Lecture 3 Flashcards
1
Q
__________ = Neuroleptic =
Major Tranquilizer
A
Antipsychotic
2
Q
is a syndrome – and can be associated with numerous different psychiatric disorders.
A
Psychosis
3
Q
Disorders in which Psychosis is a ________ Feature:
Schizophrenia
Substance Induced Psychosis
Schizophreniform Disorder
Schizoaffective Disorder
Delusional Disorder
Brief Psychotic Disorder
Psychotic Disorder due to a general medical condition
A
Defining
4
Q
Disorders in which Psychosis is an ___________ Feature:
Mania
Depression
Neurocognitive disorders
Acquired brain injuries
Delirium
A
Associated
5
Q
Positive Symptoms of schizophrenia spectrum
A
Delusions
Hallucinations
6
Q
Distortions or exaggerations in language and communication
Disorganized speech
Disorganized behavior
are examples of
A
Cognitive Symptoms
7
Q
Affective flattening
Avolition – difficulty with self-directed behaviours
Alogia – reduced speech
Anhedonia – reduced pleasure
Asociality – reduced socialization
Anosognosia – lack of insight
Apathy – lack of interest
Catatonia – abnormal movements
are all examples of
A
Negative Symptoms
8
Q
difficulty with self-directed behaviours
A
Avolition
9
Q
reduced speech
A
Alogia
10
Q
reduced pleasure
A
Anhedonia
11
Q
reduced socialization
A
Asociality
12
Q
lack of insight
A
Anosognosia
13
Q
lack of interest
A
Apathy
14
Q
abnormal movements
A
Catatonia
15
Q
Brand name: Thorazine, Largactil, CPZ
Oral and short acting injectable drug
A
chlorpromazine
16
Q
Brand name: Nozinan
Chemical class: Phenothiazine (aliphatic)
Potency: Low
Oral dosage: 10-200 mg/day PO
A
methotrimeprazine
17
Q
Brand Name: Fluanxol
A
flupenthixol
18
Q
Brand name: Clopixol
C: Thioxanthene
P: Low
D: 10-70 mg/day PO
A
zuclopenthixol dihydrochloride
19
Q
Brand Name: Haldol
Checmical Class: Butyrophenone
Potency: High
Oral Dosage: 0.5-20 mg/day PO
A
haloperidol
20
Q
Brand Name: Clozaril
Chemical Class: Dibenzodiazepine
Dosage: 75-900 mg/day
(common: 300 mg/day) PO
A
clozapine
21
Q
Brand Name: Zyprexa
Oral and short acting injectable
A
olanzapine
22
Q
B: Risperidal
C: Benzisoxazole
D: 0.5-16 mg/day PO
A
risperidone
23
Q
B: Invega
C: Benzisoxazole
D: 3-12 mg/day PO
A
paliperidone
24
Q
B: Zeldox
Comes in PO and short acting injectable drug
A
ziprasidone
25
B: Saphris
D: 5-20 mg daily PO
asenapine
26
B: Seroquel
C: Dibenzothiazepine
D: 50-800 mg/day PO
quetiapine
27
Dopamine pathways:
Mesolimbic & Mesocorticol lead to ________
Negative symptoms
28
brain stem to the limbic areas of the brain
Function: control behaviours, reward system
Mesolimbic
29
brainstem to the frontal cortex
Function: control cognition, emotion and behavior
Mesocortical
30
B: Abilify
C: Dihydrocarbostyril
D: 10-30 mg daily PO
aripiprazole
31
Are effective in treating positive symptoms – because they are potent dopamine antagonists in the mesolimbic pathway
Typical antipsychotics
32
Have an affinity for dopamine receptors
Typical antipsychotics
33
Some side effects are caused because they are potent dopamine antagonists in the other brain pathways
Typical antipsychotics
34
Hyperactivity in this pathway lead to positive symptoms
Typical antipsychotics medication lower dopamine in this pathway
Mesolimbic
35
Hyperactivity leads to negative symptoms
Typical medications lower dopamine in this pathway
Mesocorticol
36
Typical antipsychotic - lower dopamine in pathway
Function - control movement
Nigrostriatal
37
Typical lower dopamine in this pathway
Function: control endocrine hormones
Tuberoinfundibular
38
are more likely to produce postural hypotension and sedation than other drugs
Aliphatic Phenothiazines
39
These are the most likely drugs to cause extrapyramidal side effects
Piperazine Phenothiazine
40
Short acting injectable drug
Clopixol Acuphase
50-150 mg q 1-3 days
(max 150mg q 3 days)
zuclopenthixol Acetate
41
Short acting injectable drug
Clopixol Depot
150-300 mg q 2-4 weeks
zuclopenthixol decanoate
42
Short acting injectable drug
Haldol
2.5-5 mg q 4-6 h
haloperidol
43
Depot & long acting injectable drug
Haldol LA
50-400 mg q 3-4 weeks
haloperidol decanoate
44
Short acting injectable drug
Zyprexa
5-10mg q 2-4 h
(max 20 mg daily or 3 injections)
olanzapine
45
Depot & long acting injectable drug
Risperidal Consta
25-50 q 2 weeks
risperidone
46
Injectable depot & long lasting drug given deltoid
risperidone
47
Depot & long acting injectable drug
Invega Sustenna
50-150 q 4 weeks
paliperidone palmitate
48
Depot & long acting injectable drug
Invega Trinza
175-525 q 3 months
paliperidone palmitate
49
Depot & long acting injectable drug
Abilify Maintena
300-400 mg q 4 weeks
aripiprazole monohydrate
50
B: Rexulti
C: Dihydrocarbostyril
D: 1-3 mg daily PO
brexpiprazole
51
Depot & long acting injectable drug
Invega Sustenna
50-150 q 4 weeks
paliperidone palmitate
52
Latuda
Oral medication
lurasidone
53
Fluanxol Decanoate
Depot and Long Acting Injectable
flupenthixol decanoate
54
Clopixol Depot
Depot and Long Acting Injectable
zuclopenthixol decanoate
55
Haldol LA
Depot and Long Acting Injectable
haloperidol decanoate
56
Two findings contribute to this theory:
1. Antipsychotic drugs decrease dopamine activity by blocking receptors
2. Signs and symptoms of psychosis occur with drugs that increase dopamine levels in the brain (ex. Cocaine and Amphetamines)
Dopamine Hypothesis and Schizophrenia
57
Serotonin deficiency results in symptoms of depression and major depressive disorder
Serotonin deficiency may lead to cognitive symptoms
Excess serotonin can lead to positive and negative symptoms
Serotonin inhibits dopamine
Serotonin Hypothesis
58
Positive, negative, and cognitive symptoms to inactive or deficient glutamate receptors
Glutamate Hypotheses
59
Predispositions and vulnerabilities for schizophrenia (diatheses)
People's vulnerabilities must interact with life stresses to trigger the onset of the illness
Vulnerability + Stress
Stressors can include:
Trauma
Virus
Prenatal and perinatal complications
Substance use
Diathesis-stress models
60
Typical (First Generation) & Atypical (Second Generation; Third Generation)
Potency (high, medium or low)
Chemical Class
Antipsychotic classification
61
Usually require small amounts to work
They are associated with lower levels of sedation, weight gain, and anticholinergic activity
May have a high risk for extrapyramidal side effects
High potency antipsychotics
62
Are dosed in the 100's of milligrams
High levels of sedation and anticholinergic effects
Low risk of extrapyramidal side effects
Low potency antipsychotics
63
These are all ______ antipsychotics:
Phenothiazines
- Aliphatic
- Piperidine
- Piperazine
Nonphenothiazines
- Thioxanthenes
- Dibenzoxazepine
- ButyrophenoneT
Typical Antipsychotics
64
Have and affinity for dopamine receptors
Typical Antipsychotics
65
Are effective in treating positive symptoms – because they are potent dopamine antagonists in the mesolimbic pathway
Typical Antipsychotics
66
Some side effects are caused because they are potent dopamine antagonists in the other brain pathways
Typical Antipsychotics
67
1. Mesolimbic – Behaviours, reward system
- Hyperactivity in mesolimbic pathway leads to positive symptoms
2. Mesocortical – Cognition, emotion and behavior
- Hypoactivity in mesocortical pathway leads to negative symptoms
3. Nigrostriatal – Movement
4. Tuberoinfundibular – Endocrine hormones
Dopamine Pathways
68
________ – Behaviours, reward system
- Hyperactivity in this pathway leads to positive symptoms
Mesolimbic
69
_______ – Cognition, emotion and behavior
- Hypoactivity in this pathway leads to negative symptoms
Mesocortical
70
Movement pathway
Nigrostriatal
71
Endocrine hormones pathway
Tuberoinfundibular
72
Decrease dopamine
Decrease positive symptoms
(Atypical)
Mesolimbic
73
Decrease dopamine
Increase negative symptoms
(Atypical)
Mesocortical
74
Decrease dopamine
Increase acetylcholine
Increase Extrapyramidal symptoms
(Atypical)
Nigrostriatal
75
Decrease dopamine
Increase prolactin
Increase feminization effects
(Atypical)
Tuberoinfundibular
76
Nigrostriatal – EPSE/TD (contains ___ of brains dopamine)
80%
77
Mesolimbic + symptoms (increase in ______)
dopamine
78
restricts prolactin release… therefore the less ______ = more prolactin
dopamine
79
________ and Ach have an inverse relationship – decrease ____ = increase Ach – increase Ach – increase EPS
Dopamine; Dopamine
80
endocrine and prolactin release
Tuberoinfundibular
81
symptoms and cognitive (hypo function of pathway)
Mesocortical
82
These are all _______ antipsychotics: Dibenzodiazepine
Thienobenzodiazepine
Benzisoxazole
Benzothiazolyl Piperazine
Dibenzothiazepine
Benzisothiazol
Dihydrocarbostyril
Atypical Antipsychotics
83
Serotonin – Dopamine Antagonists
Treat positive symptoms by blocking dopamine in the mesolimbic pathway
Treat negative symptoms by blocking serotonin and increasing dopamine in the mesocortical pathway
Reduce negative side effects because they block serotonin and increase dopamine in the other pathways.
Atypical Antipsychotics
84
Decrease dopamine
Decrease positive symptoms
(Atypical)
Mesolimbic
85
Decrease serotonin
Increase dopamine
Decrease negative symptoms
(Atypical)
Mesocortical
86
Decrease serotonin
Increase dopamine
Decrease risk of extrapryramidal symptoms
(Atypical)
Nigostriatal
87
Decrease serotonin
Increase dopamine
Decrease prolactin
Increase feminization effects
(Atypical)
Tuberoinfundibular
88
Atypical antipsychotics are _____ and ______ antagonists.
dopamine; serotonin
89
Clozapine is the ______ atypical antipsychotic
prototype
90
Olanzapine and clozapine commonly associated with ________ and metabolic syndrome
weight gain
91
Clozapine associated with _______
agranulocytosis
92
Abilify & Rexulti
3rd generation Antipsychotics
93
should NEVER be used for maintenance treatment
Short Acting antipsychotic injections
94
Should only be used for short periods of time in acute situations
Short Acting antipsychotic injections
95
Always start with _____ before using depot
oral
96
Typically do a test dose which is ¼ to ½ dose – monitor for _____ before the full dose
7 days
97
All given dorsal gluteal except _____- – deltoid
risperidone
98
Many antipsychotics require a low dose with monitoring upon initiation of a new drug.
During this low dose monitoring the client has to be carefully monitored for side effects.
The drug is slowly titrated up over a period of time until therapeutic effects are reached.
Do not allow clients to crush or chew sustained release capsules – this will speed up the absorption and may cause toxicity.
All antipsychotics should be titrated down over a 6- 8 week period
Administration Considerations for Oral Antipsychotics
99
Anxiety
Insomnia
Gastritis
Nausea and vomiting
Dizziness
Dystonia
Dyskinesia
Paresthesia
Tremulousness
Rebound psychosis
These are all signs of...
Abrupt discontinuation
100
The drug bypasses gastrointestinal absorption
No first- pass metabolism effect
Lower rates of relapse
Advantages of Depot Medications
101
1. Need to be administered deep into muscle tissue
2. Can irritate the skin and cause pain at the injection site
3. Hold the risk of severe and long long-lasting side effects if not screened properly
Disadvantages of Depot Medications
102
Administered as a deep Intramuscular injection
Depot medication
103
Gluteal sites are the preferred sites for injection (unless the package indicates differently ex Palliperidone - deltoid)
Depot medication
104
Always check the site for masses
abscesses or scar tissue may have formed from previous IM’s and can cause problems with absorption
Depot medication
105
Inject slowly to allow the drug a chance to absorb
Depot medication
106
The dosage for _______ injectable antipsychotic medication often differs from the therapeutic dosage of a depot medication
short-acting
107
You can tell the difference by:
Label
Dosage
Thickness – the ______ will be thicker than the regular IM medication.
depot
108
are absorbed through the Gastrointestinal Tract
Oral antipsychotics
109
Antipsychotic medications are highly lipophilic (stored in fat tissues) (distribution)
Oral antipsychotics
110
are absorbed from the injection site
Intramuscular (IM) antipsychotics
111
Distribution can occur for up to 6 months after a drug has been stopped
Intramuscular (IM) antipsychotics
112
are metabolized in the liver
Oral antipsychotics
113
Antipsychotics are excreted in urine and bile
Oral antipsychotics
114
enter the bloodstream directly and do not experience a “first pass” through the liver
(metabolism)
Intramuscular (IM) antipsychotics
115
Antipsychotics cross the placenta and enter breast milk
(excretion)
Intramuscular (IM) antipsychotics
