Psych Med quiz 2

Cholinesterase Inhibitors Mechanism of Action

Prevents breakdown of acetylcholine by acetylcholinesterase, thereby increasing availability of acetylcholine at cholinergic synapses.

Result of cholinesterase inhibitors

Enhanced transmission between neurons not yet destroyed. May slow progression by a few months.

Monoclonal antibodies mechanism of action

Crosses blood-brain barrier to target/bind to protein in beta-amyloid to decrease amyloid plaques.

Who do we use monoclonal antibodies for?

Only for those in the mild stages and if positive for amyloid plaques on MRI.

How often does someone need to get monoclonal antibodies?

IV infusion every 3 weeks, extremely expensive.

Adverse effects of monoclonal antibodies

Amyloid-related imaging abnormalities (ARIAs), localized edema, microhemorrhages, H/A, dizziness, confusion, visual disturbances, nausea.

If symptoms for monoclonal antibodies are severe, what should you do?

Hold tx and give high-dose glucocorticoids

Contraindications for monoclonal antibodies

Uncontrolled HTN, bleeding disorders.

Monoclonal antibody medications

Iecanemab (Leqembi), and donanedab (Kisunla)

Uses for Iecanemab and donanemab

MCI or mild AD (limited use - side effects/costs)

Which imaging test is required for a patient on MABs?

MRI

Drug classes for neuropsychiatric symptoms

Antipsychotics

Side effects of antipsychotics

Infections, sedation/falls, blood clots, stroke, EPS such as tardive dyskinesia, dystonia.

Atypical antipsychotics

Risperidone (Risperdal) and olanzapine (Zyprexa)

Why are benzodiazepines not recommended in patients with AD?

Sedation, dizziness, and increases risk for falls

Brexipiprazole (Rexulti)

Approved in 2023 as 1st med for agitation associated with AD

Adverse effects of Cholinesterase Inhibitors

N/V, dyspepsia, diarrhea, dizziness, headache

Naltrexone Mechanism of Action

Works by blocking the effects of opioids so the individual cannot get high, must make sure they are opioid free prior to starting or can force them into immediate withdrawal. In alcohol use, it helps with cravings and reduces the pleasure in drinking by blocking the rush of endorphins, they can still get intoxicated though.

Patient education for naltrexone

Warn patient against non-prescribed or illicit opioid use, as the very high amount of opioid required to overcome the antagonist effect of naltrexone hydrochloride may result in life-threatening or fatal overdose.

How long should a patient be opioid free before stating Naltrexone?

7-10 days

Disulfiram (Antabuse)

First FDA approved medication for AUD

Disulfiram (Antabuse) mechanism of action

Blocks the processing of alcohol in the body causing nausea/vomiting, sweating, dizziness, headache lasting 30 minutes to several hours

Disulfiram (Antabuse) education

Clients must be educated to avoid all alcohol and products that contain alcohol.

Lorazepam, chlordiazepoxide and diazepam uses

Used for withdrawal

How to assess benzodiazepine dosage

CIWA-AR (Clinical Institute Withdrawal Assessment — Alcohol Scale Revised)

What to assess in a patient using benzodiazepines

Assess for seizures — Could lead to DT’s

Tegretol (carbamezapine) class

Anticonvulsant/Barbituate

Tegretol and phenobarbital are prescribed for…

Seizures/prevention

Naltrexone usage

Used to treat alcohol and opioid dependence

Injection form of Naltrexone

Vivitrol

Pill form of Naltrexone

Revia

Methadone uses

Reduces craving and withdrawal, blocks the high from opioids. Can help stabilize the individual while they are working on their addiction.

True or false: Methadone is safe while someone is pregnant or breastfeeding.

True

True or false: A patient is able to drink alcohol while using Methadone

False

how long is treatment for Methadone?

12 months at least