PC 707 Module 7 Exam - CNS Q & A Bipolar: -consists of fluctuations between depression & mania -increased risk of suicide -need to refer to psychiatrist* -medications used: Lithium, anticonvulsants, atypical antipsycho
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PC 707 Module 7 Exam - CNS Q & A Bipolar: -consists of fluctuations between depression & mania -increased risk of suicide -need to refer to psychiatrist* -medications used: Lithium, anticonvulsants, atypical antipsychotics What is the gold standard treatment for bipolar disorder? -Lithium What are the cautions with lithium use? -many drug interactions -maintain sufficient sodium levels--avoid diuretics (hyponatremia can cause lithium toxicity) -narrow therapeutic index (must be monitored very closely) Lithium use in pregnancy: -category D -benefits must outweigh the risks -associated with increased risk of cardiovascular defects* -increased toxicity risk for mother during pregnancy* -best to discontinue until postpartum period Lithium use in lactation: -monitor infant levels to maintain safety* -important that infant has adequate output* -do not use if infant is premature, dehydrated, not adequately voiding--could cause toxicity more easily* Antipsychotics are used to treat: -psychosis, delusions, bipolar, adjunct for refractory depression What is important to consider when adding other drugs when taking anti-psychotics? -potential drug interactions that could inhibit or induce the metabolism -inducing could cause treatment destabilization -inhibiting could increase risk for side effects What is the difference in MOA between 1st generation and 2nd generation (atypical) antipsychotics? -1st generation-->blocks dopamine 2 receptors which treats the positive symptoms of schizophrenia
-2nd generation (atypical)-->blocks dopamine 2 receptors AND serotonin 2A receptors which treats positive and negative symptoms of schizophrenia What is the main concern with 1st generation (conventional) antipsychotics? -Extrapyramidal side effects due to non-selective blocking of dopamine receptors* -can also cause increased prolactin levels--causing galactorrhea, amenorrhea, sexual dysfunction, weight gain What are extrapyramidal symptoms? -"Pseudoparkinsonism" - shuffling, propulsive gait, mask-like face, drooling, pill rolling etc. -akathisia, akinesia, dystonia, tardive dyskinesia What is tardive dyskinesia? -abnormal muscle movements of mouth, tongue, face, jaw -can progress to limbs -can be acute or chronic What is the main concern with 2nd generation (atypical) antipsychotics? -risk for developing metabolic syndrome -assess risks--weight gain, obesity, dyslipidemia, diabetes, CVD -monitor lipids, weight, diet What atypical antipsychotics have the highest risk of metabolic syndrome? -clozapine (Clozaril) & olanzapine (Zyprexa) What atypical antipsychotics have the lowest risk of metabolic syndrome? -ziprasidone (Geodon) & aripriprazole (Abilify) ADHD: -low levels of norepinephrine & dopamine -significant impairment in functioning, self-esteem, social relationship -high risk behaviors & impulsivity -can continue into adulthood What medications are available to help treat ADHD? -stimulants*---1st line -NRIs (atomoxetine-Strattera) -alpha 2 adrenergics (guanfacine & clonidine) -antidepressants (TCAs & bupropion) -fish oil (has shown some efficacy) Which medications are the most effective for treating ADHD? -stimulants -Ex: methylphenidate & dextroamphetamine --->behavioral therapy is the LEAST effective as it's inability not lack of willingness Stimulants: -increase the release of norepinephrine & dopamine -increased alertness, decreased fatigue, elevates mood, decreases appetite What is the most common side effects of stimulants? -insomnia, jitteriness, weight loss* -->these can be avoided by having the patient eat prior to taking medication and taking the medication early in the morning to offset increased alertness at bedtime -->can also decrease to a more tolerable dosage How do stimulants effect height in children? -can cause a height deficit in the first 3 years of treatment -there is a catch up period--and does not affect ultimate adult height* If a child has a high BMI at the initiation of stimulant therapy what could happen: -significant weight reduction Black box warning for stimulants: -potential cardiovascular risk* Potential risk with untreated ADHD? -drug abuse (self-medicating), alcoholism, accidents from impulsivity, job loss, academic failure, depression, anxiety, smoking What is Parkinson's disease? -degeneration of neurons in the substantia nigra that supply dopamine -results in an imbalance between dopamine and acetylcholine* -tremor at rest, rigidity, postural instability, bradykinesia, autonomic dysfunction, depression, psychosis, dementia, etc. What drugs are available to help treat Parkinsons? -Levodopa -dopamine agonists -anticholinergics --->increase dopamine and block acetylcholine* --->these drugs are not a cure but help with management of symptoms What is the most effective treatment for motor symptoms of Parkinsons?
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