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Form of drugs to pass blood barrier

Lipid soluble

3 ways meds act

Block, inhibit reuptake, or act on metabolism


increases activity


decreases activity

p450 system enzyme increased

decreased blood levels of the medication

Grapefruit juice

inhibits the isoenzyme which metabolize some antidepressants, antianxiety meds and anticonvulsants, raises plasma level of drug


reduce aggression, reduce psychotic symptoms, block dopamine...80% block causes EPS


sustained involuntary muscle contractions


twisting of the neck that can interfere with breathing


spasms of neck, causing it to bend backwards

oculogyric crisis

fixed upward stare, can only see whites of eyes.. seen with 1st generations

drug induced parkinsonism

cogwheeling, tremor, pill rolling of fingers, mask like facies, shuffling gait...can grab arm to see if it is shaking


not able to sit, need to keep moving

tardive dyskinesis

late onset, irreversible abnormal movements, lip smacking, tongue protrusion, foot tapping

Control EPS

artane, benadryl or congentin...must be taken

EPS meds side effects

Raise blood sugar and prolactin(milk discharge), dry mouth, blurred vision, constipation, urinary retention, paralytic ileus, orthostatic hypotension

Neuroleptic Malignant Syndrome

kills patients, high b/p and temp, diaphoresiss, muscle rigidity, increased CPK (late sign)

Reduces effectiveness of Antipsychotics


Antipsychotic effects

sedation, 2-8 weeks to act on hallucinations/delusions

1st generations antipsychotics

treat positive symptoms of schizophrenia, more likely to have EPS and cause orthostatic hypotension, avoid in elderly


skin rash if exposed to the sun, 1stgen


long acting oily form givenlong acting deep IM and last 2-4weeks, must stay 3 hours after injection, use oral first, 1st gen

2nd generation antipsychotics

treat positive and negative symptoms (lack of energy, interest,no talking) decrease dopamine and increase serotonin


serious side effect decrease WBC's so must do count weekly
2nd gen


orthostatic hypotension 2nd gen

zyprexa, seroquel

weight gain 2nd gen


need an EKG 2ng gen

3rd generation antipsychotic

blocks dopamine where it is to high and moderates dopamine in other areas


black box for suicide on elderly and adolescents, SIGECAPS, take 2-4 weeks to work

Dexamethasone test

positive when cortisol is above baseline, indicates endogenous depression


block reuptake of serotonin and norepinephrine, can be used to easily overdose, EKG must be done prior, alcohol is cardiotoxic


increase dopamine and tyramine. long acting metabolics, wait 2 weeks before starting another antidepressant, low tyramine diet, no demerol (serotonin syndrome)


lowest risk of birth defects, can't take with MAOI


most potential for sexual side effects

Serotonin Syndrome

restlessness, unstable vitals, increased B/P seizures, hyperthermia collapse of cardiovascular systems

Manic switch

bipolar patient presents as depressive and is given an antidepressants, agitation, loss of inhibitions, delusional thinking


need salt and water, may cause problems with thyroid or kidney, narrow therapeutic window check blood, 2-3 weeks for therapeutic level 1-1.5

lithium toxicity

vomiting, diarrhea, ataxia or loss of coordination, tremor or muscle weakness, drowsiness and seizures


stabilize mood, do not stop abruptly


rash may be first sign of Steven Johnson's syndrome anticonvulsant


increase Gaba,decrease anxiety, cause respiratory depression, temporary relief, not good for addicts, don't stop abruptly due to convulsion


good for addicts or patients with dual diagnosis, takes 2-4 weeks to work


potentiate GABA, Reticular activating system is responsible for arousal and sleep regulation, side effects are lapses in memory

Acetycholinesterase Inhibitors

raise ACh levels, treatment of dementia


improve attention, decrease distractibility, hyperactivity and impulsivity, used for ADHD, not good for substance abusers, do not take after 4pm, take with food

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