1. Review the MOA/DOSAGE for pharmacological therapy for a patient on a stimulant medication(s) for ADHD. (p. 747) correct answer: **Note: medication
... [Show More] therapy not first line
**Beware of stimulant use for children with tics
**Rx'ing stimulants: ALWAYS assess cardiac risk because can lead to sudden cardiac death
a. MOA: inhibit reuptake of dopamine and norepinephrine, thereby increasing concentrations in the presynaptic cleft. Amphetamines directly stimulate the release of dopamine and norepinephrine.
b. DOSAGE: Start low, titrate up. In adults, extended release preferred to maximize compliance and minimize risk of abuse. In children, start with short acting to gauge tolerability and response, then switch to a longer-acting.
Clozapine Chemical Structure correct answer: SDA - Serotonin 5HT2A Dopamine D2 antagonist.
Clozapine S/E correct answer: 1. NO EPS, NO TD, NO Hyperprolactinemia
2. Life Threatening S/E agranulocytosis
3. Highest risk for MetX/Cardio Metabolic, greatest degree of weight gain
4. Increased risk seizures
5. Sedating, hyper salivation, risk of myocarditis
Clozapine Tx Benefits correct answer: 1. Reduce risk of suicide in Schizo
2. Efficacy in treating aggression and violence
3. Reduce TD severity
"gold standard" on resistant symptoms but never first line of tx
Olanzapine Chemical Structure correct answer: Serotonin 5HT2A and D2 Dopamine antagonist
MORE POTENT THAN Clozapine
Olanzapine s/e correct answer: 1. Lacks EPS, sedating d/t Antagonist of M1, H1, a1-adrenergic
2. Highest level of cardio-metabolic s/e - weight gain, insulin resistance, triglyceride levels
Olanzapine Indications r/t mood correct answer: Improves mood not only in schizophrenia but also in Bipolar disorder and in treatment resistant depression. Especially with addition of Fluoxetine
Quetiapine Chem Structure correct answer: Serotonin 5HT2A and D2 Dopamine antagonist
Not potent binding at D2 receptor
H1 biding - enhance sleep especially with M1 and A1 adrenergic
Quetiapine Different Dosing Formulations correct answer: IR immediate vs. XR extended release
300mg IR- least effective dose for antipsychotic (it will occupy D2 at 60% but quickly decreases due to hitting peak quickly (a few hours) requires multiple doses
XR - slowly hit its peak, yet rapid enough for the 60% D2 binding
Max Dose - 800mg IR form will only occupy D2 receptors for about 12 hours above the 60% threshold
Max Dose - 800mg XR maintains fully effective d2 occupancy x 24 hours, has less peak dose sedation and not an ideal hypnotic due to delayed release
Quetiapine different doses different actions: correct answer: Papa Bear - 800mg XR = antipsychotic
Mama Bear - 300mg XR = antidepressant
Baby Bear - 50mg IR = sleeping
Quetiapine FDA Approved for correct answer: Bipolar depression and augmentation with SSRI/SNRI in unipolar depression
Neurotransmitters correct answer: Chemicals that transmit signals across a junction "synapse" from one neuron to another 'target' neuron
Where are neurotransmitters stored? correct answer: vesicles
Full Agonist correct answer: mimics the effect of the neurotransmitter
Partial Agonist correct answer: Mimic physiologic actions to a lesser degree
-Some affinity but only moderate intrinsic activity
-Also referred to as "agonist-antagonist"
Antagonist correct answer: blocks the effect a neurotransmitter
inverse agonist correct answer: chemical substance that produces effects opposite those of a particular neurotransmitter
Serotonin Chemical Structure correct answer: 5-HT - hydroxytriptamine
Has 7 5HT receptors
serotonergic drugs have a wide range of functions correct answer: DOMAINS
Serotonin effects much "DOMAINS" correct answer: D for depression -mood regulation
O is for Obsession serotonin regulates obsessive thoughts, behavior-requires higher dosage than depression doses
M is for Migraines - serotonin receptors in brain abort a migraine
A is Anxiety -SSRIs treat
I is for Intestines - 90% of serotonin in the gut, it drives motility
N is Nausea - block serotonin effective at preventing nausea (zofran)
S is sexual side effects
Serotonin Syndrome correct answer: Shits and SHIVERS
Shits is for diarrhea
S is for shivering - fairly unique symptom
H is for Hyperreflexia (overactive) and myoclonus (quick, involuntary muscle jerk)
Increased temperature
Vital sign instability - HR, BP, RR
Encephalopathy (decreased LOC)
Restlessness
Sweating is an autonomic response
a. Latuda FDA approved for
b. Off Label For correct answer: Schizophrenia age 13 and older, Bipolar Depression
b. Treatment resistant depression
b. mixed manic episode
1. Review the Contra/Adverse for pharmacological therapy for a patient on a stimulant medication(s) for ADHD. (p. 747) correct answer: c. CONTRAINDICATIONS: Do not rx methylphenidate in patients with marked anxiety, tension or agitation, glaucoma or hx of tics/Tourettes. Pre-existing cardiovascular disease, moderate/severe HTN, hyperthyroidism, or hx of substance abuse.
d. ADVERSE REACTIONS:
a. Cardiovascular palpitations, tachycardia, HTN, arrhythmias
b. GI Change in appetite, N/V
c. Neurological HA, insomnia, seizure activity
d. Growth retardation
e. Stimulant Medications - One doesn't show efficacy over another.
a. Methylphenidate (Ritalin/Concerta)
b. Dextroamphetamine (Dexedrine)
c. Amphetamine/dextroamphetamine (Adderall)
Which dementia type has a relatively quick onset? correct answer: Delirium
Which following type of dementia is characterized by early changes in behaviors vs. impairments in memory? correct answer: Fronto-temporal dementia
Which dementia is characterized by early persistent visual hallucinations, early fluctuations in cognition and attention and EPS? correct answer: LBD
Which is the following dementias are characterized by Parkinson-like movements? correct answer: LBD Lewey Body Dementia
Neurodegenerative disorder of cognition, related to Parkinsons, path by abnormal aggregation of the Alpha-Synculien
Disease process of LBD correct answer: Neurdegenerative disorder of cognition related to Parkinsons Path by abnormal aggregation of alpha synuclien
1. Progressive loss of memory, language, reasoning or higher mental functions like calculating numbers, intense visual hallucinations - common to see people, animals, errors in perception, seeing faces within inanimate objects [Show Less]