Adv. Pharmacology Final 6521(Answered)

antipsychotic medications Prescription drugs that are used to reduce psychotic symptoms; frequently used in the treatment of schizophrenia; also called neuroleptics. Block dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery. Acute and chronic psychosis, schizophrenia, manic phase of bipolar disorders, Tourette's syndrome, delusional and schizoaffective disorders, dementia. Conventional (typical) or atypical. Patient education: s/s of orthostatic hypotension - move slowly when standing up. Sedation - avoid hazardous activities such as driving until sedation wears off. Impaires libido and erection / ejaculation *avoid anticholinergic drugs, barbiturates, benzos and alcohol. first generation antipsychotics a group of medications originally developed to combat psychotic symptoms by reducing dopamine levels in the brain; also called conventional or typical antipsychotics block receptors for dopamine, acetylcholine, histamine, and norepinephrine Ex. (low potency): Chlorpromazine, Thioridazine s/e orthostatic hyposension, long Q-T syndrome, high sedation (medium potency): loxapine, perhenazine, s/e moderate sedation (high potency):fluphenazine, haloperidol, pimozide, thiothoxene, frifluoperizine s/e movement problems 00:02 01:17 second generation antipsychotics drugs that alleviate schizophrenia with less likelihood of movement problems S/E: are associated with metabolic adverse effects (eg. weight gain, dyslipidemia, hyperglycemia, and increased risk of diabetes). As such they should be monitored for changes. Olanzapine and clozapine carry the greatest risk. Ex. apripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine (Zyprexa), Quetiapine (Seroquel), Risperidone, Potency the size of the dose needed to elicit a given response Neuroleptic Malignant Syndrome (NMS) A rare and sometimes fatal reaction to high-potency neuroleptic drugs. Symptoms include muscle rigidity, fever, and elevated white blood cell count. It is thought to result from dopamine blockage at the basal ganglia and hypothalamus. Treatment: support body through withdrawal. Chlorpromazine (Thorazine) - Chlorpromazine is used to treat psychotic disorders such as schizophrenia or manic-depression, and severe behavioral problems in children ages 1 through 12. Chlorpromazine is also used to treat nausea and vomiting, anxiety before surgery, chronic hiccups, acute intermittent porphyria, and symptoms of tetanus. S/E: - This medication can cause photophobic skin reactions and damage to the retina of the eye if exposed to direct sunlight. PTs taking this should be reminded to wear protective clothing, apply sunscreen and wear sunglasses when they are outside. sedation, orthostatic hypotension, anticholinergic effects. Clozapine (Clozaril) Second Generation (Atypical) Antipsychotic low affinity to D2 dopamine receptors treats schizophrenia and suicidal behavior. Not many EPSs. S/E weight gain, orthostatic hypotension, sedation, cholinergic, urinary retention, constipation, tachycardia. extrapyramidal symptoms side effects of antipsychotic medications that affect a person's gait, movement, or posture Usually caused by high potency first gen. antipsychotics Also referred to as EPS Acute Dystonia: occurs within first few days of therapy. Severe spasm of the muscles of tongue, face, neck and back. Parkinsonism: bradykinesia, mask-like facies, drooling, tremor, rigidity, shuffling gait, stooped posture. Akathisia: pacing and squirming, need to move uncontrollably. develops in first 2 months of treatment. Tardive Dyskinesia: occurs with long-term therapy. Involuntary choreoathetoid movements of the tongue and face. Haloperidol (Haldol) An antipsychotic drug thought to block receptor sites for dopamine, making it effective in treating the delusional thinking, hallucinations and agitation commonly associated with schizophrenia. -Preferred treatment for Tourette syndrome. -Hepatic metabolism, excreted in urine. -early extrapyramidal reactions occur frequently. Long Q-T . Risperidone (Risperdal) Antipsychotic (Atypical) rapid-acting used for schizophrenia and acute bipolar mania. Absorbed rapidly, not effected by food, peaks 1 hour after dosing. Excreted through urine. S/E: increases prolactin levels but symptoms uncommon. Metabolic effects. Sedation in large doses. Olanzapine (Zyprexa) antipsychotic (atypical), mood stabilizer, thienobenzodiazepine antagonizes dopamine and seratonin type 2 in the CNSalso has antocholinergic, antihistiminic, and anti alpha1 adernergic effects decreases manifestations of psychoses Metabolized by the liver. Peaks in 6 hours 21-54 hour half-life contraindicated in lactation S/D metabolic. can cause leukopenia and neutropenia increasing risk for infection. Somnolence. Quetiapine (Seroquel) Antipsychotic (Atypical). Treats: Schizophrenia, major depression, bipolar Improves positive symptoms and lowers negative symptoms by blocking 5-HT2 receptors and D2 receptors. CYP3A4 - hepatic metabolism and excreted in urine and feces. S/E: metabolic effect, cataracts, long Q-T CYP3A4 most common metabolic enzyme involved in drug interactions Inducers: phenytoin, rifampin, barbituates, carbamazepine Inhibitors: ketoconazole, itraconazole, fluconazole, erythromycin. if using these and taking drugs metabolized by this enzyme, levels will increase which may cause toxicity. Aripiprazole (Abilify) atypical antipsychotic dopamine system stabilizers. Treats schizophrenia, acute bipolar mania, major depressive disorder, agitation associated with psychosis and irritability associated with autism spectrum disorder. Does not have metabolic s/e or EPSs. Food does not effect, protein bound, metabolized by liver, long elimination. S/E headache, agitation, nervousness, anxiety, insomnia, nausea, vomiting, dizziness, somnolence. High suicidality Cariprazine (Vraylar) atypical antipsychotic Mechanism unknown. Similar to aripiprazole. SSRIs (selective serotonin reuptake inhibitors) selectively inhibits serotonin reuptake from synaptic gap and results in potentiation of serotonergic neurotransmissions. Examples: Luvox, Paxil, Prozac, Zoloft end in [pram], [ine] citalopram [Celexa]; escitalopram [Lexapro]; fluoxetine [Prozac]; paroxetine [Paxil] initial responses are seen approx. 1-3 weeks. Max responses can take up to 12 weeks. Take for at least 1 month before changing or increasing dose. Do NOT use with MAOIs Fluoxetine (Prozac) Antidepressant, SSRI Treats: Depression (also bipolar, ocd, panic disorder, bulimia, pmdd). S/E: sexual dysfunction in 70% of adults. Treatment for this would involve decreasing dose, drug holiday on weekends, add a drug to treat this such as bupropion, nefazodone, mirtazapine. Weight gain and serotonin syndrome can be other side effects. Abrupt withdrawal can cause dizziness, headaches, nauea, sensory issues, tremors, anxiety and dysphoria - should be tapered down. Do not use in 3rd trimester Serotonin Syndrome With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist). Can resolve on it's own by discontinuing the drug. SSNRIs (selective serotonin and norepinephrine reuptake inhibitors) Block 5-HT reuptake and thereby increase 5-HT in the synapse. Examples: Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Venlafaxine (Effexor XR), LEvomilnacipran (Fetzima). TCAs (tricyclic antidepressants) Inhibit serotonin and NE re-uptake (Amitrptyline, Desipramine, exepin, imipramine, and Clomipramine-OCD) MAOIs (monoamine oxidase inhibitors) -antidepressants that inhibit the action of an enzyme (monoamine oxidase) that is responsible for breakdown of NE and 5-HT Ex: isocarboxizid (marplan), phenelzine (nardil), selegiline (emsam). -can have fatal side effects (hypertensive crisis) if foods rich in amino acid TYRAMINE are consumed -thus, not used unless other classes of medication have failed -Depression with ATYPICAL features respond well to MAOIs Aripiprazole (Abilify) Antipsychotic Aripiprazole is used to treat certain mental/mood disorders. It may also be used in combination with other medication to treat depression. Dizziness, Lightheadedness, Drowsiness, Nausea, Vomiting, Tiredness, Excess saliva/drooling, Blurred, vision, Weight gain Cyclophosphamide (Cytoxan) Alkylating agent (cytotoxic antineoplastic) Kills rapidly growing cells by interrupting DNA/RNA synthesis Can cause bone marrow suppression, N/V, acute hemorrhagic cystitis, alopecia Meridia intrauterine device that contains levonorgestrel. Prevent conception by producing a harmless local inflammatory response that is spermicidal. Also treats menorrhagia. Light spotting and amenorrhea are common. Risk : PID good for up to 5 years. Terbutaline (Brethine) Uses to relax uterine smooth muscle to inhibit uterine activity Stops preterm labor Also used for asthma attacks. Oxybutynin (Ditropan) Genitourinary Medication, Anticholinergic Stops bladder spasms S/E dry mouth Tolterodine Detrol, Detrol LA Stops bladder spasms / urinary frequency or urgency S/E anticholinergic (less than Oxybutynin) Antimuscarinic Toxicity Hot as a hare (hyperthermia) Dry as a bone (dry eyes, mouth skin) Red as a beet (flushed face) Blind as a bat (mydriasis - very dilated pupils) Mad as a hatter (delirium) Biphosphonates Alendronate (Fosamax) prevent and treat bone loss (dexa scan and bone density test to diagnose) testosterone therapy improve sexual interest (increase libido) increase prostate cancer risk increase cholesterol levels and cause liver damage worsen BPH symptoms (not used with 5 alpha reductase inhibitor) erectile dysfunction (ED) the inability of the male to attain or maintain an erection sufficient to perform sexual intercourse Treatment for erectile dysfunction -viagra and other ED drugs -injection of vasodilating drugs into the penis -penile prosthesis or implants -vascular surgery -vacuum device therapy (few medical procedures for female sexual dysfunction) efficacy effectiveness Pharmacokinetics what the body does to the drug Pharmacodynamics what the drug does to the body drug tolerance the tendency for larger doses of a drug to be required over time to achieve the same effect addiction A physiological or psychological dependence on a drug dependence the condition that results when the brain develops a chemical need for a drug and cannot function normally without it withdrawal the discomfort and distress that follow discontinuing the use of an addictive drug first pass effect The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream. idiosyncratic response unpredictable and unexplained drug reaction medication reconcilliation A procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery. Casodex bicalutamide Prostate cancer Dronabinol (Marinol) Cannabinoid Used for chemo N/V and as an appetite stimulant in AIDS and Cancer patients Can cause dissociation/dysphoria, hypotension, tachycardia Permethrin Treats scabies and lice Oprelvekin (Neumega) Uses: stimulate platelet production, thrombocytopenia related to cancer. Side effects: fluid retention, papilledema, cardiac dysrhythmia Nursing interventions: administer within 6-24 hr after chemotherapy, subcutaneous Silver sulfadiazine (Silvadene) Treatment of burns; usually used with open method of wound care; used to avoid acid=base complication; keeps eschar soft, making debridement easier; adverse reactions: penetrates wound slowly; administer pain medication prior to dressing change Neupogen (filgrastim) Neupogen is a man-made form of a protein that stimulates the growth of white blood cells in your body. White blood cells help your body fight against infection. Neupogen is used to treat neutropenia, a lack of certain white blood cells caused by cancer, bone marrow transplant, receiving chemotherapy, or by other conditions epoetin alfa (Epogen, Procrit) biosynthetic form of erythropoietin Quinine/Quinidine For Anti-malarial parenteral use. Anti-malarial: Suppresses parasite in the RBC (heme metabolism inhibitors/ schizonticide) antibiotic A chemical secreted by a living organism that kills or reduces the reproduction rate of other organisms Antiviral chemical that combats a specific viral disease (e.g. herpes) (Denavir, Famivir, Relenza, Retrovir, Tamiflu, Zovirax) Conjugated drugs are a class of biopharmaceutical drugs designed as a targeted therapy for treating cancer. Unlike chemotherapy, ADCs are intended to target and kill tumor cells while sparing healthy cells. sexually transmitted infections (STIs) Infections that can be, but are not always, transmitted from one person to the next through sexual contact. Chlamydia 1st line: Azithromycin 1g po single dose or Doxycycline 100mg po bid x 7 days 2nd line: Erythromycin base or fluoroquinolone(levofloxacin or ofloxacin)- No sex for 7 days after initiation of treatment- Canadian guidelines state to retest after 6 months Gonorrhea treatment Gonorrhea TX: IM Ceftriaxone *Cover Chlamydia with: azithromycin : 1 g orally as a single dose IM doxycycline : 100 mg orally twice daily for 7 days herpes simplex Treatment acyclovir, famciclovir, valacyclovir PID treatment Ceftriaxone 250mg IM single dose PLUS Doxycycline 100mg po bid (14days) OPTIONAL Metronidazole 500mg po bid (14 days) Syphilis treatment (primary, secondary, early latent) Antibiotics: large, injected dose of penicillin is most effective Benzathine penicillin G 2.4 million units IM single dose Latent: Benzathine penicillin G 7.2 million units total2.4 million units IM weekly X 3 weeks Methotrexate (Rheumatrex) It can treat cancer of the blood, bone, lung, breast, head, and neck. It can also treat rheumatoid arthritis and psoriasis. Sulconazole (Exelderm) an antifungal medication of the imidazole class. It is available as a cream or solution to treat skin infections such as athlete's foot, ringworm, jock itch, and sun fungus MRSA (methicillin-resistant Staphylococcus aureus) a mutated strain of the bacterium Staphylococcus aureus that is resistant to the antibiotic, methicillin.