Antipsychotic Medications Flashcards by Nathan Koranda

conditions managed with antipsychotics

Schizophrenia
Bipolar Disorder
Severe Depression
Substance Abuse (maybe symptom of above)\

Manage severe agitation
Lesser uses: nausea, vomiting, hiccups

Sometimes used to treat dementia but must use caution - Very seldome

How well did you know this?

Not at all

Perfectly

three types of symptoms for schizophrenia

positive
negative
cognitive

How well did you know this?

Not at all

Perfectly

Positive

Exaggeration or distortion of
normal function
Hallucinations 
Delusions 
Agitation
Tension 
Paranoia

How well did you know this?

Not at all

Perfectly

Negative

Loss or diminution of normal
function
Lack of motivation 
Poverty of speech
Blunted affect 
Poor self-care 
Social withdrawal

How well did you know this?

Not at all

Perfectly

Cognitive

Disordered thinking
Reduced ability to focus attention
Prominent learning and memory
difficulties
Subtle changes*
Florid changes: Thinking and
speech may be completely
incomprehensible to others

How well did you know this?

Not at all

Perfectly

Primary neurotransmitter at work when we talk about schizophrenia

dopamine

How well did you know this?

Not at all

Perfectly

Underactivity of D1 receptor

negative symtpoms

How well did you know this?

Not at all

Perfectly

Overactivity of D2 receptors

positive symptoms

How well did you know this?

Not at all

Perfectly

Three major objectives of treatment for shizophrenia

Suppression of acute episodes
Prevention of acute exacerbations
Maintenance of the highest possible level of functioning

How well did you know this?

Not at all

Perfectly

Strategic and therapeutic considerations for treatment of schizophernia

Drug selection
Dosing
Route
Oral (tablets, capsules, and liquids)
Intramuscular
Inhaled

How well did you know this?

Not at all

Perfectly

First Gen Examples

Chlorpromazine
(Thorazine)
Fluphenazine(Prolixin)
Perphenazine (Trilafon)
Trifluoperazine (Stelazine)
Thioridizine (Mellaril)
Thiothixene (Navane)
Haloperidol (Haldol)

How well did you know this?

Not at all

Perfectly

2nd Gen

Olanzapine (Zyprexa)
Clozapine (Clozaril)
Risperidone (Risperdal)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
Paliperidone (Invega)

How well did you know this?

Not at all

Perfectly

Typical action

Blocks post-synaptic D2 receptors in basal
ganglia, hypothalamus, limbic system and
medulla; lipid soluble

How well did you know this?

Not at all

Perfectly

Atypical action

Less D2 blockade than the typicals. Hypothesis:
blocks serotonin receptors in cortex which
decreases inhibition of dopamine; thus more effect
on negative symptoms of schizophrenia

How well did you know this?

Not at all

Perfectly

Typical intended effects

Reduces positive symptoms of Schizophrenia
(hallucinations, tics)
Treatment of nausea, vomiting, hiccups
Reduces aggressive behaviors
Not much effect on negative symptoms

How well did you know this?

Not at all

Perfectly

Atypical intended effects

Reduces positive symptoms of schizophrenia but
less than typicals
Reduces negative effects of schizophrenia
Also used to augment treatment of bipolar disorder, depression, delusional disorders

How well did you know this?

Not at all

Perfectly

Typical side effects

Extrapyramidal effects (EPS); tardive
dyskinesia
Anticholinergic effects
Adrenergic effects
Prolonged QT
Sedation
Hyperprolactinemia

How well did you know this?

Not at all

Perfectly

A typical side effects

Less risk of EPS, tardive dyskinesia
Metabolic syndrome: insulin resistance, weight
gain*, hyperprolactinemia
Seizures, tachycardia,dizziness, sleep problems,
constipation, rhinitis
Prolonged QT
Sedation

How well did you know this?

Not at all

Perfectly

Typical contraidincatiosn precaustions

Narrow angle glaucoma, severe liver or CVD,
bone marrow depression.
Caution: epilepsy, BPH, DM, CNS tumors.
mortality psychosis of dementia in elderly

How well did you know this?

Not at all

Perfectly

Atypical contraindications/precautions

Study These Flashcards

Drug specific

*wt gain differs by agent

METABOLISM AND

ELIMINATION

Study These Flashcards

Liver
• Thorough metabolism: N+-oxidation, N-glucuronidation, and phases 1 and 2
biotransformation with final glucuronidation before renal excretion.
• Reduce dose elderly or patients with liver disease
Kidney (partially excreted) Kidney (partially excreted)
• Most drugs: <50% of drug eliminated unchanged by renals
• Reduce dose in renal impairment (see later slide)

Antipsychotic initiation

Study These Flashcards

(first 7 days)
Goal: reduce agitation, tension, anxiety, hostility, aggression
Titrate up over several days; dose is about 50% of chronic dose
Monitor BP

Antipsychotic stabilization

Study These Flashcards

(6-12 wks)
Goal: increase socialization, self-care habits over first 4 weeks
Thought disorder improvement another 6 weeks
Should see improvement 4-12 weeks
Can use rating scale to evaluate efficacy [+/- Symptom scale (PANNS), brief
psychiatric rating scale (BPRS)}

Antipsychotic Maintenance

Study These Flashcards

Continue at least 12 months; may be lifetime

Taper slowly to avoid withdrawal

What drugs increase effects of antipsychotics

``` Antihypertensives CNS depressants Fluvoxamine Cipro Other Antipsychotics Anticholinergics Lithium Drugs that prolong QT ```

Drugs that decrease effects

Anticonvulsants | Tobacco

Typicals Monitoring

• Baseline: Assess for dementia; weight, labs: renal, liver, motor function; consider EKG • Ongoing: motor function (Abnormal Involuntary Movement Scale or AIMS), Dyskinesia Identification System: Condensed User Scale (DISCUS); PROLACTIN, BP, EKG, tardive dyskinesia, seizures • AIMS http://www.cqaimh.org/pdf/tool_aims.pdf DISCUS http://www.dhs.state.mn.us/main/groups/licensing/documents/pub/dhs_id_057837.pdf

Atypical Monitoring

* Baseline: waist circumference, BMI, BP, FBS, lipid profile. * Repeat labs at 3 months, BMI quarterly * Annual: BP, labs, waist circumference. Clozapine: CBC

Definition of bipolar disorder (BPD)

* Cyclic disorder * Recurrent fluctuations in mood * Episodes of mania and depression persist for months without treatment

Types of mood episodes seen with BPD

* Pure manic episode (euphoric mania) Pure manic episode (euphoric mania) * Hypomanic episode (hypomania) * Major depressive episode (depression) * Mixed episode

Treatment for BPD

* Drugs | * Psychotherapy

Types of Drugs used for bi poloar disorder

mood stabilizers antipsychotics antidepressants

bpd mood stabilizers

Lithium, divalproex sodium, and carbamazepine • Relieve symptoms during manic and depressive episodes • Prevent recurrence of manic and depressive episodes • Do not worsen symptoms of mania or depression; do not accelerate the rate of cycling Do not worsen symptoms of mania or depression; do not accelerate the rate of cycling

bpd antipsychotics

given during severe manic episodes

bpd antidepressants

given during depressive episodes

SNRI caution with bpd

can throw them into a manic episode

bpd drug selection

• Short-term therapy for manic episodes: Lithium and valproate • Short-term therapy for depressive episodes: Lithium or valproate, bupropion, venlafaxine, or a selective serotonin reuptake inhibitor • Long term preventive treatment: Antipsychotic agents

bpd supporting compliance

* Short-term hospitalization * Long-term prophylactic therapy * Education for both patient and family

antipsychotids four facts when treating bpd

Used to acutely control symptoms during manic episodes Used long term to help stabilize mood Benefit patients with or without psychotic symptoms Can be combined with mood stabilizer

antipsychotics approved for use in bpd

• Olanzapine [Zyprexa], quetiapine [Seroquel], risperidone [Risperdal], aripiprazole [Abilify], and ziprasidone [Geodon]

Lithium therapeutic uses

* BPD * Other uses * Alcoholism * Bulimia * Schizophrenia * Glucocorticoid-induced psychosis

Lithium MOA

* Neurotrophic | * Neuroprotective

Lithium excretion

* Short half-life * Excreted by the kidneys * Sodium levels: Lithium excretion reduced when sodium level is low * Plasma levels * 0.8 to 1.4 mEq/

Lithium plasma range

0.8 to 1.4

• Excessive lithium levels

• Greater than 1.5 mEq/L

Monitor lithium levels every

2 to 3 days at initiation of therapy and then every 3 to 6 months

lithium adverse effects

* Gastrointestinal effects * Tremors * Polyuria * Renal toxicity * Goiter and hypothyroidism * Teratogenesis

Lithium drug interactions

* Diuretics * Nonsteroidal antiinflammatory drugs * Anticholinergic drugs

Lithium preperation, dosage and administration

* Lithium carbonate * Lithium citrate * Dosage is highly individualized

Antipsychotic Medications Flashcards

(49 cards)