PHRM 311 Lecture Notes - Lecture 12: Case Report, Fluvoxamine, Clozapine

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28 Dec 2020

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To understand the basic treatment algorithm for the treatment of schizophrenia. Persistent positive symptoms that are more than mild in intensity. Assess and treat any causes of secondary negative symptoms (e. g. depression, medication-related side effects) Remaining symptoms can be considered primary negative symptoms. Threshold should be low for deciding to switch due to side effects. Some side effects can be treated with adjunctive medication. Some side effects decrease with time (e. g. sedation, postural hypotension) if patient is benefitting from medication, you may decide to wait for 4-6 weeks. Tx initiation from oral: 150 mg day 1 & 100 mg day 8 (+/- 4 days) deltoid. Half-life: 25 days (25 mg), 49 days (150 mg) Tx initiation from oral: after at least 4 months with pp1m (last two doses s/b same) Half-life: 52-86 days (deltoid), 69-120 days (gluteal) Time to steady state: not mentioned in pm. Tx initiation from oral: 400 mg (deltoid or gluteal)

Related Questions

1. Know what occurs during the four pharmacokinetic phases, as well as understand how concurrent pharmacotherapies (or dietary agents) might alter these phases

2. Know the role of the sympathetic vs. parasympathetic on the body, as well as the key neurotransmitters and receptors involved in each.

a. Understand the general mechanism of action and clinical indications for the use of sympathomimetics vs. sympatholytics

3. Know the factors that determine overall cardiac output (CO) and blood pressure (BP) and understand how the following drugs can alter each:

o Diuretics

o Nitrates

o ACE Inhibitors

4. Be able to compare and contrast the use (mechanism of action) of the following drugs in different cardiovascular pathologies (i.e. arrhythmia, hypertension, heart failure):

o Beta blockers

o Ca2+ channel blockers

o ACE Inhibitors

5. Understand the how cholesterol is synthesized in the body, the relationship between different types of cholesterol (HDL vs. LDL) and atherosclerosis, and the mechanism of action of the following drugs in treatment of cholesterol:

HMG CoA Reductase inhibitor (statin)

Cholesterol absorption inhibitors

6. Know the key neurotransmitters targeted by antianxiety and antipsychotic drugs:

Understand the mechanism of action and pharmacologic effects of the antianxiety drug class benzodiazepines

7. Know the key neurotransmitters targeted by antidepressant and anti-manic drugs:

Understand the mechanism of action for SSRIs and Lithium

8. Be able to compare and contrast the mechanism of action of opioids vs. non-opioid drugs (NSAIDs) in producing analgesia, as well as the key detrimental side effects of each class.

Receptors involved

Key signaling pathways (molecules, enzymes, involved)

9. Be able to compare and contrast the mechanism of action of the following antibacterial drugs:

Cephalosporins

Tetracyclines

Sulfonamides

Fluoroquinolones

10. Be able to compare and contrast the mechanism of action of the following antiviral drugs:

Oseltamivir

Docosonal

NRTIs

Protease inhibitors

11. Be able to compare and contrast the mechanism of action of a bronchodilator drug vs. an antileukotriene (or steroid) in asthma therapy

12. Understand the hypothalamic-anterior pituitary-gonadal axis in female and male gamete production (general overview), in addition to understanding the clinical indications and mechanism of action for the following hormones/drugs:

Estradiol/progestin

Urofollitropin

Testosterone

1. Human papilloma virus serotypes 1 and 2 (HPV-1 & HPV-2) both cause benign skin warts. Explain the likely outcome of the following two scenarios and explain in detail why you expect these outcomes. In both scenarios, a person is infected with HPV-1 in January 2012, develops a skin wart which resolves (disappears) without treatment by December 2012. Scenario 1: The same person is re-infected with HPV-1 in January 2013. Scenario 2: the same person is infected with HPV-2 in January 2013.

2. Why do herpes simplex virus type 1 or 2 (HSV-1 or HSV-2) infections recur at or near the site of the original infection? Why is HSV-1 or HSV-2 infection not eliminated from the body when the symptoms of the initial infection subside? Explain both answers in detail.

3. Describe the mechanisms responsible for antigenic drift and antigenic shift in influenza virus. Which mechanism is responsible for the yearly changes in influenza virus and which may create strains of influenza virus that result in pandemics?

4. What organism causes syphilis? How can it be treated and prevented? Describe the stages of syphilis including the order in which they appear and the symptoms of each stage.

5. Name and describe in detail the three stages of disease caused by HIV infection in the order in which they occur. What defines the beginning and end of each stage and what events occur to cause the transitions from each stage to the next?

6. Name and describe the five modes of action of antibacterial drugs. Give an example of a drug that works by each mode of action and state whether it is broad or narrow spectrum and/or suited for treatment of Gram negative or Gram positive infections.

7. Explain the mechanism of action of the antiviral drug acyclovir. Why does it not harm uninfected cells?

8. Name and describe one of the seven most common neglected tropical diseases. Describe the organism that causes the disease, the symptoms, drugs used to treat it and the approximate number of people affected. Why is it necessary to treat the entire population in a geographic region rather than just those suffering symptoms in order to prevent new infections?

9. Describe and explain the causes of rheumatic fever. Why is it important for patients to complete the dose of antibiotics prescribed for "strep throat"?

10. What organism causes Lyme disease? How is it transmitted to humans and why is it most prevalent in parts of New England and the northern Midwest? Describe the possible long-term sequelae of Lyme disease.

11. Describe the five stages of the pathogenesis of tuberculosis. Which stages are seen in asymptomatic infected individuals and which are found in people that have active infectious tuberculosis?

12. Describe the six stages of rabies virus infection and pathology including the common sources of infection in the USA. Explain why fatal disease can be prevented by vaccination after infection.

13. Describe the four mechanisms by which bacteria can become resistant to antibacterial drugs. Describe two ways bacteria may be genetically modified to achieve drug resistance naturally.

Which of the following is NOT a common side effect of circulatory medications? orthostatic hypotension and urinary frequency bradycardia fatigue, weakness, headaches, and dizziness anorexia, nausea, diarrhea, and constipation edema and shortness of breath Flag this Question Question 2 1 pts Which of the following is NOT true of HMG CoA reductase inhibitors? They are also called statins. They have few adverse reactions. The lowering of cholesterol and LDL with these medications is dose dependent. They may be discontinued when lipoprotein levels are lowered. They are used to reduce the progression of CAD, decrease cardiac problems, and decrease mortality. Flag this Question Question 3 1 pts Which of the following is NOT a type of angina pectoris? chronic exertional variant unstable all are types Flag this Question Question 4 1 pts Which of the following is NOT true regarding the treatment of cardiac dysrhythmias? Cardiac dysrhythmias are cured by the medications that are used in treatment. Cardiac dysrhythmias occur when calcium, sodium, and potassium ions that regulate the electrical impulses of the heart are disturbed. The medications for cardiac dysrhythmias are in four distinctive groups. Antidysrhythmics control rhythm by correcting or compensating for the altered rhythm. Alcohol and nicotine should be avoided while taking antidysrhythmics. Flag this Question Question 5 1 pts Antihypertensives receive the same response in all ethnic and cultural groups. True False Flag this Question Question 6 1 pts Which of the following is NOT true of adrenergic-inhibiting agents used in hypertension? They are the most frequently used medications for hypertension. They lower blood pressure and prevent serious cardiovascular complications. They include beta-blockers, alpha/beta-blockers, centrally and peripherally acting adrenergic inhibitors, and ACE inhibitors. They have few side effects and drug interactions. Some may also be used with angina pectoris. Flag this Question Question 7 1 pts Which of the following is NOT true of medications used to affect coagulation? Anticoagulants either may increase the time of coagulation or may be used to precipitate coagulation. Anticoagulants include vitamin K, heparin, and warfarin. Thrombolytic agents are used to promote the dissolution of thrombi. Antiplatelet drugs are used to inhibit the aggregation of platelets. Anticoagulants prevent venous clotting, while thrombolytics dissolve clots. Flag this Question Question 8 1 pts Which of the following is NOT true of anticoagulants? They may be given over prolonged periods of time without regard to prothrombin times. Warfarin is the oldest and most frequently used anticoagulant. Oral anticoagulants have a delayed onset of action. Patients taking anticoagulants must be watched carefully for excessive bruising, bloody stools, bleeding gums, and blood in the urine. Warfarin has a long list of drug interactions. Flag this Question Question 9 1 pts Antihypertensives cure hypertension. True False Flag this Question Question 10 1 pts Which of the following is NOT true of topical hemostatics? They are gelatin or cellulose sponges. They are used to absorb excess blood and fluids and to control bleeding in oral, dental, ophthalmic, and prostate surgery. They are ultimately absorbed by the body. The size and place of a wound have no bearing on which topical hemostatic agent is used. Some are powders, while others are foams, films, or surgical gauze.

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PHRM 311 Lecture Notes - Lecture 12: Case Report, Fluvoxamine, Clozapine

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