Bipolar Disorder and Antipsychotic Drugs Ch 34 + 36)

Question 1

With all Antipsychotics, what can they cause?

Answer 1

-Weight gain (more so for atypical Vs typical)

-Disturbances in metabolism

-Extent varies with drug

Question 2

What kind of range of treatment does Litium have? What range should it be within? What levels does toxicity occur?

Answer 2

-Narrow therapeutic range

-maintenance serum levels should range between 0.4 and <1.5 mmol/L

toxicities above 2 mmol/L, death at 2.5 mmol/L
monitor plasma levels

Question 3

Positive/exaggerated symptoms of Schizophrenia?

Answer 3

Positive symptoms (exaggeration):
-delusions (false beliefs eg persecution)
paranoia
-hallucinations (false perceptions eg auditory)
disorganized or catatonic behaviour

Question 4

Negative symptoms of schizophrenia?

Answer 4

Negative symptoms:
-Flat emotions
-Withdrawal from social contacts, lack of speech, poor self-care
-Avolition (lack of drive)

Question 5

What other drugs other then Lithium are used for seizures? When used for depression (Controversial)?

Answer 5

valproate and carbamazepine (drugs used in seizures)

Fluoxetine (Not used alone, given with other agents)

Question 6

Extrapyramidal Motor Disturbances
Tardive (“slow or delayed”) Dyskinesia symptoms?

Answer 6

Oral and facial muscles (tongue protrusion, lip smacking

-Occurs months or years after drug treatment

-Non-reversible

Question 7

Asenapine is only administered?

Answer 7

SL

Question 8

Typical Antipsychotics: Adverse Effects (early onset)

Answer 8

Extrapyramidal Motor Disturbances
Early onset effects of drugs (neck, face, tongue and eyes)

Question 9

What agent can reduce Extrapyramidal Motor Disturbances? (early onset)

Answer 9

Benztropine

(Can be reduced/managed with anticholinergics)

-Reversible

Question 10

Atypical Antipsychotics: Mechanism of Action?

Answer 10

-Block 5-HT receptors (5-HT2 receptors)

-Less effect on DA receptors than typical antipsychotics (hence less motor disturbances)

-Equal efficacy to typical antipsychotics
(more expensive)

Question 11

Adverse affects of lithium?

Answer 11

Lithium Adverse Effects (<1.5 mmol/L)
fine finger tremor
polyuria and thirst
GI upset (transient)

Question 12

Typical Antipsychotics: Adverse Effects?How long does it take to notice? What drug is given to reduce effects?

Answer 12

Neuroleptic Malignant Syndrome (usually 4-14 days after therapy start)

lead pipe” rigidity
sudden high fever (>41OC)
CV problems (BP irregularities, cardiac dysrhythmias)
may end in seizures or coma

bromocriptine

Question 13

Typical Antipsychotics: Mechanism of Action?

Answer 13

-All are dopamine (D2) receptor antagonists

-Block receptors in CNS (areas associated with emotion, cognitive function, motor function)

Question 14

Why is Clozapine not widely used?

Answer 14

Reduces bone marrow density

Question 15

Other than Bipolar disorder, what else do Atypical Antipsychotics treat?

Answer 15

Also used to treat:
anxiety states
bipolar disorder

Question 16

Psychotic Disorders examples?

Answer 16

Psychotic disorders:
-Schizophrenia
-Schizoaffective disorder
-Depressive or drug-induced psychoses

Question 17

Antipsychotics Agents: 
Client Care Implications?

Answer 17

-Do not take alcohol or other CNS depressants with these medications

Monitor for EPD

Question 18

Cognitive Symptoms of Schizophrenia?

Answer 18

disorganized thoughts and speech
memory and learning difficulties

Question 19

What happens when lithum toxicity is above 1.5mmol/L?

Answer 19

CNS Effects - check for early signs
confusion, hyperirritability of muscles
Long term signs (renal failure, thyroid disorders)

Question 20

Drugs that are labelled as Antipsychotics are used for? What may they also be used for?

Answer 20

Labelled as antipsychotics

Note that these drugs may be used for other indications eg anxiety states, bipolar

Question 21

First-generation antipsychotic? Second generation?

Answer 21

1.) chlorpromazine

2.) clozapine

Question 22

Atypical Antipsychotic (second generation) agent examples?

Answer 22

*clozapine (Clozaril) - Very little EPD

-olanzapine
-risperidone