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Psychopharmacology
study guide
| Question | Answer |
|---|---|
| Antipsychotics mechanism of action when prescribed | Dopamine antagonists ( D2 receptors)via the mesolimbic pathway psychotic disorders - schizophrenia, delusions atypicals used for long term acute agitation at any time ( esp Haldol- high potency, zipraxidone/Geodon) |
| Antipsychotics classes | typical antipsychotics ( older sedating, quicker effective) atypical antipsychotics ( maintenance) |
| Antipsychotics typical high potency = low potency = | high potency = haloperidol low potency = chlorpromazine |
| Antipsychotics atypical | **Risperidone ( antagonist of D2 and 5HTZ) Other atypical aripripazole (abilify) clozapine ( clozaril) olanzapine ( zyprexa) Seroquel zipraxidone (Geodon) |
| What is a neuroleptic? | a term used to refer to first-generation antipsychotics (such as chlorpromazine or haloperidol) because of their ability to produce neurolepsis: what is neurolepsis? Psychomotor slowing Emotional queting Affective indifference |
| What is an atypical antipsychotic? | Originally, term was used to describe a lower risk of EPS associated with clozapine use. lower risk of extrapiramidal symptoms such as tardive diskinesia. lack of prolactin elevation and efficacy in treatment resistant patients. |
| Symptoms Treated with Antipsychotic Drugs | Positive Symptoms (behaviors) -Conventional antipsychotics relieve positive symptoms. Negative Symptoms (lack of something) - Atypical relieve both positive and negative symptoms. |
| Positive Symptoms (behaviors) | Agitation Delusions Hallucinations Paranoia Racing Thoughts Rage |
| Negative Symptoms (lack of something) | Apathy-a lack of feeling, emotion, interest, or concern. ↓ motivation Social withdrawal Lack of pleasure Poor self care Flat affect |
| Side effects we will explore further include: Extrapyramidal Symptoms Dystonia Akinesia Akathisia Parkinsonism Tardive Dyskinesia Neuroleptic Malignant Syndrome Agranulocytosis Orthostatic Hypotension | Side effects we will explore further include: Extrapyramidal Symptoms Dystonia Akinesia Akathisia Parkinsonism Tardive Dyskinesia Neuroleptic Malignant Syndrome Agranulocytosis Orthostatic Hypotension |
| Dystonia | series of uncontrollable cramping, muscle movements, and spasms of the tongue, face, neck, and back. |
| Akinesia | lack of/reduced motor function. Patients have flat affect that resembles apathy. Usually occurs after the patient is on antipsychotics for weeks or months. Don't confuse this with depression; treat with anticholinergics. |
| Akathisia | inner restlessness twitches, a constant urge to be moving, and while this is abnormal, it is still voluntary movement, the urge cannot be ignored. Can escalate to irritation and agitation. Don't confuse with anxiety or restless leg syndrome. |
| Parkinsonism | muscular rigidity, tremor, akinesia, pill rolling, and impaired motor control. Patients may have the shuffling walk of PD. This is also called Parkinson's syndrome. |
| Tardive Dyskinesia | serious and permanent can occur in as little as 6 months. abnormal, involuntary movements, finger rubbing, tics, tremors, twisting, blinking, or chewing. Torticollis, twisting of the neck, is painful. The patient's head tilts in one direction. |
| Neuroleptic Malignant Syndrome | sudden high fever sweating rigidity dysrhythmias fluctuations in BP respiratory failure Treatment stop antipsychotic medication treat fever, dehydration, BP, anxiety, rigidity |
| Agranulocytosis | rare and potentially fatal reaction that occurs with the atypical antipsychotic, Clozaril clozapine. Patient must go for weekly WBC checks during the first months of treatment. |
| Agranulocytosis Symptoms | sore throat fever flu-like symptoms slowly falling WBC occurs in the first 6 months of treatment |
| Agranulocytosis treatment | antipsychotic permanently discontinued treat incidental infections |
| Orthostatic hypotension | Most common with low potency antipsychotics, like Thorazine chloropromazine patients will faint with the sudden drop in BP and injure themselves. Sitting and standing BP needs to be assessed during early treatment. |
| Anti-parkinsonian drugs like Cogentin (benztropine) decrease the symptoms of | EPS. |
| Schizophrenia is characterized by a.numerous personalities b. acute psychotic illness c. delusions, paranoia, hallucinations | C |
| Which of the following antipsychotics is known to elevate serum prolactin levels? A. Quetiapine B. Clozapine C. Aripiprazole D. Amisulpride | D - an atypical antipsychotic |
| Which category of drugs are associated with neuroleptic malignant syndrome? A. Antidepressants B. Anticholinergics C. Antipsychotics D. Mood stabilizers E. Anxiolytics | C- antipsychotics |
| Tetrabenazine is found to be effective in controlling: A. Neuroleptic-induced parkinsonism B. Neuroleptic-induced tardive dyskinesia C. Weight gain D. Hyperprolactemia | B. Neuroleptic-induced tardive dyskinesia |
| Which neuroleptic agent has the lowest likelihood of producing tardive dyskinesia? A. Imipramine B. Chlorpromazine C. Clozapine D. Fluoxetine E. Thiothixene | C. Clozapine |
| Which drug may be useful in the management of the neuroleptic malignant syndrome, although it can worsen the symptoms of schizophrenia? A. Risperidone B. Thiothixene C. Haloperidol D. Bromocriptine E. Valproic acid | D. Bromocriptine trade names Parlodel, Cycloset, an ergoline derivative, is a dopamine agonist that is used in the treatment of pituitary tumors, Parkinson's disease (PD), hyperprolactinaemia, neuroleptic malignant syndrome, and type 2 diabetes. |
| Antagonism of which dopaminergic pathway is atributed to be the cause of therapeutic actions of antipsychotic drugs? A. Nigrostriatal system B. Mesolimbic–mesocortical system C. Tuberoinfundibular pathway D. Reticular activating system | B. Mesolimbic–mesocortical system |
| patient reports fever, sore throat, or cellulitis,2 weeks of starting clozapine ? A. Trt pt with broad-spectrum abt and continue therapy B. D/C med, conduct WBC and differential counts. C. Inform pt it is common. D. Hospitalize pt. | B. Discontinue the antipsychotic and conduct WBC and differential counts. |
| Which of the following is a phenothiazine? A. Chlorpromazine B. Clozapine C. Olanzapine D. Risperidone E. Haloperidol | A. Chlorpromazine |
| Clozapine | atypical antipsychotic medication used in the treatment of schizophrenia, |
| Olanzapine | Zyprexa an atypical antipsychotic |
| Which statement is NOT correct? Antipsychotics A. produce menorrhea and increased libido in women B. decreased libido and gynecomastia in men. C. cause inhibition of prolactin secretion. D. Low-potency APs cause orthostatic hypotension | C. APs cause inhibition of prolactin secretion. |
| Which of the following agents possesses pharmacological actions characterized by high antipsychotic potency and high potential for extrapyramidal toxicity? A. Thioridazine B. Haloperidol C. Flumazenil D. Clozapine E. Carbamazepine | B. Haloperidol |
| FLUOXETINE PAROXETINE(PAXIL) Escitalopram (LEXAPRO) CITALOPRAM (CeleXa) SETRALINE (ZOLOFT) | SSRI- sounds like 'SO SEXY REALLY' ~girls like guys w flashy pecs Flashy P E C S |
| ELAVIL IMIPRAMINE DOXEPINE NOTRIPTYLINE | TCAS block CNS @ DIE antiCholinergic & hypotension, BLOCKS N & S, causes suicide block CNS @ DIE Chlomipramine Nortriptyline S- excess doses causes death Amoxepine Doxepine/desipramine(2 diff drugs) Imipramine Elavil(Amitriptyline) |
| PHENELZINE MARPLAN PARNATE | MAOIS |
| WELLBUTRIN | ATYPICAL ANTIDEPRESSANT INHIBITING DOPAMINE UPTAKE |
| VENLAFAXINE | ATYPICAL ANTIDEPRESSANT INHIBITING SEROTONIN AND NOREPINEPHRINE |
| MIRTAZIPINE | ATYPICAL ANTIDEPRESSANT INHIBITING RELEASE OF SEROTONIN AND NOREPINEPHRINE |
| REBOXETINE | SELECTIVELY INHIBITING NOREPINEPHRINE REUPTAKE |
| TRAZODONE | SELECTIVELY INHIBITING REUPTAKE OF SEROTONIN |
| CLIENTS STARTING ANTIDEPRESSANT MEDICATIONS SHOULD BE ADVISED THAT RELIEF CAN TAKE | 1-3 WEEKS PTS WITH MAJOR DEPRESSION MAY REQUIRE HOSPITALIZATION AND SUICIDE PRECAUTIONS UNTIL MEDICATIONS REACH THEIR PEAK |
| FUOXETINE[PROZAC] | SSRI selectively blocks the reuptake of monoamine neurotransmitter serotonin in the synaptic space use- depressive disorders, anxiety disorders, including panic, ocd, gad, ptsd bulimia nervosa sex dysfunc(anorgasimia), decreased libido,dystonia |
| FLUOXETINE serotonin syndrome | begins 2-72 hr after starting treatment s/s- mental confusion agitation anxiety hallucination hyperreflexia fever tremors |
| FLUOXETINE serotonin withdrawal syndrome | headache, visual disturbances, nausea, anxiety - instruct pt to taper dose gradually |
| other side effects of fluoxetine | hyponatremia- if taking diuretics rash- treated w antihistamine/withdrawal sleepiness - no driving serotonin syndrome hyperthermia, muscle rigidity, confusion, cardivascular collapse(hypotension) to treat- ciproheptadine (antihistamine), |
| contraindications fluoxeine | contraindicated for pts taking MAOIS USE CAUTIOUSLY IN PTS W LIVER AND RENAL DYSFUNCTION, CARDIAC DISEASE, SEIZRE DISORDERS, DIABETES, ULCERS, OR GI BLEEDING |
| FLUOXETINE MAOIs increase risk of serotonin syndrome | pt should not be administered MAOI while taking fluoxetine. MAOIs should be discontinued 14 days prior to starting an SSRI. If already taking fluoxetine, pt should wait 5 weeks before starting MAOI |
| FLUOXETINE COUMADIN- fluoxetine can displace warfarin from bound protein and result in increased warfarin levels | monitor PT and INR assess for bleeding A dosage adjustment may be rrequired |
| FLUOXETINE TCAs and lithium- fluoxetine can increase levels of these medications | concurrent use is not recommended |
| FLUOXETINE NSAIDS and anticoagulants- fluoxetine suppresses platlett aggregation and thus increases the risk of bleeding when used concurrently | monitor for s/s of bleeding ( bruising, hematuria) |
| fluoxetine teaching | advise pt to take with meals if taking diuretics, monitor sodium drug may take 1-3 weeks and may take 2-3 months for full benefits to be achieved therapy usually continues for 6 months after resolution of symptoms and may continue 1 yr/more |
| amitriptyline (elavil) | TCA blocks reuptake of norepinephrine and serotonin, thereby intensifying effects use- depression, depressive episodes bipolar other drugs in same class NOTRIPTYLINE (remember blocks reuptakke of nor') IMIPRAMINE (amItrip..) DOXEPINE (rem. X) |
| amitriptyline (elavil) side effects | orthostatic hypotension anticholinergic effects- dry mouth, blurred vision, photophobia, acute urinary retention, constipation, tachycardia cardiac toxicity ( usually only at excessive dosing) sedation |
| amitriptyline MAOIS | concurrent use causes hypetension |
| amitriptyline antihistamines | cause additive anticholinergic effects |
| amitriptyline epinephrine, norepinephrine | direct acting sympathomimetics there is an increased amount of these meds in the synaptic space because reuptake is blocked by TCAs, which leads to increased intensity of effects |
| amitriptyline ephedrine, amphetamine | indirect acting sympathomimetics there is a decreased response to these medications |
| amitriptyline alcohol, benzodiazepines, opiods, anhistamines | cause additive CNS depression when used concurrently |
| amitriptyline teaching | may take 1-3 weeks and it might take 2-3 months for full benefits to be achieved instruct client to continue therapy after improvement of symptoms prescribe only 1 weeks worth to prevent suicide minimize anticholinergic effects- increase fluids,fiber |
| phenelzine(Nardil) | MAOIs blocks MAO-A,thereby V increase the amount of norepinephrine(NE) and serotonin at nerve endings to relieve depression uses- depression, bulimia nervosa, ocd other drugs same class are- MARPLAN PARNATE my plan- nardil- is to partways |
| phenelzine(Nardil) side effects | CNS STIMULATION- anxiety, agitation, hypomania, mania ORTHOSTATIC HYPOTENSION HYPERTENSIVE CRISIS- resulting from intake of tyramine foods |
| HYPERTENSIVE CRISIS- what it is s/s | HINN'- RESULTS FROM intensive vasocontriction of the heart s/s include- HA NAUSEA INCREASED HR INCREASED BP trt by inducing vasodilation, so phentolamine, rapid acting alpha adrenergic blocker is given. also treated with sublingual nifedipine |
| HYPERTENSIVE CRISIS- treatment | treated with iv phentolamine sublingual nifedipine provide continous cardiac monitoring and respiratory support as indicated |
| HYPERTENSIVE CRISIS- resulting from intake of tyramine foods | ripe avocados or figs, fermented or smoked meats, liver, dried or cured fish, most cheeses, some beer and wine, protein dairy supplements |
| HYPERTENSIVE CRISIS- medication | vasopressors e.g. phenylthylamine- lead to HTN meperidine (demerol)- hyperpyrexia TCAs- - lead to htn crisis SSRIs- LEAD TO SEROTONIN SYNDROME ephedrine, amphetamine ( indirect sympathomimetics)- lead to htn crisis |
| “SIG-E-CAPS” vegetative signs that can be involved in depression. | S leep changes: increase or decrease I nterest (loss): of interest G uilt: devalue themselves E nergy (lack) C ognition/C oncentration A ppetite (wt. loss) P sychomotor: agitation (anxiety) or retardations (lethargic) S uicide/death preocp. |
| WHEN DEPRESSED, ELDERLY ARE: MORE LIKELY TO | Give somatic complaints |
| WHEN DEPRESSED, ELDERLY ARE: LESS LIKELY TO | To directly complain of depressed mood* |
| TCA drugs pneumonic | block CNS AT DIE IT causes antiCholinergic & hypotension, BLOCKS N & S, causes suicide block CNS @ DIE Chlomipramine Nortriptyline S- excess doses causes death Amoxepine Doxepine/desipramine(2 diff drugs) Imipramine Elavil(Amitriptyline) |
| block CNS @ DIE adjunct uses* Chlomipramine* Nortriptyline S- excess doses causes death Amoxepine (sounds like an ABT ..but its not) Doxepine/desipramine(2 diff drugs) Imipramine* Elavil(Amitriptyline) | Chlormipramine - OCD, complusions Imipramine- Enuresis/bed wetting TCAS cause effects such as, TACHYCARDIA, dry mouth, urinary retention, ORTHOSTATIC hypotension (FROM alpha blockade) SYMPATHETIC effects also know they are used for depression |
| pupil size changes with drugs Marijuana Heroin Cocaine Amphetamine PCP | marijuana- norMal sized pupil, slow or no reaction to light heroin- constricted non reactive pupil cocaine- C-dilated pupil,slow or no reaction to light Amphetamine- same like cocaine PCP- normal size pupil and vertical or horizontal nystagmus |
| constriction of pupils | alcohol and opioids |
| pupil dilation | Atropine, LSD, COCAINE, Amphetamines, psilocybin mushroom (hallucinogen), mescaline |
| MAOIs should be d/c before wellbutrin | discontinued 2 weeks prior to begininng treatment with bupropion |
| wellbutrin is used for | depression to quit smoking may cause seizures |
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