAO inhibition. Atypical antidepressant, anxiety, hypochondriasis
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What is the toxicity of MAOs with tyramine ingestion (in foods) and meperidine?
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Hypertensive crisis
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Other MAO toxicities? (besides w/ tyramine)
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CNS stimulation, contraindicated with SSRI's or B-agonists
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What is the mechanims of selgiline (deprenyl)?
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Selectively inhibits MAO-B, increasing DA
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what is deprenyl's (selgiline) clinical use and toxicity?
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adjunctive agent to L-dopa for Parkinsons. May enhance adverse effects of L-dopa
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