Term
| What is the precursor for DA, NE, and EPI? |
|
Definition
|
|
Term
| What receptors get activated by DA at high doses? |
|
Definition
|
|
Term
| What are the dopamine pathways and their functions? |
|
Definition
1) Mesocortical- higher order cognition
2) Mesolimbic- reward pathway
3) Nigrostriatal- movement
4) Tuberoinfundibular- prolactin |
|
|
Term
| FX of DA receptor antagonists |
|
Definition
| Worsening negative symptoms, relief of positive symptoms, extrapyramidal symptoms, hyperprolactinemia |
|
|
Term
| MOA of "typical" (first gen) antipsychotics |
|
Definition
| Block D2 receptors in brain |
|
|
Term
| What is the black box warning associated w/ all antipsychotics? |
|
Definition
| Increased risk of death in dementia patients |
|
|
Term
| Which FGA has the most anticholinergic/CV risks? |
|
Definition
|
|
Term
| Which FGA is also approved for bipolar and N/V tx? |
|
Definition
|
|
Term
| MOA of "atypical" (second gen) antipsychotics? |
|
Definition
| Block D2 as well as 5HT receptors |
|
|
Term
| For which SGAs should we use caution on the dose w/ smoking and fluvoxamine? |
|
Definition
| Clozapine/olanzapine (CYP1A2) |
|
|
Term
| For which SGA is concomitant use of 2D6 inhibitors like paroxetine, fluoxetine, and bupoprion an issue? |
|
Definition
| Risperidone, aripiprazole |
|
|
Term
| For which SGAs should we use caution w/ antifungals and other 3A4 inhibitors? |
|
Definition
| Quetiapine, Ziprasidone, aripiprazole |
|
|
Term
| What affect does dopamine have on prolactin release from the hypothalamus? |
|
Definition
|
|
Term
| Which SGAs are most likely to cause weight gain? |
|
Definition
|
|
Term
| Which SGAs are most likely to cause hyperprolactinemia? |
|
Definition
| Risperidone, paliperidone |
|
|
Term
| Which SGA is most sedating? |
|
Definition
|
|
Term
| Which SGAs cause the most QT prolongation? |
|
Definition
| Thioridazine, ziprasidone |
|
|
Term
| Which SGA starts to act like an FGA above 8mg |
|
Definition
|
|
Term
| Which SGA requires a dose adjustment when CrCl <80mL/min |
|
Definition
|
|
Term
| Which SGAs have higher risk of akathisia? |
|
Definition
|
|
Term
| Black box warnings for clozapine? |
|
Definition
| Agranulocytosis, myocarditis, seizure, orthostatic hypotension, death in dementia pts |
|
|
Term
| When can we start a pt on clozapine? |
|
Definition
| After they have failed at least 2 separate antipsychotic regimens |
|
|
Term
| Which is the most common form of EPS? |
|
Definition
| Akathisia (inner restlessness) |
|
|
Term
| Which EPS may be permanent? |
|
Definition
|
|
Term
|
Definition
| Abnormal Involuntary Movement Scale (AIMS) |
|
|
Term
| Which FGAs present the highest risk for EPS? |
|
Definition
| Haloperidol, thiothixene, fluphenazine |
|
|
Term
| Which SGAs present the highest risk for EPS? |
|
Definition
| Risperidone, paliperidone |
|
|
Term
|
Definition
| Diphenhydramine, cogentin, or propranolol for akathisia |
|
|
Term
| Tx for tardive dyskinesia |
|
Definition
1) D/C med
2) Switch med (FGA -> SGA)
3) adjuncts like clonazepam, gingko, amantidine, VMAT2 inhibitors |
|
|
Term
|
Definition
| VMAT2 (vesicular monoamine transporter 2) inhibitor -> lowers synaptic levels of monoamines |
|
|
Term
| Which VMAT inhibitors are approved in treating Huntington's? |
|
Definition
| Tetrabenazine, deutetrabenazine |
|
|
Term
| Which antipsychotics are available as long-acting injectables? |
|
Definition
FGA: haloperidole & fluphenazine
SGA: aripiprazole, olanzapine, risperidone, paliperidone |
|
|
Term
| First-line tx for manic or mixed bipolar? |
|
Definition
Valproic acid (VPA) + antipsychotic (APY)
Alternative: Li + APY |
|
|
Term
| First line tx for depressive bipolar? |
|
Definition
Li or lamotrigine
Consider Li + antidepressant (bupoprion/paroxetine) |
|
|
Term
| First-line for bipolar maintenance |
|
Definition
Li or VPA
Alternative: carbamazepine (CBZ) |
|
|
Term
| Therapeutic range for Li? |
|
Definition
|
|
Term
| What should we monitor in Li patients? |
|
Definition
Lithium levels
Insipidus (DI)
TSH
Hydration |
|
|
Term
| How can we treat Li overdose? |
|
Definition
|
|
Term
| What effect does Na status have on Li levels? |
|
Definition
| Inverse relationship: low Na can raise Li |
|
|
Term
| Which meds can raise Li concentration? |
|
Definition
| Thiazide/loop diuretics, NSAIDs, ACEs/ARBs |
|
|
Term
| Which meds can lower Li concentration |
|
Definition
| Osmotic diuretics, caffeine, theophylline, verapamil |
|
|
Term
| What is an alternative application for VPA? |
|
Definition
|
|
Term
| Which mood stabilizer is contraindicated in liver disease? |
|
Definition
|
|
Term
| Black box warnings of VPA? |
|
Definition
| Pancreatitis, teratogenic fx, hepatic failure |
|
|
Term
| You started a pt on VPA and now they're having MS changes. What could be the culprit? |
|
Definition
|
|
Term
|
Definition
| Rash/SJS/TENS, alopecia, weight gain, N/V/D, thrombocytopenia |
|
|
Term
| What is the proposed MOA of lamotrigine? |
|
Definition
| Blocks VG-Na channels, decreases presynaptic aspartate/glutamate |
|
|
Term
| What effect on lamotrigine level can OCPs have? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Which mood stabilizer can cause agranulocytosis? |
|
Definition
|
|
Term
| Proposed MOA of carbamazepine? |
|
Definition
| similar to lamotrigine; + blocks Ca influx through NMDA receptors -> lower Ca serum levels |
|
|
Term
| Which mood stabilizers can metabolize themselves (auto-induction)? |
|
Definition
| Lamotrigine, carbamazepine |
|
|
Term
|
Definition
|
|
Term
| Unique adverse fx of carbamazepine? |
|
Definition
|
|
Term
| Antipsychotic combo used to tx mood disorders? |
|
Definition
|
|
