What factors decrease renal clearance? –
Kidney Disease
NSAIDs
Hydrochlorothiazide
ACE Inhibitors ("Prils")
What psychotropic is mainly excreted in the kidneys? –
Lithium
Gabapentin
What makes adults more s
...
What factors decrease renal clearance? –
Kidney Disease
NSAIDs
Hydrochlorothiazide
ACE Inhibitors ("Prils")
What psychotropic is mainly excreted in the kidneys? –
Lithium
Gabapentin
What makes adults more sensitive to psychotropics? –
Decreased intracellular water
Decreased protein binding (drugs dont have protein to bind to, free floats in blood stream)
Low muscle mass
Increased body fat
Where is Norepinephrine produced? –
Locus Ceruleus
Medullary Reticular Formation
What is serotonin also known as? and where is it produced? –
Also known as indole
Raphe Nuclei of the brainstem
where is dopamine produced? –
Substantia Nigra
Ventral Tegmental Area
Nucleus Accumbens
Where is Acetylcholine synthesized? –
Nucleus Basalis or Basal Nucleus of Meynert
Which receptors do benzodiazepines bind to? –
GABA receptors to potentiate calming/anxiolytic effects
Autism Spectrum Disorder –
persistent deficits in social communication and social interaction across multiple contexts:
Lacks Social reciprocity
Nonverbal communication
Unable to efficiently develop, maintain and understand relationships
Restricted repetitive behavior
Stereotyped or repetitive movements
Insistence on sameness
Clock Drawing Test –
The client is asked to reproduce the face of a clock set to a specific time. This test may detect difficulties with visuospatial skills, visual perception, selective attention, memory, abstract thinking, and executive functioning.
Fastest screening tool for possible dementia
Takes 2 mins
Dopamine Pathway responsible for positive symptoms of schizophrenia –
Mesolimbic pathway - excess dopamine
Dopamine pathway responsible for negative symptoms of schizophrenia –
Mesocortical pathway - decreased dopamine
How do FGAs differ from SGAs as far as mechanism of action? –
FGAs deplete dopamine levels in both mesolimbic and mesocortical pathways which helps in reducing positive symptoms but may worsen negative symptoms.
SGAs decrease excess dopamine in mesolimbic pathways reducing positive symptoms, while increasing dopamine in mesocortical pathway improving negative symptoms
SGAs also have 5HT2A antagonism properties
Blockage of dopamine in this pathway increases Acetylcholine which causes EPS –
Nigostriatal pathway
*acetylcholine has inverse relationship with dopamine
Blockage of dopamine in this pathway causes prolactin to increase which causes galactorrhea –
Tuberoinfundibular pathway
Important things to remember with Disulfiram –
Alcohol abstinence for at least 12 hours before starting
Refrain from using anything that contains alcohol (cough med, vinegar, aftershave lotion etc) while on disulfiram and up to 2 weeks after dc
Neuroleptic Malignant Syndrome (NMS) s/sx –
Extreme muscular rigidity
Mutism
Elevated CPK
Elevated WBCs (leukocytosis)
Elevated LFTs
Myoglobinuria (Rhabdo)
hyperthermia
Tachycardia
Diaphoresis
Altered LOC
NMS tx –
1. DC antipsychotic
2. administer D2 agonist bromocriptine (Parlodel)
3. administer muscle relaxant dantrolens (Dantrium)
4. antipyretic (acetaminophen) and cooling blanket
Serotonin Syndrome S/sx –
*autonomic instability
Hyperreflexia
Myoclonic Jerks
Hypertension
agitation and restlessness
Headache
Sweating and shivering
Goosebumps
Confusion
Fever
Seizures
Unconsciousness
Serotonin Syndrome Tx –
Dc offending agent
Administer Cyproheptadine
How long should you wait before switchin SSRIs to MAOI? –
14 days
How long should you wait when switching prozac to MAOI? –
5-6 weeks washout period
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