3b: Antipsychotics and Antiepileptics

Question 1

original purpose of antipsychotics

Answer 1

replace sedatives (tranquilizers) as main form of treatment for patients

Question 2

which dopamine receptor is blocked to some extent by all antipsychotics?

Answer 2

D2 receptor

Question 3

two categories of antipsychotics

Answer 3

traditional and atypical

Question 4

causes of schizophrenia

Answer 4

genetics (chromosomal changes) and environmental triggers (brain injuries, trauma, social stresses); overactivity of dopamine pathways in the brain

Question 5

difference between traditional and atypical antipsychotics

Answer 5

traditional = more variable in effectiveness and side effects; increased incidence of movement disorders

atypical = less effective than traditional, lower incidence of relapse, and decreased risk of movement side effects

Question 6

depot administration of antipsychotics

Answer 6

method of injecting medication every 3-4 weeks for a slow, continual release during the maintenance phase of the disease (good for those with low compliance)

Question 7

other uses for antipsychotics

Answer 7

• bipolar disorder (with lithium)
• Alzheimer’s (to control agitation and aggression)

Question 8

two big risks for older adults taking antipsychotics

Answer 8

• developing movement disorders
• stroke or other CV events

Question 9

types of extrapyramidal symptoms (side effects of antipsychotics)

Answer 9

tardive dyskinesia, pseudoparkinsonism, akathisia, dyskinesia, dystonia, neuroleptic malignant syndrome

Question 10

most-feared side effect of anti-psychotics

Answer 10

tardive dyskinesia

Question 11

tardive dyskinesia

Answer 11

involuntary movements of mouth, tongue, jaw, sucking and smacking noises, serious swallow disorders may occur, choreoathetoid movements of extremities, dystonias of the neck and trunk; may be irreversible

Question 12

pseudoparkinsonism

Answer 12

motor symptoms of parkinson’s (rigidity, tremor, akinesia) caused by antipsychotic meds because they block dopamine receptors

Question 13

akathisia

Answer 13

side effect of newer anti-psychotic medications, causes sensations of motor restlessness, agitation, pacing the floor, insomnia

Question 14

dyskinesias and dystonias

Answer 14

movements in the arms, legs, neck, and face, that begin quickly after taking anti-psychotic medications

Question 15

neuroleptic malignant syndrome

Answer 15

catatonia, stupor, rigidity, tremors, and fever caused by high doses of anti-psychotic medications

Question 16

non-motor side effects of anti-psychotics

Answer 16

weight gain, increased plasma lipids, diabetes, decreased ACh function, blurred vision, dry mouth, constipation, urinary retention

Question 17

causes of seizures

Answer 17

stroke, tumor, encephalopathy, head trauma, genetics

Question 18

seizures that involve the entire brain - grand mal or petit mal seizures

Answer 18

generalized seizures

Question 19

seizures that only involve part of the brain - complex (loss of consciousness) vs. simple

Answer 19

focal seizures

Question 20

reasons for pharmacological treatment of seizures

Answer 20

• will usually resolve on their own (self-limiting)
• brain cannot sustain that level of synaptic activity for too long
• seizures can recur if untreated
• injury can occur if patient loses consciousness

Question 21

ways that anti seizure drugs act to prevent seizures

Answer 21

• initiate activity of CNS inhibitory neurons
• decrease the activity of CNS excitatory neurons
• stabilize opening/closing of Na+ or Ca2+ channels

Question 22

mechanisms of first generation anti-epileptic drugs

Answer 22

inhibit firing of certain neurons by increasing effects of GABA

Question 23

6 classes of first generation anti-epileptic drugs

Answer 23

barbiturates, benzodiazepines, hydantoins, iminostilbenes, succinimmides, valproates

Question 24

what is the main barbiturate (first generation) used as an anti-epileptic drug?

Answer 24

phenobarbital

Question 25

what are common side effects of anti-epileptic drugs?

Answer 25

sedation and ataxia

Question 26

what is the difference between first and second generation anti-seizure drugs?

Answer 26

second generation are not more effective but they have milder side effects (often combined with 1st generation)

Question 27

gabapentin

Answer 27

commonly used second generation anti epileptic drug, reduces excessive neuronal activity in seizure disorders

Question 28

pharmacokinetics of anti-seizure drugs

Answer 28

oral administration, 3-4 doses per day, drugs cross into brain, biotransformation occurs in the liver

Question 29

birth defects caused by exposure in-utero to anti-seizure drugs

Answer 29

cleft palate, cardiac defects, microencephaly, neural tube defects, developmental delays, stillbirth, infant seizures

Question 30

rehab implications of anti-seizure drugs

Answer 30

• likely lifelong medications
• PT may need to monitor effectiveness of meds (control seizures but limit side effects)
• SE: sedation, ataxia, dizziness, skin conditions, GI distress
• possible environmental triggers (lights, sound, etc.)

Question 31

3 conditions that benzos are used to treat

Answer 31

anxiety, sleep, seizures

Question 32

why are barbiturates NOT commonly used to treat seizures?

Answer 32

highly addictive and risk of intense side effects