Psychopharm Exam 1

通報

問題一覧

EPSP allow what to flow into the cell?

Na/Ca

Examples of EPSPs include:

ACh and Glutamate

IPSP allow what into the cell?

Examples of IPSPs include:

GABA and Glycine

Key CYP1A2 Drugs

Clozapine and Olanzapine

CYP1A2 Inhibitors

Fluvoxamine and Cipro

CYP1A2 Inducers

Smoking and Cruciferous Vegatables

CYP2C9 Meds

Valproic Acid and Diazepam

CYP2C9 Inhibitors

Fluconazole and Amiodarone

CYP2C9 Inducers

Rifampin and Carbamazepine

CYP2C19 Meds

Esitalopram, Clomipramine, and Diazepam

CYP2C19 Inhibitors

Fluoxetine and Omeprazole

CYP2C19 Inducers

Rifampin and Carbamazepine

CYP2D6 Meds

Fluoxetine, Paroxetine, TCAs, and Atomoxetine

CYP2D6 Inhibitors

Fluoxetine and Paroxetine

CYP2D6 Inducers

Rarely Used

CYP3A4 Meds

Quetiapine, Apripiprazole, and Alprazolam

CYP3A4 Inhibitors

Ketoconazole and Grapefruit Juice

CYP3A4 Inducers

Carbamazepine and St John's Wort

CYP2E1 Meds

Alcohol

CYP2E1 Inhibitors

Disufiram

CYP2E1 Inducers

Alcohol

Taking this med with at least 500 calories is critical to ensure therapeutic blood levels

Ziprasidone

Requires at least 350 calories for optimal absorption and therapetic drug levels

Lurasidone

Food improves absorption and reduces GI side effects (nausea). Taking it without food reduces its bioavailability by 50%.

Vilazodone

Usually not taken with food, but eating and drinking immediately after administration can reduce absorption significantly.

Asenapine

Higher gastric pH, immature enzyme activity affects drug solubility and breakdown.

Drug Absorption in Children

Increased total body water alters hydrophilic drug distribution; reduced fat affects lipophilic drugs; lower albumin levels.

Distribution in Children

Have a higher proportion of total body water (~70-80%). This increases the volume of distribution (Vd) for hydrophilic drugs like aminoglycosides, necessitating higher doses to achieve therapeutic levels.

Infants

Have lower fat stores, reducing the distribution of lipophilic drugs (e.g., benzodiazepines).

Neonates

Albumin levels and binding capacity is lower, leading to increased free (active) drug levels for highly protein-bound drugs like phenytoin

Neonates

CYP450 enzyme activity is immature but increases rapidly during the first year of life.

Phase I Reactions in Infants

Glucuronidation, a key pathway for drug metabolism (e.g., lorazepam), is underdeveloped, leading to slower elimination

Phase II Reactions in Neonates

Renal function (glomerular filtration, tubular secretion, and reabsorption) is immature and reaches adult levels by 1 year of age. This impacts the clearance of renally excreted drugs like aminoglycosides

Excretion in Neonates

Receptor systems and neurotransmitter pathways are still maturing, which can lead to increased sensitivity or resistance to certain drugs. For instance, may experience exaggerated sedation with benzodiazepines due to immature GABAergic systems.

Receptor Sensitivitiy in Children and Adolescents

Disorders like ADHD and mood disorders are often linked to delayed maturation of prefrontal cortical circuits. Medications targeting dopamine and norepinephrine systems (e.g., stimulants) are adjusted to address these developmental delays

Neurotransmitter Systems in Adolescents

May experience unique behavioral side effects due to ongoing brain development, especially in the limbic system and prefrontal cortex, which regulate emotions and decision-making

Behavioral and Cognitive Effects in Adolescents

Risks of Prescribing Medications in Pregnancy (Maternal Health Impact)

Improves symptoms, quality of life, and functioning

Risks of Not Prescribing Medications in Pregnancy (Maternal Health Impact)

Increased risk of poor self-care, substance abuse, and suicide

Risks of Prescribing Medications in Pregnancy (Fetal Development)

Potential teratogenic risks depending on the medication

Risks of Not Prescribing Medications in Pregnancy (Fetal Development)

Higher risk of preterm birth, low birth weight, and HPA axis dysregulation

Risks of Prescribing Medications in Pregnancy (Neonatal Outcomes)

Risk of neonatal adaptation syndrome and withdrawal

Risks of Not Prescribing Medications in Pregnancy (Neonatal Outcomes)

Potential long-term developmental impacts from maternal stress

Risks of Prescribing Medications in Pregnancy (Long-Term Neurobehavioral Effects)

Possible subtle effects (e.g., with SSRIs or antipsychotics)

Risks of Not Prescribing Medications in Pregnancy (Long-Term Neurobehavioral Effects)

Risk of cognitive and emotional problems due to untreated maternal illness

Mood Stabilizers that can cause neural tube defects, cardiac malformations (e.g., Ebstein's anomaly).

Valproate, LIthium

Anticonvulsants that can cause craniofacial anomalies, neurodevelopmental issues.

Phenytoin

Antidepressants known to cause congenital heart defects

Paroxetine

Antipsychotics known to cause neonatal withdrawal, extrapyramidal symptoms

Haloperidol, Chlorpromazine

Benzodiazepines known to cause oral clefts, neonatal respiratory depression.

Diazepam

Stimulants known to cause low birth weight, premature delivery.

Amphetamines

What does pregancy do to absorption of drugs?

Gastric emptying and gastrointestinal motility are slower in women, which may delay drug absorption

Discuss the Distribution of Drugs in Women and Pregancy

Women have more body fat which influences distribution of lipophilic drugs causing lower plasma levels of albumin leading to higher free drug concentrations and prolonged 1/2 lives.

Metabolism in Women

Increased CYP3A4 activity; reduced CYP1A2 activity.

Metabolism in Pregancy

Increased CYP3A4 and CYP2D6 activity; reduced CYP1A2 activity.

Compare and contrast Excretion in Women and Pregnancy

In women, slower renal clearance due to lower GFR. In pregancy, enhanced renal clearance due to increased GFR and renal blood flow.

Hormonal fluctuations (e.g., estrogen and progesterone) alter receptor sensitivity, which may influence drug responses. For instance, serotonin receptor modulation by estrogen can affect the efficacy of SSRIs.

Receptor Sensitivity in Women

Since the GFR increases up to 50% during pregancy, what effect will this have on a drug like lithium?

Enhanced renal clearance of the drug

After delivery, renal clearance of lithium returns to pre-pregnancy levels, increasing the risk of?

Lithium toxicity

What is the Target Range of Lithium during Pregnancy?

Between 0.6-1.0 mEq/L

Lithium can impair thyroid and renal function, so regular monitoring these tests is critical.

TSH and renal function tests

Lithium during pregancy increases the change of what congenital abnormality?

Ebstein's anomaly

Minimize or avoid lithium use during the ________ when teratogenic risk is highest.

First trimester

Encourage _________to reduce the risk of lithium toxicity, as dehydration and sodium depletion can increase lithium levels.

Hydration and sodium intake

Discontinue lithium _______ before delivery to reduce the risk of neonatal lithium toxicity and maternal fluid balance issues during labor.

24-48 hours

Minor changes; slower gastric emptying may delay drug onset.

Absorption in Eldery

Increased fat-to-lean ratio prolongs lipophilic drug half-life; reduced total body water concentrates hydrophilic drugs.

Distribution in Eldery

Reduced Phase I metabolism prolongs drug half-life (e.g., diazepam); Phase II metabolism remains intact.

Metabolism in Eldery

Reduced renal clearance requires dose adjustment for renally excreted drugs.

Excretion in Eldery

Greater CNS sensitivity to sedatives, anticholinergics, and opioids.

Sensitivity in Eldery

Reduced compensation increases side effect risks (e.g., orthostatic hypotension).

Homeostatic Reserve in Eldery

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