Term
| What are the positive sx of Schizophrenia? Why do these sx occur? |
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Definition
| Delusions, hallucincations, bizarre behavior, disorganized speech and thinking and insomnia. Occur bc of excessive neuronal activity. |
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Term
| First drugs (2) of choice for Schizophrenia |
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Definition
| Reserpine and chlorpromazine |
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Term
| What are the negative sx of Schizophrenia? |
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Definition
| Withdrawl, lack of motivation, affective flattening, anhedonia avolution/apathy |
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Term
| Characteristics of Schizophrenia |
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Definition
| Characterized by a marked thinking disturbance, genetically linked, assoc with DA |
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Term
| Where is the highest concentration of dopamine receptors? |
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Definition
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Term
| What is significant about the caudate nucleus? |
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Definition
| Involved in motor functions and has been shown to be atrophic in pts with Parkinson's Dz |
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Term
| Projects from cell bodies near the substantia nigra to the limbic system. |
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Definition
| Mesolimbic-Mesocortical (Dopaminergic System) |
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Term
| Projects from the substantia nigra to the caudate and putamen (involved in voluntary movements). |
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Definition
| Nigrostriatal (Dopaminergic System) |
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Term
| Connects arcuate nuclei and perventricular neurons to the hypothalamus and posterior pituitary (DA released by these neurons inhibits PRL secretion) |
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Definition
| Tubero-infundibular (Dopaminergic System) |
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Term
| Neurons in the motor nucleus of the vagus whose projections are not well defined (involved in eating behavior) |
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Definition
| Medullary-Periventricular (Dopaminergic System) |
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Term
| Connects the medial zone incerta to the hypothalamus and the amygdala. |
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Definition
| Incerto-hypothalamic (Dopaminergic System) |
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Term
| What are the role of DA Antagonists? |
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Definition
| Block dopamine in the mesolimbic and mesocortical systems (mainly at the D2 receptor). They produce antipsychotic effects and parkinsonian-like sx |
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Term
| How do you manage an individual with Schizophrenia? |
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Definition
| Hospitalization, Group therapy, Individual psychotherapy, meds, ET (Electroconvulsive therapy) |
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Term
| What are the goals of Pharmacologic Mgt in a pt with Schizophrenia? |
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Definition
| Control behavior, calm agitation, psychomotor slowing (decreased agitation, aggression and impulsivity) |
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Term
| Schizophrenia pts who are resistant to pharmacotherapy tend to have...? |
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Definition
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Term
| What are the 4 main groups of Antipsychotic Agents? |
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Definition
1. Phenothiazine derivatives
2. Thioxanthene derivatives
3. Butyrphenone derivatives
4. Atypical (more effective with negative sx) |
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Term
| How many days does it take to decrease the sx assoc with Schizophrenia? |
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Definition
| 3-10 days (Doses should be reduced gradually to a maintenance level) |
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Term
| A contraindication of phenothiazine is? |
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Definition
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Term
| Antipsychotic Agents are indicated in what type of disorders? |
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Definition
1. Schizophrenia (primary indication)
2. Schizoaffective disorder
3. Psychoses assoc with depression and mania
4. Manic phase in bipolar affective disorder
5. Tourette's Syndrome
6. Alzheimer's Dz
7. Antiemetic
8. Pruritus (Phenothiazines-H1 blocking)
9. Preoperative sedatives (Promethazine) |
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Term
| Prochlorperazine and Benzquinamide are used for as what? And what do they do? |
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Definition
| Antiemetic. They block the DA receptor in the chemoreceptor trigger zone of the medulla and peripherally in the stomach. |
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Term
| Antipsychotics are NOT indicated for...? |
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Definition
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Term
| Phenothiazine derivatives affect what type of receptors? |
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Definition
| DA, muscarinic, H1, 5-HT2 (located throughout the CNS, autonomic and endocrine systems) |
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Term
| Examples of Phenothiazine derivatives are? |
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Definition
1. Chloropromazine
2. Thioridazine
3. Piperazine (more potent, more selective)- exs: trifluoperazine, perpherazine, fluphenazine |
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Term
| Haloperidol is a type of...? |
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Definition
| Butyprophenone Derivative (Most widely used). It is more potent and has fewer autonomic effects but greater extrapyramidal effects. |
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Term
| Atypical antipsychotics inhibit what type of receptors? |
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Definition
| 5-HT2 and DA2 (both with similar potency) |
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Term
| Examples of Atypical Antipsychotic Agents are (6)? |
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Definition
1. Clozapine (limited to those who have failed conventional drugs, SE: agranuloctosis, seizure)
2. Olanzapine
3. Quetiapine
4. Risperidone
5. Ziprasidone
6. Aripiprazole |
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Term
| The following describes what type of drug class? Readily but incompletely absorbed; significant first pass metabolism; highly lipid soluble and protein bound (Longer duration of action, full relapse may not be seen until 6 wks after discontinuation of drugs) |
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Definition
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Term
| What are some behavioral SE due to Antipsychotics? |
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Definition
1. Pseudodepression- due to drug induced akinesia (responds to antiparkinson drugs)
2. Confusion |
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Term
| What are some neurologic effects (Extrapyramidal) due to administration of Antipsychotics? |
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Definition
| Parkinson's Syndrome, akathisia, acute dystonic rxns, tardive dyskinesia, seizures |
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Term
| How do you tx pts who have developed tardive diskinesia from taking antipsychotics? |
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Definition
1. Dose reduction or d/c offending agents
2. Eliminate all anticholinergic drugs, esp antiparkinsonism and TCAs
3. Switch to atypical
4. Diazepam 30-40 mg/day
5. May subside within 1 yr |
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Term
| What are common CV SE from using typical antipsychotics? What are the MC drugs that cause these SE? |
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Definition
Postural hypotension, prolongation of QTc interval (may lead to V. arrhythmia).
Thioridazine and pimozide |
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Term
| The MC SE of Fluphenazine, Clozapine and Olanzapine is? |
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Definition
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Term
| The MC SE's (2) of Chlorpromazine and Thioridazine are? |
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Definition
| Seizures and retinal pigmentation |
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Term
| 1. MC SE from using Phenothiazines? 2. Other SE include? |
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Definition
1. Photosensitivity, rash and uticaria
2. Orthostatic hypotension, high resting HR |
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Term
| The only antipsychotic that causes retinal deposits (browning of the vision)? |
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Definition
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Term
| Ziprasidne has the greatest risk of? |
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Definition
| QT prolongation (avoid combination with thioridazine, pimozide, quinidine) |
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Term
| This syndrome is seen in 1% of pts on antipsychotics. It is MC with use of typical antipsychotics and is life threatening. |
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Definition
| Neuroleptic Malignant Syndrome |
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Term
| S/S of Neuroleptic Malignant Syndrome include? |
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Definition
| Marked muscle rigidity (muscle relaxants such as dantrolene may help), fever, altered BP, increased pulse rate and WBC, elevated CK, severe extrapyramidal syndrome follows (tx with antiparkinsonism drugs) |
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Term
| Extrapyramidal syndromes are a SE of Phenothiazine derivatives. Examples of these are: |
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Definition
| Acute dystonic rxns: torticollis-neck, opisthotonos back and oculogyric crises- mouth and eye |
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Term
| Drug-induced parkinsonism is a SE of Phenothiazine derivatives. Examples of these are? Tx? |
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Definition
| cogwheel rigidity, bradykinesia, tremor, mask-like faces, drooling and loss of postural reflexes. Tx: antiparkinsonian meds like benztropine (cogentin) and trihexyphenidyl (artane) |
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Term
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Definition
| (Phenothiazine derivative SE) Motor restlessness syndrome, involves the entire body |
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Term
| Tardive dyskinesia is a SE of Phenothiazine derivatives. What is it? It's characterized by? |
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Definition
| Movement disorder, due to DA-AChl imbalances. Characterized by fasciculations, twisting and protrusion of the tongue, lateral jaw movements, lip smacking, 7 choreoathetotic movements of the extremities and trunk; reversed by neuroleptic discontinuation, irreversible in severe cases; worsen by the use of anticholinergic meds |
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Term
| Overdoses of antipsychotics are ___________? Sxs include: |
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Definition
| RARELY fatal (except mesoridazine and thioridazine). SX: drowsiness, coma, agitation, neuromuscular excitablity, convulsions, miotic pupils, DTR are decreased, hypotension and hypothermia. |
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Term
| This is often referred to as an "antimanic" drug but in many parts of the world known as "mood-stabilizing" agent. |
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Definition
| Lithium Carbonate (Eskalith) |
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Term
| Lithium is FORMLY known as the drug of choice for tx of: |
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Definition
| Mania, manic episodes of bipolar disorders and prevent mood swings in bipolar affective disorder |
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Term
| The bipolar affective disorder is characterized by: |
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Definition
| Mood swings, strong familial component and a mania phase (grandiosity, bellicosity, paranoid thoughts, overactivity) |
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Term
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Definition
1. Generates AP
2. Effects on NTs: 5-HT, NE, DA (decreases NE and DA turnover which might be relevant to antimanic action)
3. Effects on 2nd messengers and intracellular enzymes the mediate transmitter action (most promising) |
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Term
| Lithium Absorption? Excretion? 1/2 life? Target plasma concentration? Dosage? |
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Definition
6-8 hrs, peak 30 min- 2 hrs
mainly in urine
20-24 hrs
0.6-1.4 mEq/I
0.5 mRq/kg/day in divided doses |
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Term
| Valproate, olanzapine, atypical antipsychotics replaced ____________ in order to tx bipolar affective disorder |
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Definition
| Lithium bc lithium has a slow onset of action (10-14 days). |
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Term
| Recurrent endogenous depression can be controlled by? |
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Definition
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Term
| Schizoaffective disorder is treated with? |
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Definition
| Antipsychotic drugs alone or in combo with lithium |
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Term
When should the 1st concentration of lithium be obtained after the start of tx?
When should serum lithium concentrations be drawn after the last dose? |
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Definition
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Term
| Does lithium have a narrow or wide therapeutic index? Maintenance levels? Toxic levels? |
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Definition
NARROW! Maintenance levels: 0.9 mEq/L (0.6-1.2)
Toxic >2.0 |
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Term
| Lithium use reduces renal clearance by 25% when used with? |
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Definition
| Diuretics (thiazides) and NSAIDs (asa and acetaminophen do NOT interact) |
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Term
| ALL neuroleptics except _____ and _____ exhibit more severe EPS when combined with lithium. |
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Definition
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Term
| Adverse effects of lithium include: |
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Definition
| tremor (alleviated by propranolol and atenolol), choreoathetosis, motor hyperactivity, ataxia, dysarthria, asphasia. At TOXIC level- mental confusion and withdrawl (stop lithium and closely monitor) |
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Term
| Decreased thyroid fxn is a major SE of Lithium. What affects does lithium have on the thyroid? How often should TSH be monitored? |
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Definition
| Lithium is distributed mostly in brain and thyroid. Blocks thyroid hormone synthesis and release. Reversible and nonprogressive. Monitor every 6-12 months! |
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Term
| Common renal SE of lithium use include? Tx? |
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Definition
polyuria, polydipsia (common and reversible); nephrogenic diabetes insipidus (resistant to vasopressin but responds to amiloride); chronic interstitial nephritis and minimal change glomerulopathy with nephrotic syndrome.
Tx: well hydrated, periodic renal testing |
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Term
| Edema, Bradycardia-tachcardia ("sick sinus") syndrome, transient acneiform eruptions, folliculitis and leukocytosis are SE of? |
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Definition
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Term
| What do you do when a pt overdoses on Lithium? |
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Definition
| Plasma concentration may not be excessively high (2+is indicative of toxicity), dialyzed readily (peritoneal dialysis, hemodialysis*), continue dialysis until the plasma concentration falls below the usual therapeutic range. |
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Term
| Can Lithium be used during prego? |
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Definition
| Yes. Close level monitoring after delivery is important (levels will be expected to decrease) |
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Term
| Can Lithium be used during prego? |
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Definition
| Yes. Close level monitoring after delivery is important (levels will be expected to decrease) |
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Term
| Can Lithium pass through breast milk? |
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Definition
| Yes. Passes through with a concentration of about 1/3 to 1/2 of serum |
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Term
| What are the S/S of newborn toxicity? |
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Definition
| Lethargy, cyanosis, poor suck, moro reflexes, hepatomegaly |
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Term
| Drugs for the depression phase of bipolar include? |
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Definition
1. TCA-linked to precipitation of mania, with more rapid cycling of mood swings
2. SSRIs- less likely to induce mania
3. Bupropion- induce mania at higher doses
4. Lamotrigine- effective for many pts with biopolar depression
5. MAO-I |
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