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Nurs 5229 Clinical Pharmacotherapeutics > Antipsychotic Medications > Flashcards

Antipsychotic Medications Flashcards

1
Q

conditions managed with antipsychotics

A
  • 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

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2
Q

three types of symptoms for schizophrenia

A

positive
negative
cognitive

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3
Q

Positive

A 
Exaggeration or distortion of
normal function
Hallucinations 
Delusions 
Agitation
Tension 
Paranoia
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4
Q

Negative

A 
Loss or diminution of normal
function
Lack of motivation 
Poverty of speech
Blunted affect 
Poor self-care 
Social withdrawal
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5
Q

Cognitive

A 
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
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6
Q

Primary neurotransmitter at work when we talk about schizophrenia

A

dopamine

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7
Q

Underactivity of D1 receptor

A

negative symtpoms

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8
Q

Overactivity of D2 receptors

A

positive symptoms

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9
Q

Three major objectives of treatment for shizophrenia

A
  • Suppression of acute episodes
  • Prevention of acute exacerbations
  • Maintenance of the highest possible level of functioning
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10
Q

Strategic and therapeutic considerations for treatment of schizophernia

A
  • Drug selection
  • Dosing
  • Route
  • Oral (tablets, capsules, and liquids)
  • Intramuscular
  • Inhaled
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11
Q

First Gen Examples

A 
Chlorpromazine
(Thorazine)
Fluphenazine(Prolixin)
Perphenazine (Trilafon)
Trifluoperazine (Stelazine)
Thioridizine (Mellaril)
Thiothixene (Navane)
Haloperidol (Haldol)
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12
Q

2nd Gen

A 
Olanzapine (Zyprexa)
Clozapine (Clozaril)
Risperidone (Risperdal)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
Paliperidone (Invega)
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13
Q

Typical action

A

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

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14
Q

Atypical action

A

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

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15
Q

Typical intended effects

A 
Reduces positive symptoms of Schizophrenia
(hallucinations, tics)
Treatment of nausea, vomiting, hiccups
Reduces aggressive behaviors
Not much effect on negative symptoms
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16
Q

Atypical intended effects

A

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

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17
Q

Typical side effects

A 
Extrapyramidal effects (EPS); tardive
dyskinesia
Anticholinergic effects
Adrenergic effects
Prolonged QT
Sedation
Hyperprolactinemia
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18
Q

A typical side effects

A

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

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19
Q

Typical contraidincatiosn precaustions

A

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

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20
Q

Atypical contraindications/precautions

A

Drug specific

*wt gain differs by agent

21
Q

METABOLISM AND

ELIMINATION

A

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)

22
Q

Antipsychotic initiation

A

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

23
Q

Antipsychotic stabilization

A

(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)}

24
Q

Antipsychotic Maintenance

A

Continue at least 12 months; may be lifetime

Taper slowly to avoid withdrawal

25
Q

What drugs increase effects of antipsychotics

A 
Antihypertensives
CNS depressants
Fluvoxamine
Cipro
Other Antipsychotics
Anticholinergics
Lithium
Drugs that prolong QT
26
Q

Drugs that decrease effects

A

Anticonvulsants

Tobacco

27
Q

Typicals Monitoring

A

• 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

28
Q

Atypical Monitoring

A
  • Baseline: waist circumference, BMI, BP, FBS, lipid profile.
  • Repeat labs at 3 months, BMI quarterly
  • Annual: BP, labs, waist circumference. Clozapine: CBC
29
Q

Definition of bipolar disorder (BPD)

A
  • Cyclic disorder
  • Recurrent fluctuations in mood
  • Episodes of mania and depression persist for months without treatment
30
Q

Types of mood episodes seen with BPD

A
  • Pure manic episode (euphoric mania) Pure manic episode (euphoric mania)
  • Hypomanic episode (hypomania)
  • Major depressive episode (depression)
  • Mixed episode
31
Q

Treatment for BPD

A
  • Drugs

* Psychotherapy

32
Q

Types of Drugs used for bi poloar disorder

A

mood stabilizers
antipsychotics
antidepressants

33
Q

bpd mood stabilizers

A

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

34
Q

bpd antipsychotics

A

given during severe manic episodes

35
Q

bpd antidepressants

A

given during depressive episodes

36
Q

SNRI caution with bpd

A

can throw them into a manic episode

37
Q

bpd drug selection

A

• 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

38
Q

bpd supporting compliance

A
  • Short-term hospitalization
  • Long-term prophylactic therapy
  • Education for both patient and family
39
Q

antipsychotids four facts when treating bpd

A

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

40
Q

antipsychotics approved for use in bpd

A

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

41
Q

Lithium therapeutic uses

A
  • BPD
  • Other uses
  • Alcoholism
  • Bulimia
  • Schizophrenia
  • Glucocorticoid-induced psychosis
42
Q

Lithium MOA

A
  • Neurotrophic

* Neuroprotective

43
Q

Lithium excretion

A
  • 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/
44
Q

Lithium plasma range

A

0.8 to 1.4

45
Q

• Excessive lithium levels

A

• Greater than 1.5 mEq/L

46
Q

Monitor lithium levels every

A

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

47
Q

lithium adverse effects

A
  • Gastrointestinal effects
  • Tremors
  • Polyuria
  • Renal toxicity
  • Goiter and hypothyroidism
  • Teratogenesis
48
Q

Lithium drug interactions

A
  • Diuretics
  • Nonsteroidal antiinflammatory drugs
  • Anticholinergic drugs
49
Q

Lithium preperation, dosage and administration

A
  • Lithium carbonate
  • Lithium citrate
  • Dosage is highly individualized

Nurs 5229 Clinical Pharmacotherapeutics (78 decks)

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