Lecture 4: Antipsychotics Flashcards
(44 cards)
Positive Symptoms Schizophrenia (7)
- hallucinations
- hostility
- excitability
- delusions
- suspiciousness/persecution
- conceptual disorganization
- grandiosity
Negative symptoms schizophrenia (5)
lessening or absence of normal behaviors and functions related to motivation and interest or verbal/emotional expression
- Blunted effect
- Alogia
- Avolition
- Asociality
- Adnhedonia
Blunted effect
negative symptom shcizophrenia
- diminished facial and vocal
- poor eye contact
- minimal use gestures
Alogia
Negative sx schizophrenia
- short to monosyllable answers to questions
- avoids communication
- uses few words
Avolition
negative sx schizophrenia
- emotional withdrawal
- apathy
- poor grooming/hygiene
- decreased involvement with work or school
Asociality
Negative sx schizophrenia
- few friends/poor relationships
- lack of motivation for relationships
- reduced social interaction
Anhedonia
negative sx schizophrenia
- difficulty or inability to anticipate future pleasure
- few leisure activities
- lack of interest in sexual activity
Goals of therapy (4)
- efficacy: reduction in threat/harm, improvement in acute psychosis
- stabilization: reduce postitive, negative, cognitive sx, medication adherance
- Maintenance: control/remission sx, baseline return, relapse prevention
- Adverse effects: adherence to medication, management ADRS
American Psychiatric Association Guidelines
tx recommentations (4 steps)
- tx with antipsychotic
- monitor for effectivement and side effects
- continue antipsychotics if symptoms improve - Clozapine
- tx resistant schizophrenia
- suicidality remains desire other tx - Tx acute dystonia (involuntary muscle movements) with an anticholinergic rx
- Treat moderate to severe tardive dyskinesia with VMAT2 inhibitor
Tx recommendations (4)
- any antipsychotics could be considered for 1st line
- EXCP: clozapine & lumateperone
- Adequate trial=apropriate dosing for 2-6 weeks - After failure: switch one of the above
- third line: clozapine
- adequate trial: appropriate dosing for 12 + weeks - beyond: augmenting clozapine, multiple agents, ECT
Adequate trial for antipsychotics
appropriate dosing for 2-6 weeks
Exceptions to the antipsychotics 1st line of defense rule
- clozapine
2. lumateperone
Clozapine as third line
adequate dosing for 12+ weeks
1st Generation/ typical antipsychotics
Mechanism (4)
M: 1) dopamines- (DA)D2 receptor blockade
-therapeutic effect, EPS
- muscarinic- M1 receptor blockade
- histaminic- H1 receptor blockade
- Alpha- Aa1 receptor blockade
* agents differ in potency and receptor affinity
Second generation/atypical antipsychotics
MOA
EXCP
M: 1) similar to 1st generation antipsychotics
- increase D2 receptor dissociation
- additional serotonin 5HT2a antagonism
EXCP: aripiprazole, brexiprazole, and caripraszine- partial agonists at D2 receptors
D-HAMS receptors assoc. with antipsychotic therapy
- Dopaminergic
- Histamanic
- Adrenergic
- Muscarinic
- Serotonergic
Dopaminergic receptor (3)
therapeutic effects
extrapyramidal side effects
hyperprolactinemia
Histaminic receptor (2)
sedation and wight gain
Adrenergic receptor (2)
postural hypotension and reflex
tachycardia
Muscarinic receptors (6)
anticholinergic-dry mouth, contipation, urinary retention, blurred vision, decreased cognition
ALL ANTIPSYCHOTIC AE (4)
- mortality and dementia
- FDA boxed warning
- elderly: dementia, related psychosis
- meta-analysis of 17 placebo-controlled trias: 1.6 x more likely to dies compared to placebo
CAUSE: varied, but included cardiovascular and infectious
Precautions for all/most FGAs (first generation antipsychotics) (8)
- seizure disorders
- neuroleptic malignant syndrome
- movement disorders
- blood dycrasias
- inability to adjust to extreme heat
- cardiovascular disease
- hyperprolactinemia
- dysphagia
AE inhaled loxapine
Indication box warning (3)
I: ACUTE tx agitation in schizophrenia/bipolar disorder in adults
W: 1. potential cause respiratory distress and arrest
- can only be used in an enrolled facility that can intubate/ventilate patients
- do not use in patients with asthma, COPD, lung disease or physical exam positive for respiratory problems
Precautions for all/most SGAs (9)
- seizures
- neuroleptic malignant synfrome
- metabolic abnormalities the can increase cardiovascular rx
- hyperprolactinemia
- blood dyscrasia
- orthostasis and syncope
- Suicidality
- Dysphagia
- inability to adjust to extreme heat