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Pt care 7 Facts
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44
Biochemistry
Graduate
01/30/2019

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Term
SCHIZOPHRENIA DSM-V Diagnostic Criteria
Definition
2 or more of these in 1 month period (1 Sx must be 1,2, or 3)
1. Delusions 2. Hallucinations 3. Disorganized Speech 4. Grossly disorganize/Catatonic Behavior[muscular rigidity and mental stupor]
5. Negative symptoms
Term
2nd Generation antipsychotics better for_____
Definition
Negative symptoms of schizo
Term
DA Hypothesis
Mesolimbic
Definition
nucleus accumbens-Pos Sxs

involved in addiction
Term
DA Hypothesis
Mesocortical
Definition
frontal cortex-NEG Sxs
feeds back to Nac
Term
DA Hypothesis
Nigrostriatal
Definition
Motor control
Term
DA Hypothesis
Tuberoinfundibular and tuberohypophyseal
Definition
Dec prolactin release
Term
Serotonin Hypothesis
Definition
Too many 5HT2A/C rec in PFC
-Inhibs DA release to cause NEG Sxs
Term
Glutamate Hypothesis
Definition
Impaired NMDA receptors= Impaired cognition
Term
Neurodevelop Hypothesis
Definition
abnormal brain develop in fetus
Term
Inc incidenc in elderly & CV/Cerebrovascular side effect mechs of act are _____
Definition
Unknown
Term
Therapeutic efficacy in 1st and 2nd gen anti psychs
Definition
NONE
Term
1st gen antipsych MOA
Definition
D-2 lke rec antag
-Dec pos Sxs via NAC DA signals
-Block post syn D2 like re
-Neg Sxs worsen bc dec PFC signals
Term
1st Gen Antipsychs
Definition
Thioridazine, Haloperidol, Trifluoperazine
Chlorpromazine, Fluphenazine, Loxapine
Perphenazine, Pimozide, Thiothixene
Term
2nd Gen Antipsychs
Definition
Clozapine, Riperidone,Paliperidone
Iloperidone,Olanzapine,Quetiapine
Ziprasidone,Lurasidone,Asenapine
Term
2nd Gen Antipsychs have
Definition
Less sedation and cog impairment
way less mvmnt probs and prolactin SFX
-WORSE metabolicFX (wgt gn,insulin res,hyperlipid)
Term
2nd Gen Antipsychs MOA
Definition
5HT2 and D2 like blockade
-more PFC and Nac D3,4 Block than striatal D2
Term
CYP2D6 INTRXN
Definition
Chlorpromazine
Haloperidol
CLozapine
Risperidone
Term
CYP3A4 INTRXN
Definition
Haloperidol CLOZAPINE QUETIAPINE
Term
L-DOPA and anticholinergis inc side effect of
Definition
TD(Tardive Dyskinesia)= Continuous mouth and limb movements when awake
(Sxs Dec 2-5 years after Rx discontinued)
Term
Tardive Dyskinesia is a result of
Definition
D2 antagonism
Dec GABA striatonigral activity
Inc DA activity while mACH still blocked
Tx with Vmat-2 inhibs
Term
1st line Tx for Schizo
Definition
2nd Gen Antispychs
(Clozapine effective in 35-50% who dont respond to other antipsychs)
Term
Lower potency Antipsychs
Definition
-Bind D2 low affinity
-less EPS
-More H1,mACH,Alpha1 SFX
-ex: Chlorpromazine, Thioridazine
Term
High potency Antipsychs
Definition
Bind D2 receptor with High Affinity
-inc prolactin stuff
-ex:Haloperidol, Fluphenazine
Term
D-antagonist effects on Meolimbic and Mesocortical tract
Definition
Psychosis Relief
Term
D-antagonist effects on Nigrostriatal
Definition
Mvmnt disorders (parkonsonism,dystonias)
Term
D-antagonist effects on Tuberoinfundibular
Definition
Hyperprolactinemia,gynecomastia
Term
Tx for Pseudoparkonsonism
Definition
Benztropine

or AMANTADINE
Term
Tx for Acute Dystonia
Definition
Benztropine 2mg or Diphenhydramine 50mg IV or IM
Term
Tx for Akathisia
Definition
-Decreas or discontinue offending agent
-Propranolol 30-90mg/day
Term
Tx for Tardive Dyskinesia
Definition
Valbenazine (INGREZZA)V-mat2 inhibitor
Term
2nd Gen w/ significant EPS
Definition
Clozapine and Olanzapine
Term
CLOZAPINE RISKS limiting use
Definition
-Aganulocytosis 1% of pts
-Neutropenia 3% pts
Available only thorugh REMS
Term
Monitor these with 2nd Gen antipsychs
Definition
Lipids Personal and fam med Hx
HbA1c Waist/Wgt
Term
Longest lasting Injectable Antipsych
Definition
Invega Trinza (12 weeks)
Term
1st TXs for new antipsych
Definition
ZAR
Ziprasidone, Aripiprazole, Risperidone

If resistant try dif antipsych

If still not wrk try clozapine.
Term
TX for GAD
Definition
VD PEC
-BUSPAR,HYDROXYZINE, BDZ
Term
PANIC TX
Definition
BDZ + SSRI/SNRI
-V FEPS
Term
SAD TX
Definition
-V PS
-BDZs in Tx failure
Term
PTSD
Definition
PS(both short term,S is long)
Term
Appropriate duration Antidepressant in PTSD
Definition
8-12 weeks
Term
Sleep Nightmares in PTSD Tx with
Definition
Prazosin
Term
Angerin PTSD Tx with
Definition
Lamotrigine
Term
Intrusive thoughts/Hypervigilence in PTSD Tx with
Definition
Risperidone, Quetiapine
Term
OCD
Definition
-Higher doses than MDD
-FFPSC
2nd line = Clomipramine
3rd Line = Risperidone
Best outcomes is when paired with Behavioral Tx
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