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D&T II Exam 2 > Treatment of Psychosis > Flashcards

Treatment of Psychosis Flashcards

1
Q

Psychoses

A

patient with gross disturbances in comprehension of reality as evidenced by hallucinations and delusions

Resulting from abnormalities in DA neurotransmission in mesolimbic and mesocortical neuronal pathways

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2
Q

Schizophrenia

A

Positive Symptoms: excessive mesolimbic (agitation, delusions, disorganized speech, disorganized thinking, hallucinations, insomnia) respond well to neuroleptics
Negative Symptoms: insufficient mesocortical (apathy, affective flattening, lack of motivation, lack of pleasure, poverty of speech, social isolation) do not respond well to neuroleptics, use atypicals

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3
Q

Typical Antipsychotics

A

Phenothiazines: chlorpromazine, fluphenazine, thioridazine, trifluoperazine, mesoridazine, perphenazine
Thioxanthenes: thiothixene, chlorprothixene
Butyrophenones: Haloperidol, Spiperone
Azepines: loxapine
Dihydroindolone: Molindone

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4
Q

Atypical Antipsychotics

A

Azepines: Clozapine, Olanzapine, Quetiapine
Benzisoxazole: Risperidone, Aripiprazole
Benzisothiazolypiperzine: Ziprasidone

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5
Q

Antipsychotics

A

Mechanism: Competitive blockade of DA and 5-HT receptors
Typical: DA > 5HT
Atypical: 5HT> DA; works on positive and negative symptoms
Adverse effects happen from blockade of alpha1 adrenergic, Histamine (H1) and Muscarinic
Absorbed from GI, Metabolized in liver, half life= 20-40 hours, Renal excretion of glucuronide conjugates

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6
Q

Dopamine Receptors

A

D2 receptors found pre/postsynaptically, coupled to Gi or Go

Blockade of D2 results in increased DA synthesis and release, increased cAMP, and decreased K+ currents

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7
Q

Time Course of Antipsychotic Therapy

A

1-3 Days: decreased agitation, aggression, anxiety, and normalization of eat/sleep
1-2 weeks: increased socialization, self care, and mood
3-6 weeks: increased thought disorder, decreased delusions/hallucinations, appropriate conversations

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8
Q

Haloperidol

A

Tx of Gilles de la Tourette’s and Huntington’s

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9
Q

Chlorpromazine

A

Tx of intractable hiccups
deposits in lens and cornea
contraindicated in patients with seizures, lowers the threshold

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10
Q

Thioridazine

A

deposits in retina, cannot be used as an antiemetic (neither can aripirprazole)

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11
Q

Prochlorperazine

A

Tx of drug-induced nausea (chemo)

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12
Q

Scopolamine

A

Tx of motion sickness

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13
Q

Droperidol

A

component of neuroleptanesthia

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14
Q

Negative Side Effects at Dopamine Receptors - Extrapyramidal

A

Akathisia, Pseudoparkinsonism, Dystonias
From all the drugs, more common in D2 specifics (haloperidol, fluphenazine, thiothixene)
Atypicals have lower incidence
Tx: Trihexyphenidyl, Benztropine mesylate, Procyclidine HCL, Biperidin

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15
Q

Negative Side Effects at Dopamine Receptors - Tardive Dyskinesia

A

More common in typicals, incidence low with Clozapine, results from “supersensitivity” from long term blockade
No Tx

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16
Q

Negative Side Effects at Dopamine Receptors - Neuroleptic Malignant Syndrome

A

Potentially fatal - muscle rigidity, elevated temp, altered consciousness, autonomic dysfunction
more common in typicals
Tx: Bromocriptine, Dantrolene

17
Q

Negative Side Effects at Dopamine Receptors - Prolactin

A

increased levels of prolactin leading to menstrual irregularities, loss of libido, swelling of maxillary glands, galactorrhea, osteoporosis
More common in Phenothiazines

18
Q

Side Effects at Cholinergic (M1)

A

dry mouth, blurred vision, urinary retention, constipation, confusion

Thioridazine, Chlorpromazine, Olanzapine

Also Clozapine but increases salivation
Tx: Switch drug

19
Q

Side Effects at Adrenergic (alpha 1a and 2a)

A

orthostatic hypotension, syncope, inhibit ejaculation

Chlorpromazine and Mesoridazine

Tx: Switch drug

20
Q

Side Effects at Histamine (H1)

A

Sedation

Chlorpromazine, Olanzapine, Quetiapine, Clozapine

Tx: Switch Drug

21
Q

Metabolic Side Effects

A

More common with atypicals

New onset or worsening of Type 2 Diabetes, Hypertension, Hyperlipidemia

22
Q

Clozapine and Olanzapine

A

Weight gain, Increased Lipids, Increased Glucose

23
Q

Chlorpromazine

A

Weight gain, Increased lipids, increased glucose

24
Q

Risperidone

A

Weight Gain, possible change in lipids and glucose

25
Q

Haloperidol

A

Possible change in weight, no effect on lipids or glucose

26
Q

Leukopenia, agranulocytosis

A

Clozapine

27
Q

Perioral Tremor “Rabbit Syndrome”

A

prolonged antipsychotic use

28
Q

Thioridazine

A

leads to minor T wave abnormalities

29
Q

Ziprasidone

A

QT prolongation

D&T II Exam 2 (7 decks)

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