Psychiatry pimp fest

What 3 conditions do antipsych drugs  = neuroleptics treat?

Psychosis
Schizophrenia
Hallucinations

What receptors do antipsych drugs inhibit?

Central Dopamine D2 receptors

What is the drug of choice for refractive schizophrenia?

Clozapine (Clozaril)

What class of drug is Clozapine (Clozaril)?

A dibenzodiazapine, an atypical agent.

Why is it atypical?

it has different side effect profile: agranulocytosis?

What receptors does clozapine work on, unlike all other neuroleptics that work on D2 receptors?

D1 or serotonin

What group of schizo symptoms does clozapine treat?

Negative symptoms including flat affect, avolition, poverty of speech,

What long acting neuroleptics work on treating non-compliant schizo patients?

Haloperidol (Haldol) and Fluphenyzine (Prolixin)

In addition to long action what makes them useful?

IM injection availability

What extrapyramidal side effects do high potency neuroleptics cause?

Acute dystonia (sustained muscle contractions in the head and neck region)

5 muscle spasms that commonly occur with acute dystonia in the head and neck region?

Eye, tongue, jaw, neck, laryngeal (can cause airway obstruction (treat with Dyphenhydromine (Benadryl) or Benztropine (Cogentin) both anticholinergics.)

What 2 categories do neuroleptic drugs fall into?

High potency and low potency

What is time of onset of side effects of low potency antipsychotics?

Immediate, right away

What are the three classes of side effects of low potency antipsychotics?

Anticholinergic, Antihistaminergic, Antiadrenergic (usually not a problem except in overdose)

What are anticholinergic side effects?

Anticholergic is anti-cool: No water, sunglasses, no hat, alone: you become: hot, dry, red, blind, crazy.

Which are due to peripheral effect? Hot, dry, red, blind.

What are due to central effect? crazy

What causes hot and dry? suppression of cholinergic sweat glands.

What is covered under "dry"? Dry skin, mouth, nose, eyes, urine retension, no intestinal secretion, or motion?

What causes retension of urine in bladder? Lack of irritability of the detrussor muscle.

What causes red?

cutaneous flushing

What happens to eyes with anticholinergic action?

Pupils dilate: dilation wins.

What are 4 examples of ways antichol toxicity can affect CNS?

Disorientation, hallucination, seizure, coma

What are two examples of antihistaminergic side effects of low potency neuroleptics?

Sedation, weight gain

What are the two main adrenergic side effects of low potency neuroleptics?

Hypotension and reflex tachycardia

What are 4 low potency antipsychotics with high potential for side effects? 

Chlorpromazine (Thorazine) (not used much d/t high side effect profile) , Clozapine (Clozaril), Thioradazine (Melaril), Risperidone (Risperdal)

How often does Clozapine (Clozaril) induce fatal agranulocytosis?

1% of patients

How often must physicians monitor WBC blood levels of Clozapine (Clozaril) patients?

Weekly

Which is used at same dosage as Chlorpromazine (Thorazine) but much lower risk side effect profile, mainly anticholinergic? Thioradazine (Melaril)

Which has by far lowest dosage required but has low potency profile, mainly anticholinergic?

Risperidone (Risperal)

What toxicity syndrome resembles that of low potency antipsychotics?

Sympathomimetic toxicity, adrenergic overstimulation

What two drugs cause sympathomimetic toxicity?

Cocaine and amphetamines

What signs?

Hot, red, blind, crazy (NOT dry, except for urinary retension).

Which two are likely to be different with mild intoxication?

May be cool and pale.

What will the different findings be?

Eyes and skin wet, BS hyperactive = diarrhea in sympathomimetic. (mouth and nose variable).

High potency neuroleptics have 3 side effect groups. What are they?

Extrapyramidal side effects, tardive dyskinesia, NMS


Extrapyramidal: Actute dystonia, Drug-induced Parkinsonian syndrome, Akathesia

What is akathesia?

Strong feelings of inner restlessness, difficulty being still

Tardive dyskinesia symptoms?
Involuntary Tongue, mouth fingers, toes movements. Facial grimaces.

Almost any of the antipsychotics can cause tardive dyskinesia?

All of them. High potency much higher. Risperidone (Risperdal) much lower chance of this.

All may produce neuroleptic malignant syndrome except?

Clozapine (Clozaril)

Symptoms of NMS?

Severe muscle rigidity, fever, AMS, autonomic instability.

What three high potency antipych meds have highest risk of side effects?
Haloperidol (Haldol), Fluphenazine (Prolixin), Thiothixine (Navane)

What 3 abnormalities in women will prolactinemia (a common antipsych side effect) cause?

Galactorrhea, Gynecomastia, Menstrual dysfunction

What are the side effects in men?

ED, retrograde ejaculation, inhibition of orgasm,

(Non-psych questions)How to treat severe headaches with orgasm?

First need to check for subarachnoid hemorrhage. If none, treat with indomethacin 50mg PO, prior to intercourse.

What do you treat Wilson's disease with?

Penacillamine, a Copper chelator. Protecting brain, liver, kidney, cornea.

What is the general trend of cephalosporins from generation to generation?
The lower the Gen of Cephalosporin the better it works against Gram positive vs. Gram negative.

Key difference between second and third gen Cephalosporins? Third treat PSA.