1What term defines what the body does to a drug?
Pharmacokinetics
2What term defines what the drug does to the body?
Pharmacodynamics
3What is one factor that is known to be highly influential in response to a medication and the potential side effects that a pt may experience?
Genetics
4A drug that stimulate a specific biologic activitity of the receptor is known as?
Agonist
5A drug that inhibits biologic activity is known as?
antagonist
6What is a partial agonist?
A drug that is not capable of fully activating a specific receptor
7What enzyme does Lithium inhibit?
Inositol-1-phosphate
8Most medications that treat psychosis have the ability to block what receptor?
D2
9What neurotransmitter does Ketamine target?
Glutamate
10What antibiotic might have antidepressant effects for some pts?
minocycline
11What receptors are blocked with TCAs that can cause some of the most common side effects from this class of medications?
Muscarinic acetylcholine receptors
Histamine receptors
12What causes nausea and sexual dysfunction with use of SSRIs?
Blockade of serotonin reuptake
13What receptor blockade can lead to the EPS symptoms associated with use of antipsychotics?
D2
14The agnoist action of benzo receptors might lead to what symptoms?
Ataxia
Sleepiness
15What is true about weight when taking a SSRI?
Wt loss may occur at first but over time reversal occurs and wt is gained
16What serious adverse side effect is assoicated w/ clozapine?
agranulocytosis
17What serious adverse side effect is assoicated with lamotrigine?
Steven Johnson Syndrome
18What is one serious complication with DRAs (dopamine receptor atagonists)?
Tardive dyskinesia
19What is the black box warning associated with all antidepressants?
>risk of suicidality during the first few months of treatment for individuals <24 years of age
20What are the symptoms of parkinsonism induced by neuroleptics?
muscle stiffness
cogwheel rigidity
shuffling gait
stooped posture
drooling
tremor may be similar to an essential tremor vs that of a pill-rolling one that is linked to Parkinson's disease
21How is the "rabbit syndrome" defined?
Tremor that affects the lips and perioral muscles
22When would parkinsonian adverse effects typically occur?
During the days 5-90; elderly females are at highest risk of developing
23How is parkinsonism treated?
Cogentin (benztrophine)
Symmetrel (amantadine)
Benadryl
Stop anticholinergic after 4-6 weeks to assess if features return
After stopping the antipsychotics, symptoms can last up to 2 weeks and up to 3 months in elderly
24What is the treatment for neuroleptic syndrome?
dantrolene
bromocriptine
amantadine
25What antipsychotic drugs are least likely to cause neuroleptic malignant syndrome?
those w/ anticholinergic effects
26What term describes brief or prolonged contractions of muscles that result in obviously abnormal movements or postures?
Dystonia
27What medications can be used to treat dystonia or extrapyramidal disorders?
Anticholinergics: benztropine, biperiden, procyclidine, trihexyphenidyl, & orphenadrine
Antihistamines: Benadryl, amantadine
Beta Blockers: propranolol
clonidine
Benzos: clonazepam, lorazepam, busipirone, vitamin E
28What is the term to describe a subjective and/or objective feeling/sign of restlessness?
Akathisia
29What are examples of akathisia?
sense of anxiety
inability to relax
jittery
pacing
rocking motions while sitting
rapid alteractions of sitting & standing
30What is one factor about prognosis if a pt develops akathisia?
Poor treatment outcomes may occur
31What are the 3 steps assoicated with treating akathesia?
1) reduce doseage of offending rx
2) attempt tx w/ appropriate drugs
3) consider changing the rx
32What are the possible tx options for akathisia?
Beta blockers
anticholinergics
benzos
Periactin (cyproheptadine)
33What is the term used to describe a delayed effect or antipsychotics that has an onet after about 6 months of treatment and involves abnormal, involuntary, irregular choreoathetoid movements of the muscles of the head, limbs, and trunk?
Tardive dyskinesia
34What are the most common movements associated with TD?
perioral movements (darting, twisting, protruding movements of the tongue)
chewing and lateral jaw movements
lip puckering
facial grimacing
finger movements & hand clenching
tortocollis, retrocollis, trunk twisting, and pelvic thrusting
**often exacerbated by stress and disappear during sleep
35What are the 3 basic approaches to TD treatment?
1) prevention
2) diagnosis
3) management
36How is TD most preventable?
Use of antipsychotic medication only when indicated & at the lowest effective dose
37What antipsychotic has the lowest risk of TD?
clozaril (low affinity to D2 receptors & high affinity to 5HT2)
38What screening tool is essential to use when a pt is on an antipsychotic medication?
AIMS
39What is common about TD symptoms when the dopamine receptor agonist is withheld?
Exacerbation of symptoms
40What should be done once TD is identified?
Reduce dose of antipsychotic or consider stopping it
Switch to clozapine or newer SGA
Consider prescribing Lithium, Tegretol, of benzos if pt cannot continue antipsychotic to control movements & psychosis
Ingrezza is approved for treatment of TD
41What psychiatric medications can cause tremor?
lithium
stimulants
antidepressants
caffeine
valproate
42If a pt develops a tremor what are the treatments?
Reduce dose to lowest possible
Minimize caffeine intake
Take psychiatric drug at HS
Consider propranolol
43What is nocturnal myoclonus?
Abrupt contractions of the leg muscles during sleep (pt lacks subjective awareness of this & is often reported by partner)
44What is the treatment for nocturnal myoclonus?
benzos
levodopa
quinine
45What is restless leg syndrome?
Subjective feeling of deep sensations creeping inside calves when sitting or lying down (rarely painful)
Can be relentless & cause an irresistible urge to move legs & can interfere w/ falling asleep
46What is the treatment for RLS?
Movement
Massage
ropinirole
pramipexole
benzos
propranolol
valproate
carbamazepine
47How is somnolence best managed?
Adjust dose or timing of Rx
Switch to alternative Rx
+ stimulant or modafinil to treatment
48What SGA most closely resembles a FGA and has >risk of movement disorder side effects?
risperidone
49What SGA can cause severe akathisia?
Abilify
50What neurotransmitters are related to weight gain associated with psychotrophic medications?
Histamine
Serotonin
51What is one medication that may help to combat weight gain associated with use of psychiatric medications?
Glucophage
52What medications are closely linked to insulin resistance?
valproic acid
olanzapine
53What antipsychotics may notably cause weight gain?
clozaril
olanzapine
54What is often true about weight loss with use of a SSRI?
May occur initially but wt is often regained within the first few months of tx
55What antidepressant may contribute to weight loss that can be sustained?
Wellbutrin
56What antiepileptic medications may help w/ wt loss?
topiramate
zonisamide
57What antipsychotics carry the greatest risk for glucose abnormalities?
clozapine
olanzapine
58What medications may cause hyponatermia especially in elderly patients?
SSRIs
Trileptal (oxcarbazepine)
59What psychiatric medications may contribute to cognitive impairment?
benzos
60What psychiatric medications may cause memory impairment or word-finding difficulties?
SSRIs
lamotrigine
topiramate
gabapentin
lithium
TCAs
bupropion
61What class of medications can worsen memory?
Anticholinergics
62What psychiatric medications may cause severe sweating?
TCAs
SSRIs
venlafaxine
63What are treatment options for severe sweating linked as a side effect to psychiatric medications?
Hytrin
Ditropan
64What psychiatric medications affect BP and cardiac conduction?
TCAs
phenothiazines
65What medication is most commonly associated w/ torsades de pointes?
thioridazine
66What is one drawback to using Geodon (ziprasidone)?
Prolonged QT
67What psychiatric medications are most highly associated w/ Steven Johnson Syndrome?
Tegretol (carbamazepine)
Lamictal (lamotrigine)
68What medications may cause dissociative-like-states (sleepwalking, binge eating, aggressive outbursts, & night driving w/o awareness of activity)?
Sedative hypnotics: ambien, lunesta, restoril, sonata
69What psychiatric medication could provide a suicidal pt w/ a lethal dose w/ just a month supply?
TCA
70How is an overdose w/ lithium or valproic acid treated?
Hemodialysis
71____ is the effects of drugs on the plasma concentrations of eachother.
Pharacokinetics
72____ is the effects of drugs on the biologic activities of each other.
Pharacodyamics
73What medication interactions could alter the kidney function and impact lithium levels?
NSAIDs
ACE Inhibitors
Thiazides
74What medical conditions can present as depressive symptoms?
Several but notably:
Thyroid disease
Sleep apnea
75What are the benefits and draw backs about providing details of potential adverse effects or side effects?
Pro: < discontinuation
Con: > reports of side effects
76How is effective dosing achieved?
Trial and error; due to several factors that influence drug efficacy (metabolism, comorbid conditions, other medication use, & genetics)
77____ of a drug refers to the relative dose required to achieve specific effects, not to its efficacy.
potency
78What are the risks associated w/ use of subtherapeutic doses or incomplete trials?
> risk of side effects w/o providing > probablity of therapeutic benefit
>risk exists w/ underdosing than overshooting the recommended dose range
79What psychotrophic medications can be used PRN?
Those treating insomnia, agitation, or situational anxiety
80When should high-potency benzos be used?
As part of a regular schedule to prevent panic attacks
81When can a SSRI be used intermittently?
Treatment of PMDD
Take Rx during the 2 week luteal phase of the menstrual cycle
82What are some baseline diagnostics that should be obtained prior to treatment?
Labs: CBC, CMP, Lipid (antipsychotics), TSH
EKG: for evaluation of QT
Vital Signs: BP, Pulse, Ht/Wt/BMI, waist circumference
83What is the overall goal of treatment for psychiatric conditions?
Increase function; remission is often limited in many conditions
84When should the clinician prepare for treatment failure?
At the initiation of therapy
85What should be done if there are repeated drug failures?
Reassessment:
Is dx correct?
Noncompliance, medical condition, substance use?
Is pt experiencing adverse effects of treatment?
Is the appropriate dose prescribed for sufficient length of time?
86____is the need, over time, to use increased doses of a drug to maintain clinical effect.
Tolerance
87____ is when sensivity to a drug effect increases over time and produces more pronounced effects as treatment progresses.
Sensitization
88What is true about withdrawal symptoms for medications that are abruptly stopped?
The shorter the half life = > withdrawal symptoms
89What SSRI is least likely to produce discontinuation symptoms?
fluoxetine (r/t long half life)
90What SNRI is difficult to stop abruptly?
Effexor
91What SSRI is difficult to stop abruptly?
Paxil (paroxetine)
92What is the most notable difference between FGA and SGA?
Lower risk of EPS
Broader spectrum of action
Significant effects on both dopamine and serotonin systems
93What is one dx that all SGAs treat?
schizophrenia
103Symbyax
olanzapine + fluoxetine
108What is the warning label associated with all SGAs?
Monitor for weight gain, >glucose, hyperlipidemia (metabolic syndrome)
Assess BMI
Waist circumference
BP
Fasting glucose
Fasting lipid profile
109What SGA is not considered 1st line treatment?
clozapine r/t side effect profile
110What receptors do SGAs block?
D2
111What differentiates SGAs from FGAs when considering neurotransmitters?
> ratio interactions w/ serotonin receptor subtypes (esp. 5HT2A)
112What are other indications for SGAs aside from schizophrenia?
Tx of:
schizoaffective disorder
acute mania
adjunct for tx resistant depression
adjunct for MDD tx
PTSD
anxiety
behavioral disturbances w/ dementia (*caution FDA black box warning r/t > risk of death)
113What symptoms of psychosis are better treated w/ SGAs then FGAs?
Negative
114What adjunct to clozapine can >effectiveness?
risperidone
115What SGAs are approved from the maintenance tx in bipolar disorder as either monotherapy or adjunctive therapy?
aripiprazole
olanzapine
quetiapine
quetiapine XR
116True or False: All SGAs augment antidepressants in the acute management of major depression.
True
117What FDA approved combination is used for treatment resistant depression and acute bipolar depression?
olanzapine & fluoxetine
118What class of medications is effective for treating agfression or violent behaviors?
SGAs
119What SGAs are effective in treating aggression and self-injury in children?
risperidone
olanzapine
120What SGAs can be augmented with stimulants used to treat ADHD with comorbid ODD or conduct disorder?
risperidone
olanzapine
121What class of medication can be used to <risk of suicide and water intoxication in pts w/ schizophrenia?
SGAs
122What is risperidone indicated for?
acute and maintenance schizophrenia ages 13+
short-term tx of acute mania or mixed episodes of BPI 10+
combination w/ lithium or valproate for short-term tx of acute mania or mixed episodes of BPI
irritability w/ autism 5+
123What is the timing of the peak plasma level of risperidone?
1 hour
124What is the half life of risperidone?
20 hours (qd dosing)
125What is the usual dose of risperidone?
1-2mg at HS
126What is the potential side effect associated w/ dosing risperidone >6mg/day?
>EPS risk (side effects are dose dependent w/ this Rx)
127What labs need assessed while taking risperidone?
CBC
CMP
Lipid
Prolactin
128What side effect of risperidone is greatly increased with concurrent use of a SSRI?
>prolaction leadingto galactorrhea & gynocomastia
129What is paliperidone indicated for?
Acute/maintenance of schizophrenia
Acute tx of schizoaffective disorder as monotherapy or an adjunct to mood stabilizers or antidepressants
130How many days after starting paliperidone is there a steady state concentration?
4-5 days
131What is the recommended dose of paliperidone?
6mg PO AM
132What is the max dose of paliperidone?
12mg/day
133What are the side effects w/ paliperidone?
>sensitivity to temperature extremes
prolonged QT
orthostatic hypotension
tachycardia
somnolence
akathisia
dystonia
EPS
parkinsonism
134What is olanzapine indicated for?
schizophrenia
monotherapy for acute tx of manic or mixed episodes associated w/ BPI
maintenance of BPI
adjunct to lithium or valproate for BPI
combo w/ fluoxetine for tx of depressive episodes associated w/ BPI or tx resistant depression
135What is the timing of the peak plasma level of olanzapine?
5 hours
136What is the half life of olanzapine?
31 hours (qd dosing)
137What is the starting dose for olazapine?
5-10mg
138True or False: Olanzapine side effects are dose dependent.
True
139What is the recommended IM dose of olanzapine to hlep w/ acute agitation w/ schizophrenia or bipolar disorder?
10mg **do not coadminister benzos
140What is essential to communicate to staff giving olanzapine ER injectable?
Before administering the injection, aspiration of the syringe for several seconds to ensure no blood return is noted. If given into a ruptured vessel, postinjection delirium sedation syndrome may develop.
Observe pt for 3 hours after injection in the facility
141What substance can increase olanzapine absorption by more than 25%?
Alcohol
142What is the most common side effect with olanzapine?
Wt gain (> than most SGAs)
143What is quetiapine indicated for?
schizophrenia
acute tx of manic episodes w/ BPI
monotherapy for acute tx of depressive episodes associated w/ bipolar disorder
maintenance tx of BPI as an adjunct to lithium or divalproex
adjunct to antidepressants for tx of MDD
144What other antipsychotic is quetiapine most closely related to?
clozapine
145What is the timing of the peak plasma concentration of quetiapine?
1-2 hours
146What is the half life of quetiapine?
7 hours (BID or TID dosing)
147What common side effect of antipsychotics is quetiapine not associated with?
EPS
148What is the starting dose of quetiapine?
25mg BID
149Patients on high doses of quetiapine need what monitoring?
EKG
150What is the recommended dose of quetiapine if using to treat insomnia off label?
25-300mg
151When should quetiapine XR be given?
3-4 hours before bedtime
152What antiepileptic increases quetiapine levels significantly?
Phenytoin
153What other medications should be avoided concurrently w/ quetiapine?
Any medication that >QT interval
154What medications can cause prolonged QTc outside of psychiatric medications?
Antiarrhythmics (quinidine, procainamide, amiodarone, sotalol)
Antibiotics (gatifloxacin, moxifloxacin)
Other: (pentamidine, levomethadyl acetate, methadone)
155What pts should avoid using quetiapine?
Those w/ a h/o cardiac arrhythmias (bradycardia)
Pts w/ hypokalemia or hypomagnesemia
Concurrent use w/ other Rx that can cause prolonged QTc interval
Presenc of congenital prolongation of QT interval
156What are the common side effects associated w/ use of quetiapine?
somnolence
postural hypotension
dizziness
*often transient & respond to gradual titration of dose
rare: >prolaction/wt
157What medication is useful for Parkinson's psychosis?
quetiapine
158What is ziprasidone indicated for?
schizophrenia
monotherapy for acute treatment of manic or mixed episodes of BPI
adjunct to lithium or valproate for the maintenance of BPI
159What is the timing of the peak plasma concentration of ziprasidone?
2-6 hours
160What is the halflfe of ziprasidone?
5-10 hours (BID dosing)
161What is primary adverse effect associated w/ use of ziprasidone?
Prolonged QT interval (marked)
162What are the benefits of using ziprasidone?
No wt gain or > prolactin levels
163Which SGA is a potent 5HT2A antagonist?
aripiprazole
164What is one unique feature of aripiprazole regarding neurotransmitters?
D2 antagonist but can act as a partial D2 agonist; works as a modulator rather than a "blocker" & works on both pre/post synaptic autoreceptors to address excessive limbic dopamine activity & decreased dopamine in the frontal/prefrontal areas
165What is aripiprazole indicated for?
schizophrenia
acute mania
augmentation of antidepressant agenents in MDD
166What is the timing of the peak plasma concentration of aripiprazole?
3-5 hours
167What is the half life of aripiprazole?
75 hours (qd dosing)
168What should be considered when prescribing aripiprazole to older adults?
Clearance is reduced
169Is breastfeeding safe w/ aripiprazole?
Known excretion in breast milk so not advised.
170What is one negative side effect associated w/ use of aripiprazole?
Orthostatic hypotension
171What childhood conditions can be treated w/ aripiprazole?
ODD or conduct disorder
172What medications can increase aripiprazole concentrations?
ketoconazole
fluoxetine
paroxetine
quinidine
173What medications can reduce aripiprazole concentrations?
carbamazepine
valproate
174WHat is the starting dose of aripiprazole?
10-15mg/day (5mg > chance of tolerability)
175What are the common side effects of aripiprazole?
headache
somnolence
agitation
dyspepsia
anxiety
nausea
176What pt would likely not benefit from aripiprazole?
One that is agitated, restless, or has trouble sleeping (is an activating SGA)
177What are the benefits of using aripiprazole?
<risk of wt gain, not significant impact on glucose, little to no > prolactin levels or QT prolongation
178What is asenapine indicated for?
Acute schizophrenia or manic/mixed episodes in BPI w/ or w/o psychosis
179What is one advantage of asenapine?
Low anticholinergic effects
180What is the preferred route of administration for asenapine?
Sublingual
181What is the timing for peak concentration serum levels of asenapine?
1 hour
182What pt education needs provided for a pt using asenapine?
Place tab under tongue
Do not swallow it
Do not eat or drink anything for 10 minutes after taking it
183What is the max dose of asenapine?
10mg BID
184What are the side effects of asenapine?
somnolence
dizziness
EPS (not akathisia)
wt gain
prolonged QTc interval
>prolactin
185What is the timing for the peak plasma serum concentration for clozapine?
2 hours
186What is the halflife of clozapine?
12 hours (qd or bid dosing)
187What is the max dose of clozapine?
900mg/day
188What is the typical dose of clozapine?
25mg qd or bid
189What is the major risk consideration w/ clozapine?
aganulocytosis
190What medication should not be combined with clozapine if a pt has a h/o neurleptic malignant syndrome?
Lithium
191WHat medications increase serum concentrations of clozapine?
risperidone
fluoxetine
paroxetine
fluvoxamine
192WHat are side effects associated with clozapine?
sedation
dizziness
syncope
tachycardia
hypotension
EKG changes
nausea
vomiting
fatigue
wt gain
GI symptoms
anticholinergic effects
subjective muscle weakness
193What is one adverse side effect that occurs early in treatment w/ clozapine?
Sialorrhea (hypersalvation)
194What medical condition should be screened for prior to administration of clozapine?
Seizure disorder
195What is the lab monitoring required to prescribe clozapine?
Weekly CBCs for 6 mo
After 6 mo if remain normal, every 2 weeks
196When should clozapine be discontinued?
WBC <3 or granulocyte count <1.5
197What cardiac condition can develop with use of clozapine?
Myocarditis: chest pain, shortness of breath, fever, or tachypnea
198What is iloperidone indicated for?
schizophrenia in adults
199What is the timing of the peak plasma concentration of iloperidone?
2-4 hours
200WHat is the major side effect associated w/ iloperidone?
Prolonged QT & may be associated w/ arrhythmia & sudden death
201What risk factors should be screened for when considering treatment with iloperidone?
CVD
hypokalemia
hypomagnesmia
bradycardia
congential prolongation of QT interval
202What are common side effects assoicated w/ use of iloperidone?
dizziness
dry mouth
fatigue
sedation
tachycardia
orthostatic hypotension
203How is iloperidone prescribed?
Slow titiration and comes in a titration pack for initial dosing
204What is lurasidone indicated for?
schizophrenia
205What are the side effects associated w/ lurasidone?
somnolence
akathisia
nausea
parkinsonism
agitation
206What medications should not be given concurrently w/ lurasidone?
ketoconazole
rifampin
207What is the starting dose of lurasidone?
40mg daily
208What is the max dose of lurasidone if a pt has renal insufficiency?
80mg daily
209What is lumateperone indicated for?
schizophrenia
bipolar disorder (limited data)
210What is the max dose of lumateperone?
42mg
211If a pt does not respond fully to one SGA, what should the clinician do next?
Try a different SGA after a trial of at least 4-6 weeks but some data suggests waiting up to 8 weeks for full benefit
212How should a SGA be restarted if a pt has stopped the medication for >36 hours?
Resume same SGA at the initial starting dose and titrated back up to the last tolerated dose
213What is one side effect that may occur when stopping olazanpine or clozapine?
cholinergic rebound symptoms (can be avoided w/ tapering off)
214What are the symptoms of cholinergic rebound?
sweating
excessive salivation
nausea/vomiting
flushing
diarrhea
hyperactivity
215What preliminary historical information should be obtained from a pt or a family member prior to starting an antipsychotic medication?
H/O:
blood disorders
seizure disorders
CVD
hepatic & renal disease
drug abuse
216What vital sign assessment should be obtained before starting an antipsychotic?
Orthostatic BPs
217WHat diagnostics should be obtained before starting an antipsychotic?
EKG
CBC
CMP
TSH
218What is the recommended practice for transistioning a pt from a FGA to a SGA?
Taper off the FGA while titrating up the SGA
219What SGAs lack anticholinergic effects and may cause cholinergic rebound if started while tapering off either olanzapine, clozapine, or a FGA?
risperidone
quetiapine
ziprasidone
220A pt that develops agranulocytosis during treatment w/ clozapine should be transitioned to what medication?
olanzapine (safest)
221What was the first FGA used to treat schizophrenia?
Thorazine
222What is the timing for the peak plasma concentration for FGAs?
1-4 hours
223What substance interfere w/ the absorption of FGAs?
Smoking
Coffee
Antacids
Food
224What is the half life of most FGAs?
24 hours (daily dosing)
225If considering a long-acting depot formulation of a FGA, what should the clinician consider?
It can take up to 6 months to reach a steady state so oral therapy should be continued concurrently for the first month
226What is one consideration about the potency of FGAs that the clinician should keep in mind?
>potency=>EPS but < potency=>wt gain/sedation
227What disorders can be treated w/ FGAs?
acute psychosis in schizophrenia & schizoaffective disorder
management of schizophrenia & schizoaffective disorder
acute mania (as adjunct)
MDD w/ psychtoic features (adjunct)
delusional disorders (esp. paranoid)
severe agitation & violent behavior
tourette disorder
borderline personality disorder
dementia agitation
substance-induced psychosis
chorea symptoms in Huntington disease
ballismus & hemiballismus
228What is best controlled in pts w/ schizophrenia when a FGA is used?
Positive symptoms (hallucinations, delusions, agitation)
229What symptoms can worsen with the use of a FGA for the treatment of schizophrenia?
Negative symptoms (side effects mimic negative symptoms)
230How long should a pt stay on a FGA when treating schizophrenia psychosis?
1st episode: 1-2 years
>1 episode: 2-5 years
231Treatment of mania may require the adjunct use of a FGA with what other medications?
Lithium
Depakote
Lamictal
Tegretol
**due to the slow onset of action of these medications adjunct is often necessary but should be short term and tapered off slowly once therapeutic level is achieved
232True or False: FGAs can be given to severely agitated or violent patients regardless of diagnosis.
True
233What FGAs are most commonly prescribed for the treatment of tourette disoder?
haloperidol
pimozide
**clonidine < risk of neurological side effects and is often preferred over FGAs for iniital tx
234What is the recommended dose of haloperidol for dementia aggitation?
0.5-1mg/day
235When considering treating psychosis from substances, what substances would be contraindicated for the use of FGAs?
PCP (use benzo)
Alcohol Withdrawal (> risk of seizure w/ FGA use)
236What FGAs are most likely to lower the seizure threshold and should be used cautiously or avoided in a pt w/ seizure disorder or brain tumor/lesion?
chlorpromazine
thioridazine
**low potency FGAs
237What blocked neurotransmitter receptor is highly associated with the side effect of sedation caused by some FGAs?
Histamine H1
238What FGA is the most sedating?
chlopromazine
239What are the symptoms of central anticholinergic activiety?
Severe agitation
disorientation
hallucinations
seizures
high fever
dialated pupils
stupor/coma (late)
240How is anticholinergic toxicity treated?
Stop causing agent
Monitor closely
Give IV physostigmine (Antilirium) 2mg by slow IV infusion but monitor for toxicity (hypersalviation/sweating)
241What can be given if physostigmine toxicity occurs?
atropine 0.5mg
242What potency of FGAs are more toxic to the cardiac system?
Low & Haldol
243What cardiac effects may be noted with Haldol?
abnormal heart rhythm
ventricular arrhythmias
torsades de pointes
sudden death possible w/ IM administration
244What is the risk of sudden death with the use of antipsychotics?
>risk overall w/ these medications
245What potency of FGAs most commonly cause orthostatic hypotension?
Low-potency: chlorpromazine, thioridazine, & chlorprothixene
246What pt education is warranted when prescibing antipsychotics that may cause orthostatic hypotension?
Change positions slowly
Avoid caffeine & alcohol
Drink at least 2 L of fluid/day
Add salt to diet (if no dx of HTN)
Wear support hose
247What medication is contraindicated for hypotension caused by antipsychotics?
Epinephrine
248A pt that presents w/ a sore throat and fever while taking an antipsychotic should have what lab done immediately?
CBC to assess for a blood dyscrasia (blood disorder, bone marrow disorder, clotting, or lymph tissues)
249What is skin changes may occur with the use of FGAs?
allergic dermatitis
photosensitivity
250What is one adverse skin reaction that may occur w/ long-term use of chlorpromazine?
blue-gray discoloration of skin areas exposed to sunlight
251What eye complication may result from use of thioridazine?
irreversible retinal pigmentation which can progress to blindness (often associated w/ high doses >1,000mg/day)
252A pt taking a FGA that develops jaundice should be advised to do what next?
Stop the Rx
253Overdose of FGAs is not usually lethal unless combined with what other substances?
Alcohol or benzos
254What is the best practice for use of antipsychotics with pregnant women?
Avoid unless benefit outweighs the risk (try to avoid 1st trimester); high potency FGAs are preferred over low potency ones due to less risk of hypotension
255What medications can reduce the absorption of FGAs?
antacids
activated charcoal
Questran
kaolin
pectin
Tagament
anticholinergics
256Combing in TCAs with FGAs may cause what adverse reaction?
anticholinergic toxicity
257What medications may increase absorption of FGAs?
digoxin
steroids
TCAs
SSRIs (paroxetine/fluoxetine/Luvox)
258What common substance use disorder may decrease plasma levels of the FGAs?
Smoking
259What FGAs may cause false positive or negative results for pregnancy?
chlorpromazine
perphenazine
260When are FGAs contraindicated?
H/O severe allergic reaction
Ingestion of a substance that will interact w/ antipsychotic & >CNS depression (alcohol, opioids, barbituates, benzos) or cause anticholinergic delirium (scopalamine or PCP)
High risk for seizures
Narrow angle glaucoma or use of a BPH Rx w/ high anticholinergic activity is used for tx
Presence or h/o TD
Caution: hepatic disease, CVD
261What is rapid neuroleptization?
Practice of administering hourly IM doses of antipsychotic until marked sedation is achieved & is used to treat violent episodes of psychosis
262What psychotic symptoms typically improve quickly with the use of FGAs?
agitation
excitement
263True or False: Small doses of Haldol can be used PRN during the first week of treatment
True
264What timeline is typically considered the period of stabilization after a psychotic episode?
3-6 months
265After the stabilization period, what are the recommendations for medication dose adjustments for a stable pt?
Decrease dose by about 20% every 6 months until the minimum effective dose is established.
266What should be considered when a pt wants to stop the FGA?
Respect wishes
Consider severity of illness & quality of support systems
Discuss maintenance medications and proposed timelines for continuation to prevent relapse of an episode
267What side effect may occur with administration of a depot treament of a long-acting FGA combination?
frightening episode of dystonia
268What can providers consider when administering a long-acting FGA comination depot and consideration of an acute onset of dystonia?
Oral drug holiday for 3-7 days
Give only small doses of the depot preparation every few days
269What should the provider do if a pt is not responding to the FGA treatment within 4-6 weeks?
Assess a drug level (trough preferred)
270WHat was the first SSRI marketed in the US?
Prozac (fluoxetine)
278What SSRI is not FDA approved to treat depression?
Luvox (fluvoxamine)
279What SSRI has the longest half life?
fluoxetine (Prozac)
280What is the half life of fluoxetine?
4-6 days
281What is the half life of sertraline?
26 hours
282What is the half life of citalopram?
35 hours
283What is the half life of escitalopram?
27-32 hours
284What is the half life of paroxetine?
21 hours
285What is the half life of fluvoxamine?
15 hours
286What is the timing for the peak plasma concentration for most SSRIs?
3-8 hours
287What SSRI has the least plasma-protein binding property?
escitalopram
288Where are SSRIs metabolized?
liver
289WHat SSRI has the most drug-to-drug interactions?
fluvoxamine
290What drugs should not be given when a pt is taking fluvoxamine?
theophylline
clozapine
alprazolam
clonazepam
291What SSRIs interfere w/ efficacy of opioids?
fluoxetine
paroxetine
292How do SSRIs exert therapeutic effects?
serotonin reuptake inhibition
293What is a common misconception about dosing SSRIs?
Efficacy is not always achieved at higher doses and > risk of adverse effects
294What SSRIs are most selective inhibitors for serotonin reuptake?
citalopram
escitalopram
295What SSRIs weakly inhibits norepinephrine?
fluoxetine
sertraline
296What SSRI has significant anticholinergic activity at higher doses?
paraxetine
297What SSRI has 5HT1A receptor agonist properties?
vialzodone
298What neurological medication used to treat migraines can result in serotonin syndrome when combined with a SSRI?
triptans
299What pain medication can result in serotonin syndrome when combined with a SSRI?
tramadol
300What is the reason the SSRIs are first line for treatment of depression when compared to other antidepressant treatment options?
Simplicity of use
Safety
Broad spectrum of action