Week 8 Tutorial CNS questions.pptx

Central Nervous System Pharmacology Pharmacology 3002MSC 1. Drug treatment of schizophrenia AMH 2022 Antipsychotics, formulations, comparison of adverse effects John Black, a 23 year old male who works as sound engineer has been admitted to a psychiatric institution with symptoms including halluci...

Central Nervous System Pharmacology Pharmacology 3002MSC 1. Drug treatment of schizophrenia AMH 2022 Antipsychotics, formulations, comparison of adverse effects John Black, a 23 year old male who works as sound engineer has been admitted to a psychiatric institution with symptoms including hallucinations and paranoia. He was diagnosed with schizophrenia and put on haloperidol (5-10 mg every two hours) to treat his condition. The hallucinations and delusions have subsided and he has been released from hospital and put on a maintenance dose of 2mg 3 times daily. 1. What is schizophrenia, describe its symptoms and diagnosis. 2. What are the general mechanisms of action of classical antipsychotic agents? 1. Drug treatment of schizophrenia 3. What adverse effects can be expected with antipsychotics? 1. Drug treatment of schizophrenia 4. What are the endocrine effects of antipsychotics? 5. John asks you about the possibility of taking alcohol with his antipsychotic medication. What would you say to John? 6. John has complained to you about severe tremor and rigidity following ingestion of haloperidol tablets. What alternative medications could he use to reduce these symptoms? 1. Drug treatment of schizophrenia 7. John enjoys spending time in the sun. What instructions would you provide to John when he goes outdoors? 8. With the long term use of antipsychotics what motor disturbances do you need to monitor John for? How can it be cured? 9. If John has to change his antipsychotic medication, what is the recommended process for this to occur? 1. Drug treatment of schizophrenia 10. Name the atypical antipsychotics. How are they different from the classical antipsychotic agents? 11. If John is not able to gain relief from the psychotic events which drug is used for treatment resistant patients? When in use what needs to be monitored? 1. Drug treatment of schizophrenia 12. If John had to change his antipsychotic medication to an atypical antipsychotic medication what metabolic effects do you need to monitor for? Why does this condition occur? 13. Describe neuromuscular malignant syndrome? Is John at risk of this syndrome? 2. Remove patient choice The problem with releasing patients with paranoid schizophrenia into the community is that our medical system currently allows those patients to choose between injections and tablets to control the illness. Injections are for a month or so, whereas tablets are daily, thus it does take the body a while to adjust to the large dosage from the injections, but the family and the community know they have had their medication and the patient has quality of life. How many of us forget to take tablets? These patients start to feel good and stop taking their tablets. I know of a person who has been in and out of hospital for the past 20 years due to this very problem. When she was on injections, she started part time work, had a boyfriend and was doing so well then talked the doctors into allowing her to revert to tablets. She then decided she was well enough not to take them and used to flush them down the toilet. As soon as she decided she did not need her tablets, she ended up back in hospital, but to get there, she put her family and three small children through hell. This has to change. Allow the patients with schizophrenia to live out in the community, of course, but ensure they have their medication by injection. Gold Coast Bulletin 5th May, 2005 Letter. 2. Remove patient choice 1. List three (3) main points to summarise this article 2. Discuss the possible causes of schizophrenia. 3.Discuss the mechanisms of action of the antischizophrenic medications. 2. Remove patient choice 4. What drugs can also induce psychotic events, describe their mechanism/s of action. 5. Contrast the medications given for acute episodes and chronic treatment of psychosis. 2. Remove patient choice 6. What are the potential side effects associated with the use of antischizophrenic medications? 2. Remove patient choice 7. What formulations/preparations are available for antischizophrenic medications? 8. Which currently available antischizophrenic medications are available in injectable forms? What are the recommendations regarding their use in patients? 9. Draw a graph showing plasma concentrations over time for the injectable forms and oral forms of antischizophrenic medications 2. Remove patient choice 10. Why is the author of the article calling for the wider use of injectable forms of antischizophrenic medications. 11. What are the advantages and disadvantages to using depot injections? 12. Do you agree with the sentiments of the author of this article? Explain 3. Drug treatment of depression AMH 2022 Drug treatment form Major Depression Georgia Green, a 35 year old photographer has recently been diagnosed with major depression. She has been taking the serotonin reuptake inhibitor fluoxetine 20 mg/day for her condition for the past two weeks. 1. What did her GP need to assess in Georgia, prior to prescribing antidepressant medication? 2. Describe the Diagnostic criteria for major depression 3. Drug treatment of depression 3. What factors did Georgia’s GP need to consider regarding drug choice? 4. What time frame does her GP need to warn Georgia regarding the therapeutic benefits of her treatment. 5. List three (3) adverse reactions associated with the use of this class of drug. 3. Drug treatment of depression 6. Georgia complains she can not sleep at night. What do you need to tell her with regards to taking her medication? 7. Georgia has found that her treatment for depression is not working. What are the causes of treatment failure and what strategies could you suggest to relieve her condition. 3. Drug treatment of depression 8. Describe the withdrawal syndrome associated with SSRI’s. How can it be prevented? 9. If her doctor decided to change her medication to a tricyclic antidepressant, amitriptiline (25 mg/day). Indicate the antidepressant free intervals recommended when changing from one class of antidepressant to another. 4. Australian Adverse Drug Reactions bulletin Serotonin syndrome is caused by excessive central nervous system and peripheral serotonergic activity. It most commonly occurs with a combination of serotonergic agents, but may also occur with a single agent. A combination of agents increasing serotonin by different mechanisms, such as by inhibition of serotonin uptake and serotonin metabolism, is associated with a high risk of the syndrome. 1 Table 1 lists agents which have been associated with serotonin syndrome. Serotonin syndrome is a clinical triad of cognitive-behavioural changes, autonomic dysfunction and neuromuscular dysfunction. At least three of the features listed in Table 2 must be present.1,2 There is no laboratory test to aid diagnosis. The syndrome often occurs within a day of a change in treatment (increase in dose or addition of another serotonergic agent) and the evolution of symptoms is rapid. It should not be confused with neuroleptic malignant syndrome which is clinically similar, but is an idiosyncratic response to neuroleptic agents, usually occurs after longer periods of treatment and develops over a period of days or weeks.1 Table 1: Agents causing serotonin syndrome Antidepressants SSRIs, monoamine oxidase inhibitors (including moclobemide), tricyclics, mirtazapine, venlafaxine Antiparkinsonians Amantadine, bromocriptine, levodopa, selegiline, carbergoline, pergolide Illicit drugs Cocaine, hallucinogenic amphetamines such as MDMA (ecstasy), LSD, etc. Migraine therapy Dihydroergotamine, naratriptan, sumatriptan, zolmitriptan Other agents Tramadol, carbamazepine, lithium, reserpine, sibutramine, St. John's wort, bupropion, pethidine, morphine ADRAC has received 161 reports of serotonin syndrome. The majority describe the syndrome in association with the concomitant use of 2 or more serotonergic agents, in particular SSRIs (68), tramadol (29), moclobemide (23), venlafaxine (18), tricyclic antidepressants (18) and St John's wort (8). In 61 reports, the serotonin syndrome developed in association with a single agent: SSRIs (40), moclobemide (5), venlafaxine (5) and tramadol (5). Serotonin syndrome with tramadol was the subject of an earlier Bulletin article.3 Serotonin Syndrome 4. Australian Adverse Drug Reactions bulletin Table 2: Clinical features of serotonin syndrome Cognitive-behavioural changes agitation mental status changes (confusion, hypomania) Autonomic dysfunction sweating diarrhoea fever shivering hypertension Neuromuscular dysfunction hyperreflexia incoordination myoclonus tremor Serotonin syndrome is potentially serious. Reports to ADRAC have described confusion (31), convulsions (23), hypertension (22), hallucinations (12) and delirium (7). In the majority of reports, the signs and symptoms developed within 24 hours of the addition of another serotonergic agent or an increase in dose of an agent. Patients responded to withdrawal of the serotonergic agent(s) and appropriate treatment. Recovery was documented in 85% of the cases where the outcome was known and the remainder of patients had not recovered at the time of reporting. Health professionals should note the drugs that may cause serotonin syndrome, alone or in combination with other serotonergic agents, and be alert to the features of serotonin syndrome. Patients should be informed of the risk and symptoms of serotonin syndrome when serotonergic agents are prescribed. Serotonin Syndrome 4. Australian Adverse Drug Reactions bulletin 1. In three (3) sentences or less describe the main points of this article. 2. Name two (2) possible causes of unipolar depression and indicate the biochemical changes in the CNS associated with depression. 4. Australian Adverse Drug Reactions bulletin 3. Describe the classes of antidepressant listed in Table 1, with respect to the mechanisms of action and major side effects. (SSRIs, tricyclic antidepressants, monoamine oxidase inhibitors and RIMA)? 4. Australian Adverse Drug Reactions bulletin 4. What are the symptoms of serotonin syndrome? 5. What is the cause of serotonin syndrome? 6. What conditions increase the risk of serotonin syndrome? 4. Australian Adverse Drug Reactions bulletin 7. Which medications can precipitate serotonin syndrome? 8. What advice would you give a person who is receiving a drug that increases central serotonin levels or stimulates serotonin receptors? 5. LEDGER DIED FROM DRUG OVERDOSE 7 February 2008 World Entertainment News Network LATEST: Actor HEATH LEDGER was killed by an overdose of prescription drugs, the New York Medical Examiner has ruled. An autopsy into the star's death in January (08) failed to establish the cause of his death, but an overdose was suspected because a number of prescription medicines were found in his Manhattan apartment. Toxicology test results released on Wednesday (06Feb08) established six different drugs were found in the actor's system - including painkillers, sleeping pills, anti-anxiety pills and antihistamines - when he died. A statement from the Medical Examiner reads, "Mr. Heath Ledger died as the result of acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine. "We have concluded that the manner of death is accident, resulting from the abuse of prescription medications." Ledger - who was found dead on 22 January (08), aged 28 - is expected to be buried at his family's plot in Karrakatta Cemetery in his native Perth, Australia. A private funeral will be held on Saturday (09Feb08) with his ex-fiancee Michelle Williams and their two-year-old daughter Matilda in attendance. (IG/WN/MT) 5. LEDGER DIED FROM DRUG OVERDOSE 1. List three (3) main points to summarise this article 2. To which classes of drug painkiller, anti-anxiety and antihistamine do the following drugs belong; oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine. 5. LEDGER DIED FROM DRUG OVERDOSE 3. Describe the mechanism of action of each class and major side effects. 5. LEDGER DIED FROM DRUG OVERDOSE 4. What are the indications for each class of drug? 5. What side effects do all of these drugs have in common? 5. LEDGER DIED FROM DRUG OVERDOSE 6. How is it possible to obtain many different prescription medications that have similar effects? How could it be prevented? 7. What alternatives treatments are possible for insomnia?