Exam 3 Pharm blk 7

sbentley's version from 2016-02-18 16:23

Section 1

Question Answer
Give the dopamine pathway most commonly associated with psychosis.Mesolimbic-mesocortical = A10 nucleus Dopamine system (likely to be involved in anti-psychotic actions) cells near the Substantia Nigra → send processes to the limbus and neocortex
extrapyramidal effects, such as acute dystonia (facial grimacing and ocular problems); akathisia (constant movement due to leg discomfort); parkinsonian syndrome (slowing of volitional movement), tardive dyskinesia as a late effectMotor adverse effects of antipsycotics
Endocrine AEprolactin increases (all associated with this one), infertility, amenorrhea-galactorrhea
Give four definitions of atypical anti-psychoticsFewer extrapyramidal side effects • Efficacy on negative symptoms • Increased efficacy in treatment-resistant pts. • No elevation of Prolactin levels (?). • Low incidence of tardive dyskinesia. • Ability to improve cognitive functioning
Give the ratio of two neurotransmitter receptors that some researchers think is important in determining anti-psychotic efficacy5-HT2/DA2 ratio
What cardiac concerns are associated with anti-psychotics?Sudden Cardiac death. QTI changes (including atypicals Clonzapine, olanzapine
List 3 dynamic systems upon which lithium is capable of acting.Enhances 5HT. - Decreases DA and NE release. - • Blocks DA receptor supersensitivity that develops with anti-psychotics.
Describe the advantage of giving lithium with anti-psychotics.Adding Li to anti-psychotics may salvage otherwise treatment-resistant schizophrenics
What two metabolic steps in the arachadonic acid cycle are inhibited by lithiumLithium blocks conversion of IP2 → IP1 and IP → inositol which depletes PIP2.
general lithium and anti-psychotic dosing for initial manic episodes Lithium used in combination with anti-psychotics to begin the treatment regimen → when the mania is under control, the anti-psychotic is removed. • Lithium is sometimes used with anti-depressant in the depressed phase of bipolar disease.
what must be monitored during initial and maintained lithium treatmentBlood levels of lithium. Complete blood count, urinalysis and blood tests, ECG in older pts as baseline measures (sinus node effect)
what criteria are required for maintenance therapy with lithium.If pt has had only one cycle or is unreliable stop Lithium after one course with gradual discontinuation. • If cycles are worsening or more frequent or > once per year then maintain them on Lithium after remission, with approval of patient.
used alone for mania or in refractory pts with lithium as a mood stabilizer. Begin with 200 mg twice a day and increase as neededCarbamazapine
When or for whom would you use clonazepam?Useful prophylactic value in patients not completely controlled by lithium
List two symptoms that must be present to DX psycosisdelusions, prominent hallucinations (auditory > visual), incoherence (loosening of associations), catatonia, flat or inappropriate affect

Section 2

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