Anti-Psychotic Medications

Question 1

What is psychosis?

Answer 1

A characteristic of some types of mental illness in which a patient has lost contact w reality

Question 2

What are some characteristics of psychosis?

Answer 2

• delusions
• hallucinations
• lack of insight or judgement

Question 3

What are delusions?

Answer 3

Firm ideas or beliefs that are false and not founded in reality

Question 4

What are hallucinations?

Answer 4

Hearing, seeing, or perceiving something that is not present

Question 5

What are some characteristics of psychosis?

Answer 5

• inappropriate mood and affect
• inactivity or extreme agitation
• can be acute or chronic

Question 6

What is Schizophrenia?

Answer 6

A type of psychosis in which the patient exhibits a set of diverse symptoms over time such as: abnormal thoughts, disordered communication, withdrawal from people, inability to perform ADLs

Question 7

What are symptoms characterized as being in Schizophrenia?

Answer 7

Positive or negative

Question 8

What are positive symptoms?

Answer 8

Behaviours that are in addition to normal behaviours.

Question 9

What are negative symptoms?

Answer 9

Behaviours that take away from normal behaviours.

Question 10

What causes Schizophrenia?

Answer 10

• genetic

- neurotransmitter imbalance

Question 11

What is the neurotransmitter imbalance that can occur w Schizophrenia?

Answer 11

Overactive dopaminergic pathways leads to overstimulation of dopamine type 2 receptors

Question 12

What do antipsychotics do to overstimulation of D2 receptors?

Answer 12

They block them

Question 13

What are the 2 classes of antipsychotics?

Answer 13

1. first generation antipsychotic drugs

2. second generation antipsychotic drugs

Question 14

What are first generation antipsychotic drugs?

Answer 14

• include phenothiazines and non-phenothiazines

- effective but w many side effects

Question 15

What are second generation antipsychotic drugs?

Answer 15

• fewer side effects, much better adherence

- better for managing negative symptoms

Question 16

What are the symptoms associated with extrapyramidal side effects?

Answer 16

• acute dystonia (muscle spasms of back, neck, and tongue)
• akathisia (restlessness)
• tardive dyskinesia (unusual tongue and face movements associated w long-term use)

Question 17

What are phenothiazines?

Answer 17

• similar potency, efficacy and range of adverse effects within class
• indicated for use as anti-emetic for tourette’s syndrome
• effective for positive symptoms

Question 18

What are non-phenothiazines?

Answer 18

• similar potency and efficacy to phenothiazines

- produce less sedation and anticholinergic effects than phenothiazines but more EPS

Question 19

Name a phenothiazine:

Answer 19

Chlorprom

Question 20

What are some adverse effects of Chlorprom?

Answer 20

• EPS
• dizziness, headaches, drowsiness
• orthostatic hypotension
• weight gain
• altered cell blood counts (WBCs)

Question 21

Who does EPS mostly occur in?

Answer 21

• females
• older adults
• pediatrics

Question 22

Name a nonphenothiazine:

Answer 22

Haldol

Question 23

What is Haldol used for?

Answer 23

• treat acute and chronic psychotic disorders

- tourrette’s syndrome

Question 24

What are the adverse effects of Haldol?

Answer 24

• EPS (much more common and pronounced than with phenothiazines)
• less sedation and hypotension than with phenothiazines
• headache
• weight gain
• altered cell blood counts

Question 25

What is another name for second generation antipsychotic drugs?

Answer 25

Atypical antipsychotics

Question 26

Have second generation antipsychotics become the drug of choice for severe mental illness?

Answer 26

Yes

Question 27

Do second generation antipsychotic drugs have a lower incidence of adverse effects like EPS than first generation drugs?

Answer 27

yes

Question 28

Name a second generation antipsychotic drug:

Answer 28

Clozapine

Question 29

What are the adverse effects of Clozapine

Answer 29

- dizziness, headache - drowsiness - orthostatic hypotension - tachycardia - anticholinergic effects - flu-like symptoms - bone marrow suppression

Question 30

Name another second generation antipsychotic drug:

Answer 30

Olanzapine

Question 31

Does Olanzapine have more EPS than other second generation drugs?

Answer 31

Yes

Question 32

What is Risperidone used for?

Answer 32

- acute maintenance treatment of schizophrenia - management of inappropriate behaviour due to dementia - manic phase of bipolar disorder

Question 33

Is Risperidone a 1st line agent?

Answer 33

Yes

Question 34

What is a side effect of Risperidone?

Answer 34

Parkinsonism

Question 35

What is bipolar disorder?

Answer 35

Patients alternate between extreme feelings of sadness and mania

Question 36

What are some symptoms of mania?

Answer 36

- agitation, intense excitement, elevated mood, talkativeness - impulsive behaviour, short attention span - no thought about consequences of actions

Question 37

What is mania associated with?

Answer 37

- too much NE and glutamate | - too little inhibitory NTs such as GABA

Question 38

Name a drug used for bipolar disorder:

Answer 38

Carbolith

Question 39

How does Carbolith work?

Answer 39

It inhibits glutamate (excitatory NT) action

Question 40

What are the adverse effects of Carbolith?

Answer 40

- muscle weakness - lethargy - nausea, vomiting - polyuria, nocturia - headache, dizziness - tremors - confusion

Question 41

What are some long-term effects of Carbolith?

Answer 41

- kidney impairment - dysrhythmias - circulatory collapse - leukocytosis - hypothyroidism, goiter