Second-generation antipsychotics have fewer extrapyramidal side effects than first-generation drugs. They include risperidone, paliperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, asenapine, iloperidone, lurasidone, and clozapine. Clozapine is reserved for treatment-resistant cases due to its risk of agranulocytosis. These drugs differ in their receptor binding profiles and side effect risks like weight gain, metabolic effects, and QTc prolongation. Dosage selection depends on these factors and potential drug interactions.
This document discusses the development and properties of various atypical antipsychotic drugs. It provides chemical structures and names for common atypical antipsychotics like clozapine, risperidone, olanzapine, quetiapine and ziprasidone. It summarizes the pharmacokinetics, therapeutic indications, side effects and dosing for these drugs. The document also discusses differences between first and second generation antipsychotics and adverse effects of antipsychotic treatment.
Aripiprazole is an atypical antipsychotic drug that acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at serotonin 5-HT2A, 5-HT2C, and 5-HT7 receptors. It is FDA approved to treat schizophrenia, bipolar disorder, major depressive disorder, irritability associated with autism, and acute agitation related to schizophrenia or bipolar disorder. Common side effects include weight gain, extrapyramidal symptoms, hyperglycemia, and sedation. It is metabolized by CYP3A4 and CYP2D6 enzymes and can have interactions with drugs that inhibit these pathways such as ritonavir and
Olanzapine is an atypical antipsychotic approved to treat schizophrenia and bipolar disorder. It works by blocking dopamine, serotonin, histamine, and muscarinic receptors. Common side effects include weight gain, hyperglycemia, and increased mortality in elderly patients with dementia. It is generally dosed between 5-20 mg daily, with monitoring of blood glucose and lipids recommended due to metabolic side effect risks.
This document discusses schizophrenia and the atypical antipsychotic drug aripiprazole. It defines schizophrenia as a mental disorder where patients have difficulties determining what is real, thinking clearly, having normal emotions, and acting normally socially. It then describes the positive and negative symptoms of schizophrenia. The document outlines aripiprazole's uses in treating schizophrenia, bipolar mania, depression and agitation, as well as its mechanism of action, pharmacokinetics, side effects, drug interactions and comparisons to chlorpromazine. It concludes that aripiprazole is a second-generation antipsychotic that is better than chlorpromazine due to its partial agonist activity at dopamine D2 receptors resulting in milder extra
Parkinson's disease is a neurodegenerative disorder characterized by three key points:
1) Loss of dopaminergic neurons in the substantia nigra leads to decreased dopamine in the striatum and motor symptoms like bradykinesia.
2) Accumulation of alpha-synuclein protein is involved in the pathogenesis and motor symptoms result from disinhibition of movement circuits due to dopamine deficiency.
3) Treatment involves dopamine replacement therapy using levodopa although long term use can cause motor fluctuations and dyskinesias which other drugs aim to reduce.
The document reviews first and second generation antipsychotics, how they work, their side effect profiles, and monitoring recommendations. It discusses the metabolic side effects of various antipsychotics like olanzapine and clozapine which can increase risks of diabetes, dyslipidemia, and weight gain. Monitoring of weight, glucose, lipids is recommended when prescribing antipsychotics to manage these metabolic risks.
Schizophrenia is a thought disorder characterized by positive, negative, cognitive, and mood symptoms. While the true cause is unknown, there are several theories involving dopamine and glutamate imbalances. Diagnosis requires symptoms for over 6 months and significant impairment in functioning. Treatment involves first-generation antipsychotics like chlorpromazine or second-generation antipsychotics like clozapine, risperidone, and olanzapine. Two major studies, CATIE and CUtLASS, found few differences in effectiveness between first and second-generation drugs, though second-generation drugs had fewer side effects in some cases.
This document discusses the development and properties of various atypical antipsychotic drugs. It provides chemical structures and names for common atypical antipsychotics like clozapine, risperidone, olanzapine, quetiapine and ziprasidone. It summarizes the pharmacokinetics, therapeutic indications, side effects and dosing for these drugs. The document also discusses differences between first and second generation antipsychotics and adverse effects of antipsychotic treatment.
Aripiprazole is an atypical antipsychotic drug that acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at serotonin 5-HT2A, 5-HT2C, and 5-HT7 receptors. It is FDA approved to treat schizophrenia, bipolar disorder, major depressive disorder, irritability associated with autism, and acute agitation related to schizophrenia or bipolar disorder. Common side effects include weight gain, extrapyramidal symptoms, hyperglycemia, and sedation. It is metabolized by CYP3A4 and CYP2D6 enzymes and can have interactions with drugs that inhibit these pathways such as ritonavir and
Olanzapine is an atypical antipsychotic approved to treat schizophrenia and bipolar disorder. It works by blocking dopamine, serotonin, histamine, and muscarinic receptors. Common side effects include weight gain, hyperglycemia, and increased mortality in elderly patients with dementia. It is generally dosed between 5-20 mg daily, with monitoring of blood glucose and lipids recommended due to metabolic side effect risks.
This document discusses schizophrenia and the atypical antipsychotic drug aripiprazole. It defines schizophrenia as a mental disorder where patients have difficulties determining what is real, thinking clearly, having normal emotions, and acting normally socially. It then describes the positive and negative symptoms of schizophrenia. The document outlines aripiprazole's uses in treating schizophrenia, bipolar mania, depression and agitation, as well as its mechanism of action, pharmacokinetics, side effects, drug interactions and comparisons to chlorpromazine. It concludes that aripiprazole is a second-generation antipsychotic that is better than chlorpromazine due to its partial agonist activity at dopamine D2 receptors resulting in milder extra
Parkinson's disease is a neurodegenerative disorder characterized by three key points:
1) Loss of dopaminergic neurons in the substantia nigra leads to decreased dopamine in the striatum and motor symptoms like bradykinesia.
2) Accumulation of alpha-synuclein protein is involved in the pathogenesis and motor symptoms result from disinhibition of movement circuits due to dopamine deficiency.
3) Treatment involves dopamine replacement therapy using levodopa although long term use can cause motor fluctuations and dyskinesias which other drugs aim to reduce.
The document reviews first and second generation antipsychotics, how they work, their side effect profiles, and monitoring recommendations. It discusses the metabolic side effects of various antipsychotics like olanzapine and clozapine which can increase risks of diabetes, dyslipidemia, and weight gain. Monitoring of weight, glucose, lipids is recommended when prescribing antipsychotics to manage these metabolic risks.
Schizophrenia is a thought disorder characterized by positive, negative, cognitive, and mood symptoms. While the true cause is unknown, there are several theories involving dopamine and glutamate imbalances. Diagnosis requires symptoms for over 6 months and significant impairment in functioning. Treatment involves first-generation antipsychotics like chlorpromazine or second-generation antipsychotics like clozapine, risperidone, and olanzapine. Two major studies, CATIE and CUtLASS, found few differences in effectiveness between first and second-generation drugs, though second-generation drugs had fewer side effects in some cases.
This document provides information on several second-generation or atypical antipsychotic medications including clozapine, olanzapine, quetiapine, risperidone, paliperidone, ziprasidone, aripiprazole, and carbamazepine. It describes the indications, mechanisms of action, pharmacokinetics, dosages, drug interactions, and side effects of each drug. It also discusses risks of weight gain and diabetes associated with some of these medications and monitoring parameters for patients taking them.
Paliris XR is an extended-release formulation of paliperidone, an atypical antipsychotic drug approved to treat schizophrenia and schizoaffective disorder. It uses an osmotically released oral delivery system to provide a consistent release of paliperidone over 24 hours. Paliperidone is a metabolite of risperidone and works as an antagonist at dopamine, serotonin, alpha-1, and histamine receptors. It has fewer side effects than risperidone and allows therapeutic drug levels to be reached without requiring supplementation during initiation of treatment. The document provides information on dosing, side effects, pharmacokinetics, and advantages of paliperidone over risperidone for treating
This document discusses the history and development of atypical antipsychotic medications. It begins with an overview of the serendipitous discoveries that led to the development of early antipsychotics like chlorpromazine in the 1950s. It then covers the development of second-generation atypical antipsychotics from the 1990s onward, including clozapine, risperidone, olanzapine, quetiapine, and others. The rest of the document details the mechanisms of action, therapeutic indications, side effect profiles, and dosing of various atypical antipsychotics.
Amisulpride is an atypical antipsychotic that selectively blocks dopamine D2 and D3 receptors. It is used to treat schizophrenia and related psychotic disorders. Key points:
- It works by antagonizing dopamine receptors in the limbic system, resulting in fewer extrapyramidal side effects than other antipsychotics.
- It is effective in improving both positive and negative symptoms of schizophrenia.
- Common side effects include extrapyramidal symptoms, insomnia, hypersalivation, nausea and weight gain.
- It has a low risk of metabolic side effects like diabetes and high cholesterol compared to other second-generation antipsychotics.
This document discusses newer anti-epileptic drugs (AEDs) including their mechanisms of action, indications, dosages, and adverse effects. Some key newer AEDs mentioned are gabapentin, pregabalin, levetiracetam, lamotrigine, topiramate, tiagabine, vigabatrin, and lacosamide. These drugs were developed to address limitations of older AEDs like phenobarbital, phenytoin, and carbamazepine, which often caused adverse effects like behavioral changes, rashes, and interactions with other medications. The ideal properties of an AED and treatment guidelines are also summarized.
Delirium and dementia have different onset patterns and symptoms. Delirium has a rapid onset and fluctuating symptoms, while dementia has a slower insidious onset. The primary goals in treating delirium are to address the underlying cause and manage symptoms like psychosis and insomnia with antipsychotics like haloperidol. Dementia treatments focus on symptomatic relief of cognitive and memory issues using acetylcholinesterase inhibitors like donepezil, rivastigmine, and galantamine. Common forms of dementia include Alzheimer's disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia.
1) Asenapine and agomelatine are drugs used to treat schizophrenia, bipolar disorder, and major depressive disorder. Asenapine is an antipsychotic while agomelatine is an antidepressant with a novel mechanism of action targeting melatonin receptors.
2) Both drugs have advantages like rapid onset of action and promising safety profiles. However, they also have limitations and warnings. Asenapine is associated with increased mortality in elderly patients with dementia. Agomelatine requires dose adjustment in patients with hepatic impairment.
3) The document provides details on the pharmacology, pharmacokinetics, clinical trials, dosing, precautions and drug interactions of asenap
Classical versus atypical antipsychoticsAkhil Joseph
This document summarizes key differences between typical and atypical antipsychotics. It discusses their mechanisms of action, efficacy, side effect profiles, pharmacokinetics, and drug interactions. Typical antipsychotics work mainly through D2 receptor antagonism and have higher rates of extrapyramidal side effects, while atypicals have additional 5-HT2A antagonism and generally cause more metabolic side effects like weight gain. Both classes present risks like QT prolongation, NMS, and low seizure thresholds that require monitoring.
This document summarizes several newer antipsychotic medications introduced after 2005, including paliperidone, iloperidone, asenapine, lurasidone, blonanserin, and cariprazine. It describes the indication, mechanism of action, pharmacokinetics, adverse effects, dosing, and precautions for each drug. It also briefly discusses brexiprazole and several investigational antipsychotics targeting non-dopamine receptors with limited success to date, such as pomaglumetad, sarcosine, and pimaverine.
The document describes 4 atypical antipsychotic drugs - Cariprazine, Clozapine, Lurasidone, and Olanzapine. It provides information on the mechanism of action, classification, potential adverse effects and toxicity, recommended dosing, and brand names for each drug. The drugs have varying mechanisms of action involving dopamine and serotonin receptor antagonism and agonism, and can cause side effects like drowsiness, weight gain, increased blood sugar and lipids, and in rare cases neuroleptic malignant syndrome or pancreatitis.
Risperidone is an antipsychotic medication developed in the 1980s-1990s and approved by the FDA in 1994. It is on the WHO's list of essential medicines. Risperidone is effective at decreasing hallucinations and delusions in psychotic patients, allowing them to function better. It is available in tablet, liquid, and injectable forms. Risperidone is metabolized in the liver and has an oral bioavailability of 70%. Common side effects include extrapyramidal symptoms, weight gain, and hyperprolactinemia. It is indicated for schizophrenia, bipolar mania, autism-related irritability, and other off-label uses, though has black box
This document provides an overview of pharmacotherapy for Parkinsonism. It discusses the clinical features and etiology of Parkinson's disease and outlines the mechanisms and uses of various drug classes for treatment, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, and other drugs. Side effects and considerations for each class are also reviewed. Non-motor symptoms can be treated with additional drugs like antidepressants, anxiolytics, and atypical antipsychotics as adjunctive therapy.
This document provides an overview of various anti-epileptic drugs classified into different categories. It describes the mechanism of action, pharmacokinetics, adverse effects and uses of common anti-epileptics such as phenobarbitone, primidone, phenytoin, carbamazepine, oxcarbazepine, ethosuximide, valproic acid, clonazepam, clobazam, lamotrigine, gabapentin, pregabalin, topiramate, zonisamide and levetiracetam. The summary highlights the classification of anti-epileptics and briefly discusses the properties and clinical applications of select first-line drugs
Ms. RS is a 35-year-old female patient with schizophrenia and hypothyroidism who presents with auditory and visual hallucinations, disturbed sleep, and suspicious thoughts. She exhibits both positive symptoms like delusions and hallucinations as well as negative symptoms like lack of activeness. She was initially prescribed typical antipsychotics like haloperidol and fluphenazine but developed resistance, so she was switched to clozapine and olanzepine, both atypical antipsychotics. Depot injections of antipsychotics are beneficial for schizophrenia management as they ensure medication adherence and more stable drug levels over time, reducing relapse risk compared to oral medications.
The document discusses drugs acting on the central nervous system (CNS). It first introduces that CNS drugs are used for both medical and non-medical purposes to act on the brain and spinal cord. It then discusses the major neurotransmitters of the CNS including noradrenaline, dopamine, serotonin, and acetylcholine. For each neurotransmitter, it briefly describes their physiological functions. The document also provides information on drugs used for Parkinson's disease, epilepsy, and schizophrenia, outlining their mechanisms of action, therapeutic uses, and common medications employed to treat each condition.
The document summarizes the key differences and treatment approaches for delirium and dementia. Delirium is characterized by a rapid onset, fluctuating course, and primary defect in attention, while dementia has a more insidious onset and primary defect in memory. Treatment for delirium focuses on treating the underlying cause, while treatment for dementia aims to manage cognitive and behavioral symptoms through acetylcholinesterase inhibitors or other medications depending on the symptom.
The document summarizes antiparkinson drugs. Levodopa is the gold standard treatment for Parkinson's disease as it is converted to dopamine in the brain. Carbidopa is given with levodopa to reduce side effects by inhibiting peripheral conversion. Other drugs include dopamine agonists like pramipexole and ropinirole, COMT inhibitors like entacapone, and MAO-B inhibitors like selegiline. Anticholinergics and amantadine are also used to treat symptoms of Parkinson's disease.
Unlock your potential with the ultimate NAPLEX study guide, meticulously designed to ensure you pass your pharmacy licensing exam with flying colors. This guide offers a thorough exploration of all the essential topics covered in the NAPLEX, including pharmacotherapy, pharmacy law, and medication management. Each chapter is structured to enhance your understanding, complete with clear explanations, practical examples, and review questions to test your knowledge.
Management of adverse effect of antipsychotics 1sadaf89
The document summarizes the management of adverse effects of antipsychotics. It discusses neurological side effects like neuroleptic induced movement disorders including acute dystonia, akathisia, parkinsonism, and tardive dyskinesia. It also discusses non-neurological side effects. For each side effect, it covers clinical presentation, risk factors, pathophysiology, treatment options and implications. The management of adverse effects is an important aspect of antipsychotic treatment.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
This document provides information on several second-generation or atypical antipsychotic medications including clozapine, olanzapine, quetiapine, risperidone, paliperidone, ziprasidone, aripiprazole, and carbamazepine. It describes the indications, mechanisms of action, pharmacokinetics, dosages, drug interactions, and side effects of each drug. It also discusses risks of weight gain and diabetes associated with some of these medications and monitoring parameters for patients taking them.
Paliris XR is an extended-release formulation of paliperidone, an atypical antipsychotic drug approved to treat schizophrenia and schizoaffective disorder. It uses an osmotically released oral delivery system to provide a consistent release of paliperidone over 24 hours. Paliperidone is a metabolite of risperidone and works as an antagonist at dopamine, serotonin, alpha-1, and histamine receptors. It has fewer side effects than risperidone and allows therapeutic drug levels to be reached without requiring supplementation during initiation of treatment. The document provides information on dosing, side effects, pharmacokinetics, and advantages of paliperidone over risperidone for treating
This document discusses the history and development of atypical antipsychotic medications. It begins with an overview of the serendipitous discoveries that led to the development of early antipsychotics like chlorpromazine in the 1950s. It then covers the development of second-generation atypical antipsychotics from the 1990s onward, including clozapine, risperidone, olanzapine, quetiapine, and others. The rest of the document details the mechanisms of action, therapeutic indications, side effect profiles, and dosing of various atypical antipsychotics.
Amisulpride is an atypical antipsychotic that selectively blocks dopamine D2 and D3 receptors. It is used to treat schizophrenia and related psychotic disorders. Key points:
- It works by antagonizing dopamine receptors in the limbic system, resulting in fewer extrapyramidal side effects than other antipsychotics.
- It is effective in improving both positive and negative symptoms of schizophrenia.
- Common side effects include extrapyramidal symptoms, insomnia, hypersalivation, nausea and weight gain.
- It has a low risk of metabolic side effects like diabetes and high cholesterol compared to other second-generation antipsychotics.
This document discusses newer anti-epileptic drugs (AEDs) including their mechanisms of action, indications, dosages, and adverse effects. Some key newer AEDs mentioned are gabapentin, pregabalin, levetiracetam, lamotrigine, topiramate, tiagabine, vigabatrin, and lacosamide. These drugs were developed to address limitations of older AEDs like phenobarbital, phenytoin, and carbamazepine, which often caused adverse effects like behavioral changes, rashes, and interactions with other medications. The ideal properties of an AED and treatment guidelines are also summarized.
Delirium and dementia have different onset patterns and symptoms. Delirium has a rapid onset and fluctuating symptoms, while dementia has a slower insidious onset. The primary goals in treating delirium are to address the underlying cause and manage symptoms like psychosis and insomnia with antipsychotics like haloperidol. Dementia treatments focus on symptomatic relief of cognitive and memory issues using acetylcholinesterase inhibitors like donepezil, rivastigmine, and galantamine. Common forms of dementia include Alzheimer's disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia.
1) Asenapine and agomelatine are drugs used to treat schizophrenia, bipolar disorder, and major depressive disorder. Asenapine is an antipsychotic while agomelatine is an antidepressant with a novel mechanism of action targeting melatonin receptors.
2) Both drugs have advantages like rapid onset of action and promising safety profiles. However, they also have limitations and warnings. Asenapine is associated with increased mortality in elderly patients with dementia. Agomelatine requires dose adjustment in patients with hepatic impairment.
3) The document provides details on the pharmacology, pharmacokinetics, clinical trials, dosing, precautions and drug interactions of asenap
Classical versus atypical antipsychoticsAkhil Joseph
This document summarizes key differences between typical and atypical antipsychotics. It discusses their mechanisms of action, efficacy, side effect profiles, pharmacokinetics, and drug interactions. Typical antipsychotics work mainly through D2 receptor antagonism and have higher rates of extrapyramidal side effects, while atypicals have additional 5-HT2A antagonism and generally cause more metabolic side effects like weight gain. Both classes present risks like QT prolongation, NMS, and low seizure thresholds that require monitoring.
This document summarizes several newer antipsychotic medications introduced after 2005, including paliperidone, iloperidone, asenapine, lurasidone, blonanserin, and cariprazine. It describes the indication, mechanism of action, pharmacokinetics, adverse effects, dosing, and precautions for each drug. It also briefly discusses brexiprazole and several investigational antipsychotics targeting non-dopamine receptors with limited success to date, such as pomaglumetad, sarcosine, and pimaverine.
The document describes 4 atypical antipsychotic drugs - Cariprazine, Clozapine, Lurasidone, and Olanzapine. It provides information on the mechanism of action, classification, potential adverse effects and toxicity, recommended dosing, and brand names for each drug. The drugs have varying mechanisms of action involving dopamine and serotonin receptor antagonism and agonism, and can cause side effects like drowsiness, weight gain, increased blood sugar and lipids, and in rare cases neuroleptic malignant syndrome or pancreatitis.
Risperidone is an antipsychotic medication developed in the 1980s-1990s and approved by the FDA in 1994. It is on the WHO's list of essential medicines. Risperidone is effective at decreasing hallucinations and delusions in psychotic patients, allowing them to function better. It is available in tablet, liquid, and injectable forms. Risperidone is metabolized in the liver and has an oral bioavailability of 70%. Common side effects include extrapyramidal symptoms, weight gain, and hyperprolactinemia. It is indicated for schizophrenia, bipolar mania, autism-related irritability, and other off-label uses, though has black box
This document provides an overview of pharmacotherapy for Parkinsonism. It discusses the clinical features and etiology of Parkinson's disease and outlines the mechanisms and uses of various drug classes for treatment, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, and other drugs. Side effects and considerations for each class are also reviewed. Non-motor symptoms can be treated with additional drugs like antidepressants, anxiolytics, and atypical antipsychotics as adjunctive therapy.
This document provides an overview of various anti-epileptic drugs classified into different categories. It describes the mechanism of action, pharmacokinetics, adverse effects and uses of common anti-epileptics such as phenobarbitone, primidone, phenytoin, carbamazepine, oxcarbazepine, ethosuximide, valproic acid, clonazepam, clobazam, lamotrigine, gabapentin, pregabalin, topiramate, zonisamide and levetiracetam. The summary highlights the classification of anti-epileptics and briefly discusses the properties and clinical applications of select first-line drugs
Ms. RS is a 35-year-old female patient with schizophrenia and hypothyroidism who presents with auditory and visual hallucinations, disturbed sleep, and suspicious thoughts. She exhibits both positive symptoms like delusions and hallucinations as well as negative symptoms like lack of activeness. She was initially prescribed typical antipsychotics like haloperidol and fluphenazine but developed resistance, so she was switched to clozapine and olanzepine, both atypical antipsychotics. Depot injections of antipsychotics are beneficial for schizophrenia management as they ensure medication adherence and more stable drug levels over time, reducing relapse risk compared to oral medications.
The document discusses drugs acting on the central nervous system (CNS). It first introduces that CNS drugs are used for both medical and non-medical purposes to act on the brain and spinal cord. It then discusses the major neurotransmitters of the CNS including noradrenaline, dopamine, serotonin, and acetylcholine. For each neurotransmitter, it briefly describes their physiological functions. The document also provides information on drugs used for Parkinson's disease, epilepsy, and schizophrenia, outlining their mechanisms of action, therapeutic uses, and common medications employed to treat each condition.
The document summarizes the key differences and treatment approaches for delirium and dementia. Delirium is characterized by a rapid onset, fluctuating course, and primary defect in attention, while dementia has a more insidious onset and primary defect in memory. Treatment for delirium focuses on treating the underlying cause, while treatment for dementia aims to manage cognitive and behavioral symptoms through acetylcholinesterase inhibitors or other medications depending on the symptom.
The document summarizes antiparkinson drugs. Levodopa is the gold standard treatment for Parkinson's disease as it is converted to dopamine in the brain. Carbidopa is given with levodopa to reduce side effects by inhibiting peripheral conversion. Other drugs include dopamine agonists like pramipexole and ropinirole, COMT inhibitors like entacapone, and MAO-B inhibitors like selegiline. Anticholinergics and amantadine are also used to treat symptoms of Parkinson's disease.
Unlock your potential with the ultimate NAPLEX study guide, meticulously designed to ensure you pass your pharmacy licensing exam with flying colors. This guide offers a thorough exploration of all the essential topics covered in the NAPLEX, including pharmacotherapy, pharmacy law, and medication management. Each chapter is structured to enhance your understanding, complete with clear explanations, practical examples, and review questions to test your knowledge.
Management of adverse effect of antipsychotics 1sadaf89
The document summarizes the management of adverse effects of antipsychotics. It discusses neurological side effects like neuroleptic induced movement disorders including acute dystonia, akathisia, parkinsonism, and tardive dyskinesia. It also discusses non-neurological side effects. For each side effect, it covers clinical presentation, risk factors, pathophysiology, treatment options and implications. The management of adverse effects is an important aspect of antipsychotic treatment.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
8. +
The term atypical is used because these drugs differ in their
side effect profiles, most notably a lower risk of
extrapyramidal side effects (EPS)
As of 20 1 3 , ten second-generation antipsychotic drugs were
approved by the Food and Drug Administration (FDA).
These include the following: Risperidone (Risperdal), Olanzapine
(Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon),
Aripiprazole (Abilify), Paliperidone (Invega), Asenapine (Saphris),
Lurasidone (Latuda), Iloperidone (Fanapt), and Clo zapine
(Clozaril).
9. +
MECHAN ISMS OF ACTION
The presumed antipsychotic effects of the SDAs are blockade
of D2 dopamine receptors. Where the SDAs differ from older
antipsychotic drugs is their higher ratio interactions with
serotonin receptor subtypes, most notably the 5-HT2A
subtype, as well as with other neurotransmitter systems.
It is hypothesized that these properties account for the distinct
tolerability profiles associated with each of the SDAs. All SDAs
have different chemical structures, receptor affinities, and side
effect profiles.
10. +
THERAPEUTIC INDICATIONS
Schizophrenia
Acute Mania
Adjunctive therapy in major depressive disorder.
Posttraumatic stress disorder
Anxiety Disorders
**All of these agents are considered first-line drugs for
Schizophrenia except Clozapine
11. +
Risperidone (Risperdal)
INDICATIONS:
Acute and maintenance treatment of Schizophrenia in adults and
adolescents.
Short-term treatment of acute manic - mixed with lithium or
valproate
Irritability associated with autistic spectrum DO in 5-16 years of
age
On August 22, 2007, risperidone was approved as the ONLY drug agent available
for treatment of schizophrenia in youths, ages 13–17
12. +
Pharmacology
Extensive first pass hepatic metabolism to 9-hydroxy
risperidone
Peak plasma level for the parent compound – 1hr
Metabolite – 3hrs
Half-life - 20hrs (implication?)
If dose is below 6mg per day – less likely to cause EPS
13. +
Dosages
Availability – 0.25, 0.5, 1, 2, 3 and 4mg tablets and a 1mg/ml
oral solution.
Initial dosage is usually 1 to 2mg at night which can be
increased to 4mg per day.
14. +
Side Effects
EPS – dosage dependent
Weight gain
Anxiety
Nausea and vomiting
Erectile dysfunction
Elevated prolactin
15. +
Drug Interaction
Paroxetine and fluoxetine inhibits CYP2D6 – block formation
of risperidone’s active metabolite.
SSRIs + Risperidone = significant elevation of prolactin >
leading to?
16. +
PALIPERIDONE (INVEGA)
Indications:
Acute and maintenance treatment for
schizophrenia
Acute treatment of schizoaffective disorder as
monotherapy
Adjunct to mood stabilizers or antidepressants
17. +
Pharmacology
MAJOR active metabolite of risperidone
No dose adjustment required in patients with hepatic impairment
Peak plasma concentration – 24 hours after dosing
Steady-state concentrations – 4 or 5 days.
18. +
Dosage
Available in 3,6, and 9 mg tablets
Recommended dosage: 6mg OD in the morning.
No more than 12mg per day
(Invega Sustenna) – by IM once a month
39mg, 78mg, 117mg (recommended), 156mg, 234mg paliperidone
palmitate.
Half life = 25-49 days.
20. +
OLANZAPINE (Zyprexa)
Indications:
Schizophrenia
Monotherapy for the ACUTE treatment of manic
or mixed episodes associated with bipolar I
disorder adjunct to lithium or valproate
Adjunct to fluoxetine for the treatment of
depressive episodes associated with bipolar I
21. +
Pharmacology
85% absorbed in the GI
40% inactivated by first pass hepatic metabolism
Peak in 5 hours
Half life averages 31 hours
Once daily dosing
22. +
Dosages
2.5, 5, 7.5, 10, 15, and 20mg oral tablets.
Initial dosage for psychosis – 5 or 10mg
Acute mania – 10 or 15mg
30 to 40mg – treatment-resistant patients.
23. +
DRUG INTERACTIONS
Cimetidine (Tagamet) – increases concentration of Olanzapine
Carbamazepine and phenytoin – decreases serum
concentration of Olanzapine
Ethanol increases olanzapine absorption by more than 25
percent
24. +
SIDE EFFECT
More frequent WEIGHT GAIN
Somnolence, dry mouth, dizziness, constipation, dyspepsia,
increased appetite, akathisia, and tremor
Dose related EPS
26. +
Quetiapine (Seroquel)
Indications:
Schizophrenia
Acute treatment of manic episodes associated with bipolar I disorder
(monotherapy or adjunct to lithium or divalproex)
27. +
Pharmacology
Structurally related to clozapine
Rapidly absorbed in the GI tract, peak plasma concentrations
reached 1-2 hours
Steady state half life 7 hours (dosing is two or three times a
day)
Not associated with EPS
28. +
Dosages
25, 50, 100, 200, 300, and 400mg tablets
Dosing should begin 25mg twice daily, with doses increased
by 25 to 50mg per dose every 2 to 3 days, up to a target of 300
to 400mg a day.
More aggressive dosing is both tolerated and effective
25 to 300mg at night – used for insomnia
30. +
Side Effect
Somnolence, postural hypotension, and dizziness – most
common
Least likely to cause EPS
Transient weight gain
31. +
Ziprasidone (Geodon)
Indications:
Schizophrenia
Monotherapy for the acute treatment of manic or mixed episodes
associated with bipolar I DO adjunct to lithium or valproate
32. +
Pharmacology
Peak 2-6 hours
Recommended twice daily dosing
Peak serum concentrations of IM ziprasidone occur
approximately 1 hour, with a half life of 2 to 5 hours.
33. +
Dosages
20, 40, 60 and 80mg capsules
IM use – single use 20mg/ml vial.
Oral ziprasidone dosing should be initiated at 40mg a day
divided into two daily doses.
34. +
Side Effects
Somnolence, headache, dizziness, nausea, and
lightheadedness are the most common adverse effects
Prolongation of QTc complex
35. +
Aripiprazole (Abilify)
D2 antagonist, partial D2 agonist and potent 5-HT2A
antagonist
Indications:
Schizophrenia and schizoaffective disorders
Acute and maintenance treatment and adjunctive
therapy to either lithium or valproate for manic and
mixed episodes associated with bipolar I disorder.
Treatment of irritability associated with autistic disorder.
36. +
Aripiprazole (Abilify)
Well absorbed, reaching peak plasma
concentrations after 3 to 5 hours.
Absorption is not affected by food.
Mean elimination half-life: 75 hours
Clearance is reduced in elderly persons.
minimal EPS and may cause orthostatic
hypotension.
Primarily metabolized by CYP3A4 and CYP2D6
genes.
37. +
Aripiprazole (Abilify)
Drug Interactions:
Carbamazepine and valproate reduce serum
concentrations
Ketoconazole, fluoxetine, paroxetine, and
quinidine increase serum concentrations
Combined with antihypertensives may cause
hypotension. Drugs that inhibit CYP2D6
activity reduce elimination.
38. +
Aripiprazole (Abilify)
Dosage and guidelines
Available as 5, 1 0, 1 5, 20, and 30 mg tablets.
The effective dosage range is 10 to 30 mg per day. Starting dose
is 10 to 15 mg per day.
Initial dose of 5 mg increases tolerability.
Side effects
Headache, somnolence, agitation, dyspepsia, anxiety, and nausea
Akathisia, Insomnia, weight gain or diabetes
39. +
ASENAPINE (SAPHRIS)
Acute treatment of adults with schizophrenia and of manic or
mixed episodes associated with bipolar I disorder with or
without psychotic features.
Affinity for several receptors: serotonin, noradrenergic,
dopaminergic and histamine.
Negligible affinity for muscarinic-1 cholinergic receptors
40. +
ASENAPINE (SAPHRIS)
Dosage
5 mg and 10 mg sublingual tablets
Bioavailability is <2% when swallowed, but is 35% when
absorbed sublingually.
Avoid drinking or eating for 10 minutes after because this may
lower the blood levels.
Recommended starting and target dose for schizophrenia is
5mg BID and 5-10 mg BID for Bipolar disorder.
41. +
ASENAPINE (SAPHRIS)
Side Effects
somnolence, dizziness, EPS other than
akathisia, and increased weight.
can elevate prolactin levels during chronic
administration
Galactorrhea, amenorrhea, gynecomastia, and
impotence.
42. +
CLOZAPINE (CLOZARIL)
Most effective drug treatment for patients who have failed to
respond to standard therapies and also benefits patients with
severe tardive dyskinesia.
treatment of psychotic patients who are intolerant of EPS caused
by other agents, treatment-resistant mania, severe psychotic
depression, idiopathic Parkinson's disease, Huntington's disease,
and suicidal patients with schizophrenia or schizoaffective disorder
Pervasive developmental disorder, autism of childhood, and OCD
43. +
CLOZAPINE (CLOZARIL)
It is rapidly absorbed with peak plasma levels reached in about
2 hours.
Steady state is achieved in less than 1 week if twice daily
dosing is used. Elimination half-life is about 12 hours
An antagonist of 5-HT2A, D1, D3, D4, and adrenergic
receptors. It has relatively low potency as a D2 receptor
antagonist.
44. +
CLOZAPINE (CLOZARIL)
Dosage and interactions
Available in 25 mg and 100 mg tablets. Initial dose is usually 25
mg OD or BID.
The dosage can then be increased gradually to 300 mg a day in
divided doses and up to 900 mg a day.
Agranulocytosis or bone marrow suppression.
Lithium may increase the risk of seizures, confusion, and
movement disorders. Clomipramine (Anafanil) can increase the
risk of seizure.
Risperidone, fluoxetine, paroxetine, and fluvoxamine increase
serum concentrations. Paroxetine may precipitate clozapine-
associated neutropenia.
45. +
CLOZAPINE (CLOZARIL)
Side effects
Most common: sedation, dizziness, syncope, tachycardia,
hypotension, ECG changes, nausea, and vomiting.
Fatigue, weight gain, various GI symptoms (most commonly
constipation), anticholinergic effects.
Hypersalivation, is a side effect that begins early in treatment and is
most evident at night.
Risk of seizures is about 4% in patients taking dosages >600 mg a
day
Leukopenia, granulocytopenia, agranulocytosis, and fever
Containdications: WBC count <3,500 cells per mm3; a
previous bone marow disorder; history of agranulocytosis; drugs that
suppress the bone marrow such as carbamazepine (Tegretol).
46. +
ILOPERIDONE (FANAPT)
For acute treatment of schizophrenia in adults.
peak concentration of 2 to 4 hours and a half-life that is
dependent on hepatic metabolism (18 – 37 hrs)
47. +
ILOPERIDONE (FANAPT)
Side Effects
Prolongs the QT interval at12mg twice daily.
dizziness, dry mouth, fatigue, sedation,
tachycardia, and orthostatic hypotension
Dosing
Titrated slowly to avoid orthostatic hypotension
Effective dose(12 mg) should be reached in
approximately 4 days based on a twice-a-day dosing.
The maximum recommended dose is 12 mg BID.
48. +
LURASIDONE HCL (LATUDA)
Oral, once-daily, atypical antipsychotic indicated for schizophrenia.
Side Effects
somnolence, akathesia, nausea, parkinsonism, and agitation.
Causes less weight gain and metabolic changes than asenapine and
iloperidone.
Drug Interactions
should not be used in combination with a strong CYP3A4 inhibitor
(e.g., ketoconazole) or CYP3A4 inducer (e.g., rifampin).
Dose should not exceed 40 mg per day with coadministration with a
moderate CYP3A4 inhibitor such as diltiazem.
49. +
LURASIDONE HCL (LATUDA)
20, 40, 80, and 120 mg tablets. Recommended starting dose is
40 mg OD and should be taken with food.
Effective in a dose range of 40 to 120 mg per day.
Dose adjustment for patients with renal impairment. <80 mg per
day for moderate and <40mg severe renal impairment.
50. +
CLINICAL GUIDELINES FOR SDAS
All SDAs are appropriate for the management of an initial
psychotic episode, but clozapine is reserved for persons who
are refractory to all other antipsychotic dugs.
The choice of drug should be based on the patient's clinical
stats
and history of response to medication.
Use of all SDAs must be initiated at low dosages and gradually
tapered upward to therapeutic dosages.
Patient's history should include information about blood
disorders, epilepsy, cardiovascular disease, hepatic and renal
diseases, and drug abuse.
51. +
CLINICAL GUIDELINES FOR
SDAS
The physical examination should include supine and standing
blood pressure measurements to screen for orthostatic
hypotension.
The laboratory examination should include an ECG and several
complete blood counts with WBC counts and liver and renal
function tests. Blood glucose, lipids, and body weight.
Persons who developed agranulocytosis while taking clozapine
can safely switch to olanzapine.
SDA use by pregnant women has not been studied, but
consideration should be given to the potential of risperidone to
raise prolactin concentrations, sometimes up to three to four times
the upper limit of the normal range. Because the drugs can be
excreted in breast milk, they should not be taken by nursing
mothers.
Editor's Notes
Galactorrhea
acts as a modulator and acts on both postsynaptic D2 receptors and presynaptic autoreceptors.
hence less incidence of dry mouth, blurred vision, constipation, and urinary retention.
hepatic isoenzyme metabolism (CYP2D6 and CYP3A4)
18 to 26 hrs in CYP2D6 extensive metabolizers and is 31 to 37 hrs in CY2D6 poor metabolizers.
associated with arrhythmia and sudden death.
Cardiovascular disease, hypokalemia, hypomagnesemia, bradycardia, congenital prolongation of QT interval, and concurrent use of inhibitors of CYP3A4 or CYP2D6 may increase the risk of QT prolongation.