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PHARMACOLOGY STUDY REVIEW NOTES
Typical Antipsychotics - 1st Generation
(targets positive symptoms: delusions, catatonia, bizarre behavior, hallucinations)
Drug Uses Actions/ Contraindicatio ns Side Effects Therapeutic Effects haloperidol acute psychosis Action: blocks dopamine receptors in brain don't give if pt has: parkinson’s, seizures, severe mental depression akathisia ( restlessness ) dystonia ( uncontrollable muscle contraction- results in twisting of body ) Assess for: EPS, TD, parkinsonism uncontrollable temper outburst stereotypic behavior (banging head on wall) NMS - assess temp. alopecia urinary retention amenorrhea breast engorgement galactorrhea priapism gynecomastia seizures hyperthermia Assess for: laryngospasm / bronchospasm hyperglycemia, hypoglycemia, hyponatremia sedation, decreased agitation, decreased combativeness, decreased psychomotor activity, decreased hallucinations, decreased delusions, decreased psychotic behavior (Haldol) chronic useful for schizophrenia outpatients in long-acting form mental retardation with hyperkinesia tourettes in children autism spectrum disorder targets positive symptoms conversion disorder Thiothixene (Navane) acute psychosis orthostatic hypotension NMS = Neuroleptic Malignant Syndrome :escalates rapidly - usually starts w/ fever - life
threatening hyperpyrexia, severe HTN, diaphoresis,
(103 °, 116 bpm, 34 Resp, 100/50 BP) stop immediately; bring to ER
benztropine (Cogentin) a nticonvulsant for EPS usually taken with 1st gen. antipsychotics,
also treats symptoms of Parkinson’s disease.
If antipsychotics are abruptly stopped, can get acute
psychosis. If taking antipsychotics watch glucose & TSH
Atypical Antipsychotics - 2nd Generation
Not typically used...too expensive
(Latuda) depression, bipolar 1 disorder receptors (^) grapefruit juice
Paliperi done schizo/psychotic^ administer^ in^ the^ morning
(Invega) disorders
Ziprasi done
(Geodon) SNRI dizziness, sedation, DRESS: (drug reaction with eosinophilia & systemic symptoms) - a serious skin reaction watch EKG, risk for pacemaker take with food
Quetiapine
(Seroquel) schizophrenia , bipolar disorder Low binding D2- receptors, H1 and serotonin receptor blocker, A receptor weight gain risk for metabolic syndrome orthostatic hypotension somnolence
Risperi done
(Risperdal) schizophrenia, incarcerated for violent acts D2-receptor blockage 5-HT2 receptor orthostatic hypotension, sedation, weight gain, sexual dysfunction
CBC,
LFT,
UA ,
renal function Cariprazine (Vraylar) schizophrenia, bipolar disorder do not take if older adult has dementia increased death in older adults with dementia- related psychosis Granulocytosis - fever, sore throat, mouth sores Metabolic Syndrome - hypertension, hyperglycemia, hyperlipidemia, increased weight, diabetes, increased BP,
(Typical) Phenothiazine Antipsychotics
1st Gen Neuroleptics ( typical & traditional ) ( -azine )
Drug Uses Actions/ Contraindications Side Effects Therapeutic Effects
chlorprom azine
(Thorazine) excessiv e anxiety, schizophrenia, depression Action: blocks dopamine don't give if pt has: liver damage, severe depression, parkinsonism, CAD, bone marrow depression, coma photosensitivity, EPS effects: akathisia (can't sit still), TD, dystonias, drug-induced parkinsonism, NMS Teach pt: stay hydrated; dark urine is normal, pale stools, or yellowing of eyes or skin.
fluphen azine
(Prolixin)
perphen azine
(Trilafon)
treatment of choice for benzo OD GABA = major inhibitory neurotransmitter in the CNS
SSRI - Antidepressants (-ine, - pram)
Drug Uses Actions/ Contraindications Side Effects Therapeutic Effects
fluoxet ine (Prozac)
sertral ine (Zoloft)
citalo pram (Celexa)
escitalo pram
(Lexapro)
fluvoxam ine (Luvox)
paroxet ine (Paxil)
first-line for depressio n Used for: depression with anxiety, depression with psychomotor agitation, social phobia, OCD, PTSD, [first line] somatic disorders agitatio n, anxiety, sleep disturbance, tremors, sexual dysfunction, ( primary anorgasmia ) tension headache Serotonin Syndrome: nausea, diarrhe a, HA, dizziness , insomnia , dry mouth, sedation, skin rash, sexual dysfunction less dangerous when taken in overdose. atypical antidepressants have a low lethality risk in suicide attempts Black Box Warning: increase in suicidal thinking and/or behavior when taking the drug. monitor for excessive weight loss Fluoxetine is for: bulimia nervosa drug should be withdrawn every 2 to 6 weeks to avoid withdrawal symptoms monitor liver function take in the morning with food Serotonin syndrome : hyperactivity or restlessness, tachycardia (cardiovascular shock), fever (hyperpyrexia), elevated BP, altered mental status (delirium), Irrationality, mood swings, hostility, seizures (status epilepticus), myoclonus, incoordination, tonic rigidity, abdominal pain, diarrhea, bloating, apnea (death) Emergency measures: discontinue offending agent, initiate symptomatic treatment: ○ Serotonin receptor blockade: cyproheptadine, methysergide, propranolol ○ Cooling blankets, chlorpromazine for hyperthermia ○ Dantrolene, diazepam for muscle rigidity or rigors ○ Anticonvulsants ○ Artificial ventilation ○ Paralysis
Drug Uses Actions/ Contraindications Side Effects Therapeutic Effects phenelzine
(Nardil)
isocarboxazid
(Marplan)
tranylcypromine
(Parnate)
selegiline (Emsam)- transdermal patch [no dietary modifications ] second-line for atypical depression in pts: who haven’t responded to other meds or ECT treatment used in re- refractory anxiety states or cardiac arrhythmias. Panic disorder, social phobia, GAD, OCD, PTSD, bulimia. contraindications : cerebrovascular disease, hypertension, CHF, liver disease avoid foods high in tyramine, tryptophan, dopamine avoid if had surgery in the previous 10 to 14 days Younger than 16 food and drug Interactions with tyramine diet modifications, avoid alcohol restrict intake of tyramine, may provoke [ hypertensive crisis] selegiline (Emsam) no dietary modifications pt must have a wallet card describing the MAOIs regimen monitor pt’s BP during first 6 weeks of treatment instruct pt after MAOI treatment is stopped, drug and dietary restriction should be maintained for 14 days. consult pharmacist when taking OTC meds ACTION: inhibits the breakdown of tyramine in the liver. high risk for hypertensive crisis.
Hypertensive crisis - when taking foods rich in tyramine, tryptophan, dopamine:
● occipital HA, ● circulatory collapse, ● intracranial hemorrhage, ● death
Medications to avoid when taking MAOI:
● amphetamines, ● anti-asthmatics, ● certain antidepressants, ● levodopa, ● Meperidine. ● Cyclobenzaprine + MAOI = hyperpyretic crisis, seizures, death
Anticonvulsant Mood Stabilizers
Drug Uses Actions/ Contraindication s Side Effects Therapeutic Effects valproate/divalproex (Depakote/ Depakene) impulsive aggression confusion, cognitive impairments, ataxia, may lead to falls increased risk for thrombocytopenia
carbamazepine
(Tegretol)
acute mania, bipolar
lamotrigine
(Lamictal)
maintenance therapy Watch for rash! may indicate Steven Johnson syndrome (SJS)
oxcarbazepine
(Trileptal)
gabapentin
(Neurontin)
topiramate
(Topamax)
Mood Stabilizers
Drug Uses Actions/ Side Effects Therapeutic Effects
1. Which of the following neurotransmitters is elevated in schizophrenia?
○ Dopamine ○ Serotonin ○ Histamine ○ GABA
2. Which of the following medications requires a tyramine restricted diet? ○ Fluoxetine ○ Lithium ○ Phenelzine ○ Amitriptyline 3. A client taking fluphenazine presents with a BP of 200/110, a HR of 130, a temp of 103. and muscle rigidity. What is the possible cause for these symptoms? ○ Acute dystonic reaction ○ Neuroleptic malignant syndrome ○ Serotonin syndrome ○ Hypertensive crisis 4. A 44 year old male with a past alcohol addiction is being prescribed a medication to decrease his anxiety. Which of the following medications would be appropriate for this client? ○ Flurazepam ○ Alprazolam ○ Lorazepam ○ Buspirone 5. A client taking olanzapine should have which lab value monitored closely? ○ White blood cell count ○ Glucose ○ Temperate ○ TSH 6. Which of the following assessment findings is most concerning with a client taking clozapine? ○ 96.6 temperature ○ Sore throat [because of agranulocytosis] ○ WBC 11, ○ 2lb weight gain 7. A new client admitted to the mental health unit is taking ziprasidone. Which of the following labs/diagnostics should be in the chart? ○ TSH ○ EKG ○ Glucose ○ RBC
