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LMSW Pharmacologic Interventions

Terms in this set (74)

Antipsychotics
Used for treatment of schizophrenia and mania
Typical antipsychotic (older) HTP
Haldol (haloperidol)

Thorazine (chlorpromazine)

Prolixin (fluphenazine)

Mellaril (thioridazine)

Navane (thiothixene)

Stelazine (trifluoperazine)

Used to treat schizophrenia and psychotic symptoms
injectable antipsychotis
-Haldol D (Decanoate)
-Prolixin D
Give three examples of first generation/typical antipsychotics.
Haloperidol, chlorpromazine, prochlorperazine
What does Neuroleptics mean?
refers to the ability of a drug to cause a syndrome known as "neurolepsis"
what features do neurolepsis syndrome have?
Psychomotor slowing
Emotional quieting
Affective indifference
Dopamine antagonists
...
What are the main general side effect of typical antipsychotics?
Extrapyramidal effects
what is Agranulocytosis? what antipsychotic can cause it?
Clozapine can cause the symptoms. an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, and thus causing a neutropenia in the circulating blood
What extrapyramidal symptoms are seen due to using antipsychotics?
dyskinesias , akathisia, acute dystonic reactions tardive dyskinesia, Parkinsonism
What happens in acute dystonic reactions
involuntary parkinsonian movements or muscle spasms
What is akathisia?
State of restlessness
What happens in NMS and what is the cause?
Rigidity, confusion, autonomic dysregulation and pyrexia
Blockage of the nigrostriatal pathway
What is the late side effect of typical antipsychotics?
Tardive dyskinesia
What is neuroleptic malignant syndrome?
a life-threatening reaction that can occur in response to neuroleptic or antipsychotic medication

Symptoms: high fever, irregular pulse muscle rigidity
What kind of drug is dantrolene?
a postsynaptic muscle relaxant that lessens excitation-contraction coupling in muscle cells
What happens in tardive dyskinesia?
Pointless, involuntary and repetitive movements like lip smacking
What is the mechanism of action of typical antipsychotics and what is the main pathway affected?
the exact mechanism of action of antipsychotic drugs is unknown.

first-generation antipsychotics are D2 antagonists. reduce dopaminergic neurotransmission in the four dopamine pathways.
Atypical antipsychotics (newer) name 5 ARSCZ
Abilify

Risperdal

Seroquel

Clozaril--requires frequent blood test

Zyprexa
Whats the major drawback and potential side effects of older antipsychotics?
Tardive Dyskinesia (TD) is irreversible and causes involuntary movements of the face, tongue, mouth and jaw. Also tremor or muscle rigidity.
Side effects of antipsychotics
Dystonia
Akathisia
Tardive dyskinesia
Antipsychotics (neuroleptics) are used to treat
schizophrenia
Antipsychotics (neuroleptics) mainly address the ______________________ symptoms of schizophrenia
positive
Give four examples of atypical second generation antipsychotics.
Olanzapine, risperidone, cloazpine, quetiapine
What is the treatment of acute dystonia?
Procyclidine - anticholinergic agent
What medication is used to treat neuroleptic malignant syndrome?
Dantrolene
What is a breast side effect of typical antipsychotics?
Hyperprolactinaemia leading to lactation and gynaecomastia
What is the action of second generation antipsychotics? Which pathway is the main one affected?
block post-synaptic dopamine receptors particularly in the mesolimbic pathway
What are the main side effects associated with atypical antipsychotics?
Weight gain
Hyperglycaemia
Metabolic syndrome
Mood Stabilizers
Used to treat Bipolar Disorder
what are Anticonvulsants commonly used for? What mental illness can they be use with?
are a diverse group of pharmacological agents used in the treatment of epileptic seizures. They can be used to treat bi-polar as well.
Which of the second generation antipsycotic most often causes breast symptoms?
Risperidone
Can you get extrapyramidal side effects with second generation antipsychotics?
YES - so always explain them
What is the key side effect of clozapine?
AGRANULOCYTOSIS - must warn patients.
What motinoring is done for clozapine?
FBC prior to starting then weekly FBCs for four weeks and then monthly FBCs for duration of the treatment
Mood stabilizers LLDDT
Lamictal

Lithium--Blood work for toxic dose to kidney or thyroid

Depakote-check liver function

Depakene

Tegretol-check liver function

Can cause weight gain, regular blood work.
What drugs are used to treat bipolar disorder?
1. Lithium
2. Valproate 3. Carbamazepine 4. Lamotrigine
What are the symptoms of lithium toxicity?
Vision decreased, D and V, hypokalaemia, ataxia, tremor, dysarthria, coma
What are normal plasma levels of lithium? Above what level do you get signs of overdose?
Normal - 0.6-1
Overdose >1.5 = symptoms
What is the monitoring required for lithium?
Check levels 12 hours after any dose
At start - weekly until constant for 4 weeks
Monthly for 6 months
3 Monthly is stable
Can lithium, valproate and carbamazepine be prescribed during pregnancy?
No they are all teratogenic
What is the main side effect of lamotrogine in treatment of bipolar?
Maculopapular rash and SJS
What other non psych drugs can cause agranulocytosis?
Carbimazole
What pathway is effected when extra-pyramidal side effects are shown?
Nigrostriatal
Anticonvulsants
-Valproic Avid (Depakote)
-Gabapentin (Neurontin)
-Lamotrigine (Lamictal)
-Topiramate (Topomax)
-Carbamazepine (Tegretol)
Anticonvulsants are best for treating
atypical bipolar disorder, rapid cycling, mix bipolar disorders
This anticonvulsant is best for rapid cycling
-Valproic Avid (Depakote)
Most common anticonvulsant used
-Carbamazepine (Tegretol)
side effects of anticonvulsants
bone marrow, pregnancy problems, need to monitor blood
side effects of lithium
thyroid, kidney, need to consistently check blood levels
Lithium is best for treating
typical bipolar disorder, prevents manic episodes
Antidepressants: SSRIs
-Paroxetine (Paxil)
-Sertraline (Zoloft) OCD
-Escitalopram (Lexipro)
-Fluoxetine (Prozac)
-Fluvoxamine (Luvox) OCD
-Citalopram (celexa)
-Vilazodone (vilbryd)

Cannot overdose,expensive, loss in libido, ineffective after 1 year
What drug is prescribed first line for depression? What is its action?
SSRI - citalopram. Selective serotonin reuptake inhibitor.
SSRI's are used to treat?
anxiety, depression, OCD
What are the three most common SSRIs?
Citalopram, fluoxetine, sertraline
What are the main side effects of SSRIs?
1. GI upset and weight disturbance
2. Hypersensitivity
3. Hyponatramia/SIADH
4. Suicidal thoughts and behaviour
5. Lower seizure threshold and prolong QT interval - risk of epilepsy and arrythmias
6. Bleeding
What happens if you withdraw SSRIs too quickly?
Sudden withdrawal can cause tummy upset, flu like symptoms and sleeplessness
Atypical Antidepressants EWC
Effexor

Wellbutrin-sometimes prescribed in combination with SSRI

Cymbalta-recommended w/depression with somatic complaints
An atypical medicine for treating depression, that is not an SSRI or SNRI
Buporpion(Wellbutrin)
SNRI's
-Duloxetine (cymbalta)
-Desvenlafaxine (Pristiq)
Older class of drugs used to treat depression
MAOI's and Tricyclics
Tricyclic antidepressants
-Imipramine (Tofranil)
-Amitripyline (Elavil)
-Desipramine (Norpram)
-Nortriptyline (Pamelor)
-Doxepin (Aventyl Sinequan)

block reuptake of serotonin and norepinephrine. dry mouth.Not in common use due to cardiac monitoring issues
What is the action of tricyclic antidepressants and give an example?
Inhibits neuronal reuptake of serotonin and noradrenaline and block a wide array of receptors - muscarinic, histamine, adrenergic and dopamine D2. Amitryptyline.
What are the main side effects of tricyclics?
1. Antimuscarinic side effects - dry mouth, constipation, urinary retention and blurred vision
2. Sedation
3. Hypotension
4. Convulsions, hallucinations and mania
Other than depression what can tricyclics be prescribed for even though they are not licensed for this use?
neuropathic pain
In what situation are tricyclics particularly dangerous:?
Overdose - can cause severe hypotension, convulsions, arrythmias, coma and respiratory failure
MAOIs Monamine Oxidase Inhibitors
-Phenelzine (Wardil)
-Tranycypromine (Parnate)
-Isocarboxard (Marplan)

Not in common use as they require a special diet.
Benzodiazepines are used to treat?
anxiety
Benzodiazepines
-Diazepan (Valium)
-Lorazepam (Ativan)
-Alprazolam (Xanax)
-Clonazepam (Klonopin)
-Chlorazepate (Tranxene)
What drug is frequently used in overdoses?
benzodiazepines
Stimulants
-Methylphenidate (Ritalin, Metadate, Concerta, Daytrana)
-Amphetamine (Adderall)
-Dextroamphetamine (Dexedrine, Dextrostat)
stimulants are used to treat
ADHD
Used to Treat Alzheimer's Disease
-Donepezil (Aricept)
-Memantine (Namenda)
What eight factors should a mental status examination include?
1. Appearance
2. Orientation
3. Speech pattern
4. Affect/Mood
5. Impulsivity/Potential for harm
6. Judgment/Insight
7. Thought processes/Reality testing
8. Intellectual functioning/Memory
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