Zoom Final Review PDF

Zoom Final Review Live Lecture **Look at text messages with exam answers** Olanzapine (Zyprexa) exerts e ects on serotonin and dopamine. Helps with side e ects and negative symptoms of schizophrenia. SGA includes aripirazole (Abilify...

Zoom Final Review Live Lecture **Look at text messages with exam answers** Olanzapine (Zyprexa) exerts e ects on serotonin and dopamine. Helps with side e ects and negative symptoms of schizophrenia. SGA includes aripirazole (Abilify), clonazpine (clozaril), Lurasidone (Latuda), Olanzapine (Zyprexa), Paliperidone (Invega), Quetiapine (Seroquel), Risperidone (Risperdal) and Ziprasidone (Geodon), Asenapine (Saphris), Iloperidone (Fanapt) Block of which receptor causes anticholinergic S.E. of antidepressants medications: blockade of acetylcholine. FGA, TCA & SSRI (Paroxetine). Dry mouth, blurry vision, constipation, urinary retention, drowsiness. Sedation. Phenelzine (Nardil) who eats pizza: hypertensive crisis. MAOIs - tyramine free diet. Aged cheese, cured or processed meats, nuts, beer. Mechanism of Action for MAOI: MAOI-A metabolizes serotonin, norepinephrine and dopamine whereas MAO-B metabolizes dopamine. Combined results in greater increases in all three NT than just one MAOI drugs include: Isocarboxazid (Marlin), Phenelzine (Nardil), Selegiline (Emsan, Elderpryl and Zelapar) and Tranlycypromine (Parnate) For lithium: concern for working out every day in the gym Lithium functions in the body as a salt {must be careful for the hydration in the body} For MAOI, the tyramine does not get broken down in the body Lithium level of 1.5 is toxic Levels: acute treatment 1.0-1.5, chronic 0.6-1.2, mania 1.0-1.5 and depression 0.6-1.0 A medication such as uphenazine (Prolixin) isn’t helpful in treating which of the following? Anhedonia, at a ect and avolition Avolition - lack enthusiasm or enjoyment of life FGA include: Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Haloperidol (Haldol), Loxapine (Loxitane), Perphenazine (Trilafon), Primozide (Oral), Thiothixene (Naval) and Tri uoperazine (Stelazine) Negative symptoms of schizophrenia: typical or FGA only exert their e ects on the dopamine, therefore no e ect on the negative symptoms Which of the following are extrapyramidal side e ects - akathisia, Parkinsonism, dystonia from dopamine blockade Which labs prioritize for patient taking clozapine (clozaril) - ANC. Want to keep it above 1.5! Patient on uphenazine has altered mental status, temp 102, pulse 112, BP 110/70 = NMS (since it is a rst generation antipsychotic) NMS: dopamine antagonist, days to weeks, prolonged course, hypertension, hyperthermia, tachycardia, tachypnea, labs: elevated creatinine kinase, di use “lead pipe” rigidity Serotonin syndrome vs. NMS —> serotonin overload vs. dopamine blockage. Serotonin syndrome with antidepressants or serotonergic agents vs. medications that block dopamine. Both are emergent cases, stop medication and seek evaluation. Mesolimbic - positive symptoms of schizophrenia {hallucinations, delusions} Nigrostriatal - EPS side e ects Mesocorticol = cognition and negative symptoms of schizophrenia { at a ect, anhedonia} Tuberinfundibular pathways = increase prolactin Propranolol used to treat symptoms of akathisia - true. Akathisia is a D2 receptor blockage by antipsychotic medication that presents as psychomotor restlessness. Appears after an antipsychotic is started or after a dose is increased. Treatment is through a decrease of dose, benzodiazepine or a beta blocker. People have to move, pace, rocking, cannot sit still. Internal restlessness - feeling they can’t settle down. What is used to treat acute dystonia from haloperidol (haldol)? - benztropine and Benadryl. Dystonia acute IM, non-acute PO cogent or Benadryl. Sti , looking up. Both are anticholinergic in nature fl fl fl fi ff fl ff ff ff ff ff ff fl ff ff ff  Lorazepam is treatment for pseudoparkinsonsonism - false. Treat with anticholinergic - cogent and also decrease in dose of Parkinsonism E exor e ects norepinephrine and serotonin (SNRI). Duloxetine often used to treat neuropathic pain. These medications have dual NT e ects for anxiety and depression Patient is taking Zoloft, careful to take St. John’s Wort due to serotonin syndrome. Rapidly peaking, increased tone, legs more than arms, tremor, hyperre exia, hypertension, hyperthermia, tachycardia, tachypnea, labs - elevated or normal creatinine kinase (muscle rigidity) Valproic acid (Depakote) and pregnancy - neural tube defects Lithium is linked to Epstein’s Bar Anomaly Natural for sleep - valerian root and melatonin are both supplements that can be used Methylphenidate (Ritalin) will increase dopamine and norepinephrine. It blocks the re-uptake of these two. With adderall, it does the same thing PLUS an additional dopamine transmitter so that is why there is more of an addictive e ect Trichotallominia - N-acetylcholinase Sometimes folate helps metabolize antidepressants (some research on this, not on exam) Pregnancy - know depakote, lithium and Paxil because lots of research on this. Now, we gured out the research on lithium and paxil is old but now we know it is exaggerated. They’ve repeated the study but are not getting the same number anymore If someone is stable on lithium, this is stable than having them relapse hospitalized. Riskier. Better for her to be stable than have more in ammatory makers going o. No literature saying adjusting dose or bringing it down helps but there is literature that says keeping the number down is helpful Depakote has the worst teratogenic e ects so either don’t prescribe or remove in the beginning if possible (if they are stable and can do without the medication) Nothing that says that Zoloft is the go-to, Seroquel passes least amount through placenta however, lots of weight gain and gestational diabetes PCOS and hair loss with Depakote Tegretol (mood stabilizer/anticonvulsant) is an inducer of birth control and can lead to unplanned pregnancies Teratogenic e ects usually happen in the rst trimester, so the 1 and 2 trimesters are very important with medication management (talk to women of child bearing age about this) SAMe is used for depression. E ects serotonin (if they are taking with SSRI) - can have serotonin syndrome (also same for St. John’s Wort) Ginkgo is not a great medication, people use this for cognition Paxil (Paroxetine) has lots of anticholinergic S.E. compared to other SSRIs and TCAs have lots too! Also FGA - they work really well as SGA but because of S.E. anticholinergic, people don’t like (including TD and EPS) but de nitely lots of anticholinergic side e ects. Overdose is fatal with TCA because of the cardiac toxicity, complicated to revive from this verses the other antidepressants (like SSRIs) fi ff ff ff ff ff fi fi fl ff ff fl ff ff