Pharmacology Ch 14-Exam 2

stimulant

ADD/ADHD are best treated by __________________ medications. This is the first-line drug therapy.

respiratory depression

Benzodiazepines cause _______________, which can be deadly when taking with other CNS depressants.

tapered

Benzodiazepines must be ______________ when ending drug therapy in order to decrease withdrawal symptoms and severity.

alcohol, or any other CNS depressant

CNS depression is associated with FGAs. Therefore, _________ should be avoided while taking these medications.

anticonvulsant

Carbamazepine is considered a(n) ______________________, but can also be used to treat bipolar depression as a mood stabilizer.

increased risk of serotonin syndrome and increased risk of neuroleptic malignant syndrome.

Combining SSRIs/SNRIs and atypical antipsychotics can cause what adverse reactions?

-schizophrenia -psychoses -delusional disorders -bipolar disorder -depression -emesis -Tourette syndrome -Huntington's chorea

Conditions treated with antipsychotic class medications

16-20 weeks

How long may it take for negative symptoms to improve after starting SGAs?

The three neurotransmitters serotonin, norepinephrine, and dopamine at CNS receptors.

It is hypothesized that depression is caused by deficiencies in what?

1.) nightmares 2.) sleep terrors 3.) sleep walking

Parasomnias include:

2

Stimulant medications are schedule ______________ controlled substances.

dizziness, sedation, & hypotension

The blockage of alpha 1-adrenergic receptors, induced by atypical antipsychotics, can produce which side effects?

p. 406

goal of treatment for MAOIs

typical antipsychotics

Another name for FGAs (first-generation antipsychotics)

atypical antipsychotics

Another name for SGAs (second-generation antipsychotics)

-orthostatic hypotension -sedation -cardiac arrhythmias

Anticholinergic effects related to FGAs

comorbid

Depression and anxiety are often ____________________ conditions, which makes their psychopharmacologic treatment oftentimes very similar.

1.) difficulty initiating sleep 2.) difficulty maintaining sleep 3.) early awakening

Dyssomnias include:

-acute dystonia (abnormal muscle contractions-repetitive involuntary twisting movements of neck, trunk, face, extremities) -Parkinsonian symptoms -shaking palsy -trembling palsy -akathisia (inner restlessness) -tardive dyskinesia (involuntary movements of facial muscles and tongue) -neuroleptic malignant syndrome (irreversible, toxicity)

Extrapyramidal symptoms (EPS) include:

~dopamine-2 (D2) ~acetylcholine ~histamine (H1) ~norepinephrine ~some muscarinic ~alpha-1 adrenergic

FGAs block which receptors?

-positive symptoms of psychosis -agitation -hyperactive behavior

FGAs reduce what behaviors?

dopamine-2 (D2)

FGAs work by blocking which receptors in the mesolimbic area of the brain?

Chronic pain condition that occurs when descending norepinephrine is deficient in the dorsal region of the brain.

Fibromyalgia

Drug Class: Phenothiazines: 1. Chlorpromazine 2. Perhpenazine 3. Trifluoperazine Drug Class: Antiemetic/antipsychotic: 4. Haloperidol

First Generation Antipsychotics (FGAs) and their drug class include:

positive

First-generation antipsychotics (FGAs) help decrease _______________ symptoms of Schizophrenia.

1. tricyclic antidepressants (TCAs) 2. SSRIs 3. SNRIs 4. monoamine oxidase inhibitors (MAOIs)

Four major types of antidepressant medications

1. remission of depressive symptoms and 2. prevention of relapse

Goals of treatment for TCAs include....

p. 403 (depression)

How do SSRIs work (neurotransmitter function)?

They aren't; they are very similar

How is the duration of treatment of SGAs and FGAs different?

can be delayed up to 2-4 weeks, may require dosage increase if no improvement by 6-8 weeks

How long does it take for symptoms to improve when starting TCAs?

as soon as 1 week; may continue to improve over the next 4-6 weeks after

How long does it take psychotic symptoms to improve after starting FGAs?

4-6 weeks

How long does it take to see some improvement after starting SGAs (in general)?

Why are MAOI and SSRI/SNRI concurrent use contraindicated?

Increased risk of Serotonin Syndrome; life threatening serotonin surge by inhibiting the breakdown and reuptake of serotonin. Wait 5 weeks to switch to/from one or the other.

Phenelzine

MAOI for depression that is linked to vitamin B6 deficiency

bipolar disorder/bipolar depression

Mood stabilizing drugs are used to treat ______________.

-lack of self care -lack of motivation -social withdrawal -agitation -poor judgement and sight -emotional withdrawal -poverty of speech -apathy -blunted affect

Negative symptoms of psychosis include:

Adverse reaction to first-generation antipsychotics with muscle rigidity, high fever, altered mental status (paranoia), wide swings of bp, excessive sweating, and exessive secretion of saliva.

Neuroleptic Malignant Syndrome

1.) antidepressants (3) 2.) centrally acting alpha 2 adrenergic agonists (2)

Nonstimulant drug classes (2) used to treat ADHD include:

These symptoms can begin 5-30 days after FGA drug therapy is started. Symptoms include: bradykinesia (slow movement and muscle rigidity), mask-like faces, tremors, rigidity, drooling, stooped posture, and shuffling gait.

Parkinsonian Symptoms

tyramine

Patients taking MAOIs are at risk of hyptertensive crisis. Because of this, patients who take these are instructed to refrain from eating/drinking _____________-rich foods and drinks, such as cheese and alcohol.

metabolic syndrome

Patients taking SGAs should always be closely monitored for signs and symptoms of ________________.

-hallucinations -paranoia -delusions -distorted thinking

Positive symptoms of psychosis include:

-FGAs less expensive -pts w/ inadequate response w/ SGAs may respond to FGAs -weight gain tends to happen less with FGAs than with SGAs -Both are available as injectable depot, which allows longer duration of effects

Positives of FGAs vs. SGAs

-schizophrenia and other psychotic disorders -acute mania and bipolar depression -maintenance of bipolar disorder -behavioral disorders -disorders associated w/ impulse control and agitation

SGAs can therapeutically treat what disorders?

1.) metabolic syndrome (weight gain) 2.) high blood glucose (and diabetes-due to weight gain and other factors)

SGAs have an increased risk of which two serious adverse effects?

Aripiprazole: partial dopamine agonist, 5-HT2 antagonist Asenapine: dopamine and 5-HT2 antagonist Clozapine: benzodiazepine Iloperidone: dopamine antagonist *only used for schizophrenia* Lurasidone: dopamine antagonist Olanzapine: thienobenzodiazepine, dopamine and 5-HT2 antagonist Paliperidone: dopamine antagonist Quetiapine: atypical antipsychotic Risperidone: dopamine antagonist Ziprasidone: dopamine/serotonin antagonist, 5-HT2 antagonist

Second-generation antipsychotic medications include:

negative AND positive

Second-generation antipsychotics (SGAs) help reduce ____________ symptoms of Schizophrenia.

-increased heart rate -appetite suppression -increased blood pressure -insomnia (if taken before bed)

Stimulant effects on the body include:

True; pregnant women or women who are attempting to become pregnant should be counseled about this.

T or F? Teratogenic effects are potential when pregnant women take MAOIs.

they have a significant side effect profile

TCAs are considered second-line drug treatment for depression because.....

norepinephrine, serotonin

TCAs block reuptake of _______________ and _____________ pumps in the synaptic space.

to offer partial or complete relief of symptoms (treatment); they do not cure psychotic disorders.

The goal of antipsychotic drug therapy is what?

lithium

The most common mood stabilizing medication is ____________________, and is considered the first-line treatment for bipolar disorder.

Serotonin, Norepinephrine, and Dopamine (all monoamine)

The three neurotransmitters involved with anxiety and depression include:

Selegiline

This MAOI can be used to treat Parkinson disease in low-dose. It is the only member of its lass that is also available as a transdermal patch for med administration.

Tranylcypromine

This MAOI is contraindicated in patients w/ low body weight or eating disorders (particularly anorexia).

1. Phenelzine 2. Selegiline 3. Tranylcypromine

Three MAOIs for depression:

1.) Mood stabilizers 2.) 1st generation antipsychotics 3.) 2nd generation antipsychotics

Three drugs classes that treat bipolar disorder include:

1. benzodiazepines and/or 2. SSRIs 3. SNRIs

Three types of medications anxiety responds well to (anxiolytic=antianxiety)

suppress the CNS

To treat sleep disorders, the main goal of drug therapy is to _______________.

serotonin, norepinephrine, histamine, muscarine, acetylcholine, and dopamine

Tricyclic antidepressants (TCAs) boost the availability of the neurotransmitters ______________, _____________, ____________, _____________, ______________, and _____________ in the brain.

norepinephhrine, serotonin

Tricyclic antidepressants work by blocking the _______________ reuptake pump and the _____________ reuptake pump in the synaptic space.

True

True or False? Adolescents and young adults (under 25 years) taking antidepressants should be routinely evaluated for the emergence of suicidal thoughts.

True

True or False? All antipsychotic agents should be prescribed at the lowest possible effective dose to reduce the possibility of side effects.

False; MAOIs are not CNS depressants. Most of their side effects and adverse reactions include symptoms of CNS stimulation (e.g. anxiety, insomnia, agitation, elevated mood).

True or False? MAOIs are considered CNS depressants and most of their side effects include symptoms of CNS depression.

True; they work on the same neurotransmitters. If these conditions persist, patients may require TCA drug therapy long-term (months to years).

True or False? TCAs are also beneficial for chronic pain and anxiety.

benzodiazepines and barbiturates

Two prescription drug therapies to treat sleep disorders are:

2-4 weeks

Upon starting taking the medication, how long does it take SSRIs to work effectively?

anticonvulstant; but can be used as a mood stabilizer to treat bipolar disorder

Valproic acid is considered what type of medication?

-control motor tics -use of obscene language & other symptoms related to the disorder

What benefits do FGAs provide for Tourette syndrome?

blocking of the hypothalamic D2 receptors creates an increased temperature set point and impairs cutaneous vasodilation, sweating, and other ways in which the body reduces its temperature.

What causes neuroleptic malignant syndrome (related to FGAs)?

benzodiazepines

What class of drugs is considered the first-line drug therapy for anxiety, and primarily acts on the CNS?

Selective Serotonin Reuptake Inhibitors (SSRIs)

What is the first line of treatment for a patient who has both anxiety and depression (or just depression)?

antihistamines and OTC sleep aids; can further depress CNS. alcohol and benzodiazepines should also be avoided or used with caution because of this.

What medications should be avoided/used with caution when taking in combination with SGAs, due to their CNS depression?

-dopamine-D2 -*strongly* blocks multiple serotonin receptors -norepinephrine -acetylcholine -alpha 1-adrenergic -at a lesser extent, muscarinic receptors in brain and histamine receptors

What receptors do SGAs block?

In acute episodes until control of bipolar symptoms is gained. After this, a mood spailizer or an SGA should be used for further treatment.

When/how would one use FGAs to treat bipolar disorder?

Clozapine

Which SGA carries a "black box" warning for seizures, myocarditis, agranulocytosis, unspecified resp/cardio effects, and increased mortality in elderly pts with dementia?

1. Paliperidone 2. Risperidone

Which SGAs are used to treat schizoaffective disorder?

SGAs; they reduce both positive and negative symptoms of psychosis, whereas FGAs only reduce positive.

Which antipsychotic medications, SGAs or FGAs, have been more commonly used since the 1990s, and why?

1. Aripiprazole: (s & bd) + depression, autism-related irritability 4. Paliperidone: (s & bd) + schizoaffective disorder 5. Quetiapine: (s & bd) + psychosis related to Parkinson disease, (in combination w/other meds, can treat major depressive disorder) 6. Risperidone: (s & bd) + schizoaffective disorder, autism related irritability

Which atypical antipsychotic medications can alternate disorders besides schizophrenia and bipolar disorder (s & bd), and what is it that they treat?

Olanzapine

Which atypical antipsychotic's principal side effects are weight gain and metabolic effects (hyperglycemia or diabetes)?

1. Clozapine 2. Iloperidone 3. Olanzapine

Which atypical antipsychotics ONLY treat schizophrenia?

1. Aripiprazole 2. Asenapine 3. Lurasidone 4. Paliperidone 5. Quetiapine 6. Risperidone 7. Ziprasidone

Which atypical antipsychotics are approved for treatment of mania/bipolar disorder?

1. Aripiprazole 2. Risperidone

Which atypical antipsychotics are used to treat autism-related irritability?

1. depression 2. bipolar disorder 3. neuropathic pain 4. panic disorder 5. obsessive-compulsive disorder

Which disorders are TCAs indicated for (5)?

-monoamine oxidase inhibitors (MAOIs) -tricyclic antidepressants (TCAs)

Which two drug classes are considered the second-line drug treatment for depression?

Compared to typicals (FGAs), they do not generally cause the same degree of kinesthetic side effects.

Why are SGAs called "atypical"?

This can increase serotonin levels, increasing the risk of serotonin syndrome. Both SSRIs and FGAs inhibit the reuptake of serotonin. (synergistic effect=same effect)

Why are SSRIs not warranted for use in a patient who takes FGAs?

They are the safest of all of the antidepressant medications, and they are the best tolerated by patients.

Why are SSRIs the first-line drug therapy for depression, and concurrent anxiety and depression?

The effects will directly oppose that of FGAs, which block dopamine receptors.

Why should patients taking FGAs NOT be advised to take medications that activate dopamine receptors?

it opposes the desired blockade of D2 receptors that SGAs produce because it is a D2 receptor agonist

Why would a patient taking an atypical antipsychotic not want to take Levodopa as well?

They offer long-acting efficacy, which can be useful in patients that either have memory problems and may forget to take oral medications. They may also be indicated for patients who are considered a great risk of harming self or others, and is nonadherent to taking the medication PO.

Why would an injectable depot form of an antipsychotic be preferred to an oral antipsychotic?

buspirone

_________________ is best used as an adjunct in the treatment of anxiety, and has mostly benign side effects. It is most often used for treatment-resistant anxiety disorders, and is not considered to be in any specified drug class.

p. 406

how do MAOIs work (neurotransmitters)

2-4 weeks; dosage increase may be required if the med is not helpful by 6-8 weeks

onset of action of MAOIs