pharm psych goshko info.txt

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pharm psych goshko info.txt
2012-10-26 23:25:26
pharm psych goshko info

pharm psych goshko info.txt
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  1. lithium MOA
    unclear. possibilities include affecting second messengers/altering intracellular signaling, neuroprotective/antiapoptitic, alteration of neurotransmitter metabolism, or alteration of sodium transport across membrane of nerve/muscle cells.
  2. lithium kinetics
    narrow therapeutic index. takes 1-3 weeks to start working (like pretty much all other psych drugs).
  3. lithium indications
    bipolar, acute mania, resistant depression (adjunct)
  4. lithium contraindications
    renal/CV disease, dehydration/sodium depletion, pregnancy/breastfeeding (Cat D). black box warning for lithium toxicity (treat only if you can monitor it).
  5. lithium interactions
    lithium + diuretics (both Na and Li are monovalent cations, so both get reabsorbed, can lead to toxicity).
  6. lithium side effects
    weight gain, nephrotoxicity, tremor (can be helped by co-prescribing propranolol).
  7. FGA MOA
    Antagonize D2 receptors. In the mesolimbic tract, this results in a relief of psychosis (however in the nigrostriatal tract, this can result in movement disorder SE).
  8. FGA kinetics
    highly lipophilic. haloperidol, chlorpromazine, and thioridazine have active metabolites. Injectables: IM formulations faster acting (onset <1h), depot formulations are long-acting (duration of 3 weeks).
  9. FGA indications
    psychosis. haloperidol acute agitaition/delerium/mania. haloperidol and pimozide Tourette's. haloperidol and chlorpromazine intractable hiccups. chlorpromazine and prochlorperazine nausea and vomiting (immediate).
  10. FGA contraindications
    not approved for dementia-related psychosis (black box). thioridazine and droperidol black box for proarrhythmic effects (QT prolongation).
  11. FGA side effects
    EPS and hyperprolactemia as a result of D2 anatagonism. Antagonism of other receptors includes muscarinic (dry mouth, constipation, blurred vision), histamine (sedation, haloperidol is the least sedating), alpha1 (hypotension).
  12. Extrapyramidal Symptoms
    parkinsonian (bradykinesia, rigidity, resting tremor), dystonia (muscular spasms), akathisia (feeling of motor restlessness), tardive dyskinesia (involuntary muscle movements, sometimes irreversible).
  13. SGA MOA
    Antagonize dopamine and serotonin receptors (specifically 5HT2A). Better at treating "negative" symptoms than FGAs.
  14. SGA indications
    schizophrenia, bipolar, depression (adjunct). clozapine resistant schizophrenia or suicide prevention. rispiradone irritability in autistic kids. HOWEVER, about 60% of their use is off-label (no effect on insomnia, even though it is frequently used there).
  15. SGA contraindications
    clozapine black box warning for agranulocytosis (restricted distribution, CBC/ANC needed to dispense, 4wks at a time). antipsychotics in general increase stroke and mortality risk in elderly dementia pts, so save them for the really bad ones.
  16. SGA side effects
    weight gain/metabolic effects (worse c olanzapine, less so c aripiprazole), QT prolongation (worse c geodon). Lower likelihood of EPS than the FGAs (blockade of serotonin may lead to more dopamine release?). aripiprazole has the best tolerability profile, clozapine has the worst.
  17. quetiapine dosing
    schizophrenia 150-750mg/d div BID-TID; bipolar 200-400mg/d div BID
  18. aripiprazole dosing
    schizophrenia 10-15mg qd
  19. olanzapine dosing
    schizophrenia 10mg qd
  20. SGA kinetics
    aripiprazole is available as an injection (acute tx of agitation associated c schizophrenia/bipolar).
  21. olanzapine
    olanzapine depot (Zyprexa Relprevv) has a black box warning for post-injection delerium/sedation syndrome, pts should be observed for 3 hrs after each injection (restricted distribution).
  22. Benzos MOA
    Enhances the effects of GABA at the GABA-A receptor. This has a sedative, hypnotic, and anxiolytic effect.
  23. non-BZ hypnotics MOA
    also work via enhancement of GABA, however they bind to a different subunit than the traditional benzos. The exception in ramelteon, which is a melatonin receptor agonist
  24. short acting BZ
    triazolam (most likely to develop dependence/withdrawal sx)
  25. intermediate acting BZ
    alprazolam and lorazepam
  26. long acting BZ
  27. quick onset BZ
    alprazolam and diazepam (most likely to be abused)
  28. best BZ for the liver
    lorazepam, oxazepam, temazepam
  29. Benzos indications
    sedation, insomnia, acute seizure tx, EtOH withdrawal, muscle relaxation. best for short-term use.
  30. Benzos contraindications
    pregnancy/lactation (Cat D). new black box for strange sleep-related behavior and severe allergic reactions (as early as the first dose).
  31. Benzos side effects
    respiratory depression, amnesia (may be beneficial).
  32. alprazolam dosing
    anxiety 0.25-0.5mg TID
  33. clonazepam dosing
    panic disorder 0.5-2mg BID
  34. diazepam dosing
    anxiety 2-10mg BID-QID
  35. lorazepam dosing
    anxiety 2-6mg/d div BID-TID
  36. CNS stimulants MOA
    increase levels of dopamine and norepinephrine in the synapse by enhancing chatecholamine release, inhibiting reuptake, and inhibiting MAO. Increased dopamine in prefrontal cortex thought to be the reason it helps in ADHD, however increased dopamine in the nucleus accumbens leads to euphoria and helps explain why they are abused.
  37. CNS stimulants indications
    ADHD, narcolepsy
  38. methylphenidate dosing
    pediatric ADHD 18-54mg qam; adult ADHD 18-72mg qam
  39. CNS stimulants kinetics
    ProCentra is a solution, 5mg/5mL. Vyvanse is dextroamphetamine bound to lysine, gets cleaved off in gut (no high if you snort/inject it).
  40. atomoxitine
    atomoxitine (Strattera) is a nonstimulant indicated for ADHD. Likely not as effective, but may have less side effects. black box for suicidality.
  41. CNS stimulants side effects
    sudden cardiac death, psychosis, abuse (black box), seizures, growth suppression (long term use). ???
  42. CNS stimulants contraindications
    hyperthyroidism, hypertension, tics, gluacoma, drug/alcohol abuse, known cardiac defects, bipolar disorder, seizure hx/risk. ?????
  43. CNS stimulants interactions
    CNS stimulants + MAOI (additive effects). others ???