exam study for weeks 7-11

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 norep

What is the mmechanism 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)

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)

What are the symptoms of hyperthyroidism? (5)

• hyperactivity

• insomnia

• heat intolerance

• fatigue

• increased appetite but weight loss

What are the symptoms of hypothyroidism? (5)

• hypothermia

• decreased appetite but weight gain

• dry skin + hair

• fatigue

• constipation

What is the pharmacologic treatment for hyperthyroidism? (2)

• Antithyroid medications

• Beta-blockers

What is the pharmacologic treatment for hypothyroidism?

Medications that replace thyroid hormone, like Levothyroxine

What is the treatment for thyroid storm?

thyroid storm = extreme case of hyperthyroidism

treatment = cooling, NO aspirin, fluid replacement

What is a goiter?

Enlarged thyroid gland

What is myxedema?

A life threatening complication of long untreated hypothyroidism

In primary thyroid disorders, what part is dysfunctional?

Thyroid

In secondary thyroid disorders, what part is dysfunctional?

Pituitary

In tertiary thyroid disorders, what part is dysfunctional?

Hypothalmus

What is the function of the pancreas?

Keeps blood glucose within normal range

What are the physiological actions of insulin? (3)

• Promotes entry of glucose into cells

• Provides storage of glucose

• Inhibits breakdown of fat and glycogen

What is the cause of type 1 diabetes mellitus?

Caused by absolute lack of insulin secretion due to autoimmune destruction of pancreatic islet cells

What type of insulin is rapid acting?

Lispro / Humalog

What type of insulin has prolonged action?

Glargine / Lantus

How long does it take for rapid acting insulin to take effect?

10 - 20 mins

How long does it take for long acting insulin to take effect?

30 mins - 4 hours

How long does rapid acting insulin last?

3 - 5 hours

How long does long acting insulin last?

16 - 24 hours

When is rapid acting insulin usually administered?

At the start of a meal

When is short acting insulin usually administered?

30 - 60 mins before a meal

What is the preferred site for insulin injection?

Abdomen

What type of insulin can be used intravenously?

Regular insulin

What is the safest way to give insulin?

Insulin pen

What are signs and symptoms of hypoglycemia? (5)

• sweating

• tachycardia

• confusion

• drowsiness

• convulsions

Which drugs can raise blood glucose levels? (4)

• Phenytoin

• NSAIDs

• Diuretics

• Corticosteroids

Which drugs can lower blood glucose levels? (3)

• Lithium

• ACE inhibitors

• Beta-blockers

What is type 2 diabetes?

Pancreas can secrete some insulin, but the insulin receptors have become resistant

How do oral anti-diabetic medications treat type 2 diabetes?

Lowers blood glucose

What are the classes of oral anti-diabetic drugs? (6)

• Sulfonylureas

• Biguanides

• Alpha-glucosidase inhibitors

• Thiazolidinediones

• Meglitinides

• Incretin enhancers

How do sulfonylureas treat type 2 diabetes?

stimulates the release of insulin from pancreatic islet cells

What are adverse effects of sulfonylureas? (3)

• Hypoglycemia

• Weight gain

• hepatotoxicity

Why are biguanides usually the first line of therapy for type 2 diabetes?

Do not cause weight gain and hypoglycemia

What is the only drug in the biguanide class?

Metformin

How do biguanides treat type 2 diabetes?

Decreases hepatic production of glucose and reduces insulin resistance

What are some side effects of biguanides? (2)

Usually GI related, like diarrhea and nausea

What is important to remember about biguanides?

Stop medication if getting IV dyes for radiological study

What is a rare and fatal adverse effect of biguanides?

Lactic acidosis

What is the onset of Metformin?

less than 1 hour

What is the duration of Metformin?

12 hours

How do alpha-glucosidase inhibitors treat type 2 diabetes?

Blocks enzymes in the small intestine that break down complex carbs

How do thiazolidinediones treat type 2 diabetes?

Reduce blood glucose by decreasing insulin resistance and inhibiting hepatic gluconeogenesis

How long does it take for thiazolidinediones to work optimally?

3-2 months

What are the common adverse effects of thiazolidinediones? (3)

• fluid retention

• headache

• weight gain

How do meglitinides treat type 2 diabetes?

act by stimulating the release of insulin from pancreatic islet cells

How long is the duration of action for meglitinides?

2 - 4 hours

What is the most common adverse effect for meglitinides?

Hypoglycemia

How do incretin enhancers treat type 2 diabetes?

Mimic effects of incretins- hormones released into the blood by intestine in response to food to signal insulin secretion and stop glucagon production

What is nociceptive pain?

Pain caused by tissue damage

What is neuropathic pain?

Pain from damage to nerve cells

What is breakthrough pain?

Persistant pain that has been aggravated

What are clinical manifestations of pain? (4)

• Increased BP, HR, and RR

• Diaphoresis

• Pallor

• Dialated pupils

How does Acetaminophen treat pain?

Inhibits synthesis of prostoglandins

What is the difference between NSAIDs and Acetaminophen?

NSAIDs have anti-inflammatory properties, where Acetaminophen does not

What is the antidote to Acetaminophen?

Acetylcysteine

How do salicylates (Aspirin) treat pain?

Reduces the production of prostoglandins

What is important to remember about Aspirin?

Children should not take Aspirin due to the risk of Reye’s syndrome