What factors decrease renal clearance? - Ans-Kidney Disease NSAIDs Hydrochlorothiazide ACE Inhibitors ("Prils") What psychotropic is mainly excreted in the kidneys? - Ans-Lithium Gabapentin What makes adults more sensitive to psychotropics? - Ans-Decreased intracellular water Decreased protein binding (drugs dont have protein to bind to, free floats in blood stream) Low muscle mass Increased body fat Where is Norepinephrine produced? - Ans-Locus Ceruleus Medullary Reticular Formation What is serotonin also known as? and where is it produced? - Ans-Also known as indole Raphe Nuclei of the brainstem where is dopamine produced? - Ans-Substantia Nigra Ventral Tegmental Area Nucleus Accumbens Where is Acetylcholine synthesized? - Ans-Nucleus Basalis or Basal Nucleus of Meynert Which receptors do benzodiazepines bind to? - Ans-GABA receptors to potentiate calming/anxiolytic effects Autism Spectrum Disorder - Ans-persistent deficits in social communication and social interaction across multiple contexts: Lacks Social reciprocity Nonverbal communication Unable to efficiently develop, maintain and understand relationships Restricted repetitive behavior Stereotyped or repetitive movements Insistence on sameness Clock Drawing Test - Ans-The client is asked to reproduce the face of a clock set to a specific time. This test may detect difficulties with visuospatial skills, visual perception, selective attention, memory, abstract thinking, and executive functioning. Fastest screening tool for possible dementia Takes 2 mins Dopamine Pathway responsible for positive symptoms of schizophrenia - Ans-Mesolimbic pathway - excess dopamine Dopamine pathway responsible for negative symptoms of schizophrenia - Ans-Mesocortical pathway - decreased dopamine How do FGAs differ from SGAs as far as mechanism of action? - Ans-FGAs deplete dopamine levels in both mesolimbic and mesocortical pathways which helps in reducing positive symptoms but may worsen negative symptoms. SGAs decrease excess dopamine in mesolimbic pathways reducing positive symptoms, while increasing dopamine in mesocortical pathway improving negative symptoms SGAs also have 5HT2A antagonism properties Blockage of dopamine in this pathway increases Acetylcholine which causes EPS - AnsNigostriatal pathway *acetylcholine has inverse relationship with dopamine Blockage of dopamine in this pathway causes prolactin to increase which causes galactorrhea - Ans-Tuberoinfundibular pathway Important things to remember with Disulfiram - Ans-Alcohol abstinence for at least 12 hours before starting Refrain from using anything that contains alcohol (cough med, vinegar, aftershave lotion etc) while on disulfiram and up to 2 weeks after dc Neuroleptic Malignant Syndrome (NMS) s/sx - Ans-Extreme muscular rigidity Mutism Elevated CPK Elevated WBCs (leukocytosis) Elevated LFTs Myoglobinuria (Rhabdo) hyperthermia Tachycardia Diaphoresis Altered LOC NMS tx - Ans-1. DC antipsychotic 2. administer D2 agonist bromocriptine (Parlodel) 3. administer muscle relaxant dantrolens (Dantrium) 4. antipyretic (acetaminophen) and cooling blanket Serotonin Syndrome S/sx - Ans-*autonomic instability Hyperreflexia Myoclonic Jerks Hypertension agitation and restlessness Headache Sweating and shivering Goosebumps Confusion Fever Seizures Unconsciousness Serotonin Syndrome Tx - Ans-Dc offending agent Administer Cyproheptadine How long should you wait before switchin SSRIs to MAOI? - Ans-14 days How long should you wait when switching prozac to MAOI? - Ans-5-6 weeks washout period Serotonin Discontinuation Syndrome sx - Ans->Flu-like sx due to cholinergic rebound esp in TCAs >Fatigue and lethargy >Myalgia (muscle soreness and achiness) >Decreased concentration >Nausea tx - SSRI discontinuation syndrome - Ans-Do not DC abruptly May restart and taper MMSE (Folstein Scale) - Ans-Tool to quantify cognitive status in adults Asesses Orientation Attention Calculation Recall Language Motor skills monitors cognitive status over time Thought Process - Ans-Tangentiality Circumstantiality