Week 7

What are 3 non-pharmacological methods to treat psychotic disorders?

• bio feedback

• relaxation techniques

• cognitive behavioural therapy

What kind of antipsychotics have the most risk of extrapyramidal symptoms?

1st generation antipsychotics, ‘typical’

What type of antipsychotic has fewer side effects?

2nd and 3rd generation antipsychotics, ‘atypical’

What do atypical antipsychotics increase the risk for?

Increased risk for type 2 diabetes

What are examples of extrapyramidal symptoms? (4)

• Acute dystonias

• Akathisia

• Pseudoparkinsonism

• Tardive dyskinesia

What would the symptoms of lip smacking, worm-like movements of the tongue, uncontrolled chewing and grimacing indicate when taking antipsychotics?

Tardive dyskinesia

What would the symptoms of tremor, muscle rigidity, and stooped posture indicate when taking antipsychotics?

Pseudoparkinsonism

What would the symptoms of inability to rest and relax, and pacing indicate when taking antipsychotics?

Akathisia

What would the symptoms of muscle spasms of the face, tongue, neck, and back indicate when taking antipsychotics?

Acute dystonia

What would the symptoms of dry mouth, tachycardia, and blurred vision indicate when taking antipsychotics?

Anticholinergic effects

What would the symptoms of high fever, confusion, muscle rigidity, and high serum creatine kinase indicate when taking antipsychotics?

Neuroleptic malignant syndrome

How to the atypical antipsychotics Phenothiazines work?

They interrupt dopamine + serotonin pathways in the brain

What type of antipsychotic works best for positive symptoms?

Typical, or 1st generation antipsychotics

What type of antipsychotic treats both positive and negative symptoms?

Atypical antipsychotics

What are adverse effects of atypical antipsychotics? (4)

• Weight gain

• Decreased libido

• Osteoporosis

• Change in glucose metabolism (if diabetic watch sugars)

What do anxiolytics affect?

works on the CNS

What are 4 classes of CNS depressants used to treat anxiety?

• Antidepressants

• Benzodiazepines

• Nonbenzodiazepine anxiolytics

• Barbiturates

What is rebound insomnia?

Insomnia caused by discontinuation of a long-used sedative drug

What is electroencephalogram (EEG)?

A tool for diagnosing sleep disorders, seizure activity, depression, and dementia

What are indications for the use of benzodiazepines? (5)

• Insomnia caused by anxiety.

• Seziure disorders.

• Alcohol withdrawal.

• Central muscle relaxation.

• Induction agent in anesthesia.

What is the mechanism of action for benzodiazepines?

Binds to GABA receptor-chloride channel molecule, which intensifies the effects of GABA

What are adverse effects of benzodiazepines? (3)

• Drowsiness

• Dizziness

• Respiratory depression

Why are barbiturates rarely prescribed anymore?

Low therapeutic index, very easy to overdose

How long does it take for antidepressants to relieve anxiety symptoms?

4-6 weeks

What classes of antidepressants are used to reduce symptoms of anxiety? (4)

• Tricyclic antidepressants (TCAs)

• Monoamine oxidase inhibitors (MAOIs)

• Selective serotonin reuptake inhibitors (SSRIs)

• Atypical antidepressants

What are some side effects of SNRIs? (4)

• Weight loss

• Sexual dysfunction

• Abnormal dreams

• Constipation

Who cannot take tricyclic antidepressants (TCAs)?

Patients with heart block, arrhythmias, or history of heart attacks

What are side effects of tricylic antidepressants? (6)

• Dry mouth

• Blurred vision

• Urine retention

• Hypertension

• Anticholinergic effects

• Cardiac dysrhythmias

What should people taking monoamine oxidase inhibitors (MAOIs) avoid?

Foods containing tyramine (cheese, wine, pickled foods)

What are common adverse effects of monoamine oxidase inhibitors (MAOIs)? (3)

• Orthostatic hypotension

• Headache

• Diarrhea

What are adverse effects of SSRIs? (6)

• Sexual dysfunction

• Nausea

• Headache

• Weight gain

• Anxiety

• Insomnia

What are sympathomimetic effects?

Cardiovascular side effects including tachycardia, hypertension, heart attack and stroke.

What antidepressant drug is contraindicated in patients who have seziures?

Wellbutrin (NDRI)

How do tricyclic antidepressants work?

Blocks the reuptake of norepinephrine and serotonin

What is the mechanism of action of MAO Inhibitors?

decreases the effectiveness of monoamine oxidase

What can occur if someone taking MAOIs eats food containing tyramine?

Hypertensive crisis

What is the mechanism of action of lithium?

Affects sodium transport across cell membranes

What is an adverse affect of lithium?

excessive loss of sodium

What is important to remember for patients taking lithium?

It has a narrow therapeutic index, so regular bloodwork is needed

What drugs are used to treat bipolar disorder? (3)

• Lithium

• Valproic acid (antiseziure drug)

• Risperidone (atypical antipsychotic drug)

What is the mechanism of action for CNS stimulants for ADHD?

acts as a norepinephrine and dopamine reuptake inhibitor (NDRI)

so, it blocks the reuptake of dopamine and norepinephrine :D

What are adverse effects of CNS stimulants (4)

• Insomnia

• Weight loss

• Nervousness

• Anorexia

What is a non-stimulant drug used to treat ADHD?

Norepinephrine reuptake inhibitors (NRIs)