3b: Antipsychotics and Antiepileptics Flashcards
original purpose of antipsychotics
replace sedatives (tranquilizers) as main form of treatment for patients
which dopamine receptor is blocked to some extent by all antipsychotics?
D2 receptor
two categories of antipsychotics
traditional and atypical
causes of schizophrenia
genetics (chromosomal changes) and environmental triggers (brain injuries, trauma, social stresses); overactivity of dopamine pathways in the brain
difference between traditional and atypical antipsychotics
traditional = more variable in effectiveness and side effects; increased incidence of movement disorders
atypical = less effective than traditional, lower incidence of relapse, and decreased risk of movement side effects
depot administration of antipsychotics
method of injecting medication every 3-4 weeks for a slow, continual release during the maintenance phase of the disease (good for those with low compliance)
other uses for antipsychotics
- bipolar disorder (with lithium)
- Alzheimer’s (to control agitation and aggression)
two big risks for older adults taking antipsychotics
- developing movement disorders
- stroke or other CV events
types of extrapyramidal symptoms (side effects of antipsychotics)
tardive dyskinesia, pseudoparkinsonism, akathisia, dyskinesia, dystonia, neuroleptic malignant syndrome
most-feared side effect of anti-psychotics
tardive dyskinesia
tardive dyskinesia
involuntary movements of mouth, tongue, jaw, sucking and smacking noises, serious swallow disorders may occur, choreoathetoid movements of extremities, dystonias of the neck and trunk; may be irreversible
pseudoparkinsonism
motor symptoms of parkinson’s (rigidity, tremor, akinesia) caused by antipsychotic meds because they block dopamine receptors
akathisia
side effect of newer anti-psychotic medications, causes sensations of motor restlessness, agitation, pacing the floor, insomnia
dyskinesias and dystonias
movements in the arms, legs, neck, and face, that begin quickly after taking anti-psychotic medications
neuroleptic malignant syndrome
catatonia, stupor, rigidity, tremors, and fever caused by high doses of anti-psychotic medications
non-motor side effects of anti-psychotics
weight gain, increased plasma lipids, diabetes, decreased ACh function, blurred vision, dry mouth, constipation, urinary retention
causes of seizures
stroke, tumor, encephalopathy, head trauma, genetics
seizures that involve the entire brain - grand mal or petit mal seizures
generalized seizures
seizures that only involve part of the brain - complex (loss of consciousness) vs. simple
focal seizures
reasons for pharmacological treatment of seizures
- will usually resolve on their own (self-limiting)
- brain cannot sustain that level of synaptic activity for too long
- seizures can recur if untreated
- injury can occur if patient loses consciousness
ways that anti seizure drugs act to prevent seizures
- initiate activity of CNS inhibitory neurons
- decrease the activity of CNS excitatory neurons
- stabilize opening/closing of Na+ or Ca2+ channels
mechanisms of first generation anti-epileptic drugs
inhibit firing of certain neurons by increasing effects of GABA
6 classes of first generation anti-epileptic drugs
barbiturates, benzodiazepines, hydantoins, iminostilbenes, succinimmides, valproates
what is the main barbiturate (first generation) used as an anti-epileptic drug?
phenobarbital
what are common side effects of anti-epileptic drugs?
sedation and ataxia
what is the difference between first and second generation anti-seizure drugs?
second generation are not more effective but they have milder side effects (often combined with 1st generation)
gabapentin
commonly used second generation anti epileptic drug, reduces excessive neuronal activity in seizure disorders
pharmacokinetics of anti-seizure drugs
oral administration, 3-4 doses per day, drugs cross into brain, biotransformation occurs in the liver
birth defects caused by exposure in-utero to anti-seizure drugs
cleft palate, cardiac defects, microencephaly, neural tube defects, developmental delays, stillbirth, infant seizures
rehab implications of anti-seizure drugs
- likely lifelong medications
- PT may need to monitor effectiveness of meds (control seizures but limit side effects)
- SE: sedation, ataxia, dizziness, skin conditions, GI distress
- possible environmental triggers (lights, sound, etc.)
3 conditions that benzos are used to treat
anxiety, sleep, seizures
why are barbiturates NOT commonly used to treat seizures?
highly addictive and risk of intense side effects
