Antipsychotics BLOCK III Flashcards
What is psychosis
general term that describes several mental disorders characterized by a defect of lost contact with reality often with hallucinations or delusions
What defines schizophrenia
Schizophrenia: thought disorder characterized by a mix of symptoms such as:
- Hallucinations
- Ideation
- Reality (e.g. delusion)
- Cognition (e.g. loose association)
- Emotions (e.g. flat affect)
What is alogia
Inability to carry on conversation
What is Catatonia
the predominant clinical features involve disturbances in a person’s movement; may exhibit a dramatic reduction in activity, to the point that voluntary movement stops
What is hebephrenia
Disorganized
is thought to be an extreme expression of disorganization syndrome that has been hypothesized to be one feature of a 3-factor model of schizophrenia symptoms, the other factors being; Delusions/hallucinations (reality distortion) Psychomotor poverty (poor speech, lack of spontaneous movement, and blunting emotion)
How do 5-HT blockers effect schizophrenia
Increase the release of DA to alleviate negative symptoms
How do D2 blockers like haloperidol effect schizophrenia
Inhibit DA action and alleviate positive symptoms (hallucinations/ .delusions)
What are the primary NTs involved in Schizo DO
Dopamine
5-hydroxtryptamine (5HT; serotonin)
Glutamate
Is polypharm or monopharm preferred for schizo DOs
Monopharm
What is the APA recommendation for 1* vs 2* gen antipsychotics
Use an atypical antipsychotic first (less risk for EPS)
Patients who prefer or have a history of response to typical antipsychotics may first use typical antipsychotics
Response to medications is NOT immediate, maximal treatment response may take 6 months or longer to be observed
After treatment response observed; maintain current therapy for a minimum of 6 months
What are the 7 clinical uses of Antipsychotics
Antiemetic (Typicals)
Stop Hiccups (Chlorpromazine)
Adjunct Pain Control (off label)
Depression (off label)
Rapid acting Formulations
( acute agitated and disruptive behavior)
Long acting Formulations ( used in pts that lack compliance)
Define EPS
-Dystonia: abnormal tonicity; severe muscle spasm of the head, neck and tongue
-Tardive Dyskinesia (may not be reversible)
Syndrome of involuntary movements of the face, mouth, tongue, trunk and limbs
Occurs in prolonged therapy with drugs that have a high affinity for the D2 receptor (i.e. haloperidol)
-Akathesia (most common EPS)
Desire to be in constant motion (inability to sit still, pacing).
May include feeling of fright, rage, suicide.
Can be confused with anxiety or exacerbation of psychosis
How do we tx EPS
Low dose propranolol and reduce dose of antipsychotics
What is the black box label for antipsychotics
Black Box Warning: increase mortality in elderly patients with dementia-related psychosis
What is the MOA of 1* gen Antipsychotics
Competitive blockers of dopamine receptors D2 in the mesolimbic pathway
Also have activity at histamine, muscarinic, and alpha-receptors
Relatively less effective at controlling the negative symptoms of schizophrenia
How do we treat psuedo Parkinson’s ( drug induced)
Reduce dose
Use an Atypical (2* gen)
Anticholinergic: Trihexyphenidyl or Benzotropine
Antihistamine: diphenhydramine
What are the ADE of 1* gen antipsychotics
QT prolongation Negative/ cognitive s/s Weight gain Postural HOTN Anticholinergic Fx Sedation
What is the most severe ADE of 1* gen antipsychotics
Nueroleptic Malignant Syndrome
Occurs in all agents, but more common with high-potency typical drugs
Symptoms: agitation, confusion, changing levels of consciousness, fever, tachycardia, hypertension, and sweating
Most severe adverse drug event; mortality rate is high and it should be taken seriously
Discontinue the offending agent and provide supportive therapy
What is the relationship of dopamine to prolactin
Dopamine is the major prolactin inhibiting factor so blocking dopamine results in prolactin elevation
Symptoms:
Women: galactorrhea and menstrual irregularities
Men: gynecomastia, sexual dysfunction and decreased fertility
What are the low potency 1* gen antipsychotics
Chlorpromazine and Thioridazine
Lower affinity for dopamine receptors; thus less risk of causing EPS
Possess anticholinergic, antihistaminic, and α-adrenergic blocking properties
Higher rates of sedative, anticholinergic and autonomic adverse effects
What are the high potency 1* gen antipsychotics
Trifluoperazine
Fluphenazine
Haloperidol
High affinity for the dopamine receptors; thus higher rates of extrapyramidal symptoms (EPS)
Less potency at the other receptors
What antipsychotic Tx hiccups
Chlorpromazine
When using chlorpromazine for hiccups, what is the ADE associated with this drug
May cause pigment deposits on the retina and corneal opacity
What are the ADE of Thioridazine
High anti-cholinergic side effects
Highest occurrence of sedation
Black Box Warning: Torsade’s de pointes and sudden death
