MH 701 SAFETY EXAM #2 Questions With 100% Correct Solutions.

What differentiates SGAs from FGAs? - SGAs have: D2 and 5HT2A receptor antagonism + Antidepressant action, treat pos and neg schizo sx, metabolic SE, D2D interactions, approved for schizophrenia, mania, and acute mania FGAs have positive symptom antipsychotic actions - EPS, hyperprolactinemia Mostly D2 receptor antagonism Which SGA has lowest EPS SE, but is associated with substantial risk of agranuloycytosis? - Clozapine The lower D2 receptor action is probably why clozapine does not cause EPS Weekly WBC counts are indicated to monitor the patient for development of agranulocytosis. What causes breast secretions while receiving perphenazine? Is this typical with both FGAs and SGAs? - Perphenazine blocks dopamine 2 receptors in the pituitary, causing hyperprolactinemia, which can cause galactorrhea. Except for risperidone, SGAs do not elevate prolactin. Which of the SGAs is most likely and which is least likely to worsen a metabolic profile? - Most likely: olanzapine -weight gain, metabolic risk Least likely: ziprasidone -weight neutral, lowers triglyceride levels Describe a cross taper from risperidone to olanzapine - Taper the risperidone off over three weeks while simultaneously beginning olanzapine at 10 mg per dayrisperidone, quetiapine, and ziprazodone lack anticholinergic effects. Abrupt transition from a DRA, olanzapine, or clozapine to one of these agents may cause cholinergic rebound What are some monotherapy agents used as primary treatment of acute mania? - "All of the SDAs (except clozapine) are FDA approved for this. Serotonin dopamine antagonist (SDAs) risperidone (Risperdal), and olanzapine (Zyprexa), ziprasidone (Geodon) Explain Serotonin Dopamine antagonist (SDA) - The newer second-generation antipsychotic drugs, also called atypical antipsychotics are dopamine and 5HT2a antagonists. Down regulate both Dopamine and Serotonin receptors. SDAs include clozapine (Clozaril), risperidone (Risperdal), and olanzapine (Zyprexa). Which medications are FDA-approved for use in bipolar depression? - quetiapine (Seroquel) is approved for bipolar depression. A fixed combination of olanzapine and fluoxetine known as Symbyax is approved as a treatment for acute bipolar depression, The FDA has added a new warning about which SGA, cautioning prescribers about potential QT interval prolongation when above-recommended doses of this drug are combined with which specific drugs? - paliperidone (Invega) may cause an increase in QT interval and should be avoided in combination with other drugs that may cause QT interval prolongation. Effectiveness in treating symptom types in schizophrenia and schizoaffective disorder: DRAs compared to SDAs - Positive symptoms: SDA = or DRA Negative & cognitive symptoms: SDA DRAThe presumed antipsychotic effects of the SDAs are blockade of D2 dopamine receptors. How do the SDAs differ from older antipsychotic drugs? - Higher ratio interactions with serotonin receptor subtypes, most notably the 5-HT2A subtype, as well as with other neurotransmitter systems. This yields antidepressant effects. FDA approved antipsychotics for use in children and adolescents with aggression, severe behavioral issues, and severe psychiatric disorders? - Second Generation antipsychotics Dopamine Seratonin antagonists What mood stabilizer carries the greatest risk of serious birth defects? - Valproate - Risk of neural tube defects ranging from 1 to 6% Also not recommended in women of childbearing age What mood stabilizer is being used with increasing regularity for the treatment of pregnant women with bipolar disorder? - Lamictal - there is a small but documented increased risk for oral cleft defects. Safer than valproate and lithium In clinical trials, what SGA had lower rates of placental passage compared with risperidone and olanzapine. Prospective studies show no increase in fetal malformations or adverse neonatal health outcomes related to this SGA, and manufacturer safety data reveal no teratogenic effect. - quetiapine (Seroquel) - In clinical trials, quetiapine had lower rates of placental passage compared with risperidone and olanzapine. Quetiapine is a reasonable first choice when a new atypical antipsychotic is indicated for a pregnant patient. Which potency FGA neuroleptic agents are recommended if needed in managing pregnant women with psychiatric illness? - Recent studies have not demonstrated teratogenic risk associated with high-or medium-potency neuroleptic medications; A recent meta-analysis noted a higher risk of congenital malformations after first-trimester exposure to low-potency neuroleptic agents.In clinical practice, higher potency neuroleptic agents such as haloperidol (Haldol), perphenazine (Trilafon), and trifluoperazine (Stelazine) are recommended over the lower potency agents in managing pregnant women with psychiatric illness. (Lecture notes) What are the neurotransmitters involved in the pathology of mood disorders? - Dopamine D, Norephinephrine NE, Serotonin SE What 2 classes of medications are used to treat early onset bipolar disorder? - Mood stabilizers (anti-convulsants) and atypical antipsychotics. What are specific examples of common medications used to treat early onset bipolar disorder from each class of medications? Which work quicker? - Atypical antipsychotics: olanzapine, quetiapine, risperidone, aripiprazole, ziprasidone Mood stabilizers: lithium and lamotrigine. Atypical antipsychotics work quicker: quetiapine, resperidone Gabapentin is most useful for these conditions - Insomnia, neuropathic pain, anxiety disorders (social phobia, panic disorder) In what psychiatric disorders or symptoms is topiramate (Topamax) beneficial? - Migraine prevention, obesity treatment, bulimia, binge eating, alcohol dependence