4.4 Pharmacology of Psychotic Disorders Flashcards
Schizophrenia
- Usually requires multiple treatment approaches including psychological, social and medications.
Antipsychotics (Neuroleptics)
- Major Tranquilizers
- Used to treat acute, chronic, and maintenance for schizophrenia
Bi-polar Mania
- Olanzapine
- Chlorpromazine
- Quetiapine
- Asenapine
- Ziprasidone
- Risperidone
- Aripiprazole
Typical Antipsychotics (First-Gen)
- Blocks dopamine, acetylcholine, histamine, and norepinephrine receptors
- Controls positive symptoms
Medication of Choice
- Chlorpromazine
- Fluphenazine
- Haloperidol
- Lozapine
Atypical Antipsychotics (Second Generation)
- Weaker dopamine receptor antagonist but more potent serotonin antagonist
- FIRST LINE OF TREATMENT
- Addresses both positive and negative symptoms
- Blocks serotonin and dopamine
Medications of Choice
- Risperidone (increased risk of prolactin)
- Olanzapine
- Quetiapine
- Olanzapine
- Ziprasidone
Third Generation Antipsychotics
- Aripiprazole
- Decreased extrapyramidal symptoms (EPS)
- Less weight gain
- Fewer anticholinergic effects.
- Rebalances dopamine and serotonin
Side-effects of Antipsychotics
Blocking Dopamine
- May cause extrapyramidal symptoms and elevated prolactin (galactorrhea, gynecomastia)
Blocking Cholinergics
- May cause dry mouth, blurred vision, constipation, urinary retention, tachycardia)
Alpha-1 Blocker
- Dizziness, orthostatic hypotension, tremors, reflex tachycardia
Histamine Blocker
- Weight gain and sedation
OTHER EFFECTS
- Photosensitivity, ECG changes, diabetes, reduction of seizure threshold, agranulocytosis (low WBC), Tardive Dyskinesia (involuntary movement), neuroleptic malignant syndrome
Precautions
- Coma
- Blood Dyscrasias
- LIVER/RENAL/CARDIAC PATIENTS
- Seizure disorders
- Dementia (contraindicated)
- History of prolonged QT interval
- Parkinsons
- Immunosuppression (cancer)
- Diabetes
Long-Acting Neuroleptics
- Unpleasant side-effects and denial of illness can cause non-adherence to medications
- Long Acting Injectables (LAI) can be given every 2-4 weeks
- Make sure to remain by patients side due to adverse effects
Extrapyramidal Symptoms
- Antiparkinsonian agents can counteract EPS
Opisthotonos - Abnormal posture due to brain injury that impair muscle/brain function. Characteristics include severely arched spine, head and heels that tilt backwards.
Dystonia - Sudden involuntary muscle contractions/spasms (tongue, neck, face, back)
MEDICAL EMERGENCY
Oculogyric Crisis (OGC) - Prolonged involuntary upward deviation of eyes
MEDICAL EMERGENCY
Parkinsonism - Tremors, shuffling gait, drooling, stooped posture, instability
Akathisia - Compulsive, repetitive motions, agitation
Tardive Dyskinesia - Lip smacking, Worm like tongue movement, Fly catching
Anticholinergics
- Used to counteract EPS
- Benztropine
Anticholinergics
- Used to counteract EPS
- First line of treatment for dystonia and oculogyric crisis is Cogentin and Benadryl
- Stay with patient because they may be frightened or in pain
Side Effects
- Dry Mouth
- Blurred Vision
- Tachycardia
- Nasal Congestion
- Constipation
- Urinary Retention (report to provider)
- Orthostatic BP
TREATMENT OF SIDE EFFECTS
- Sips of water
- Sugarless gum
- Suck on hard candy
- Change position slowly
- Increase fiber
Agranulocytosis
- Occurs within first 3 months of treatment
- CBC and WBC prior to administration and weekly for the first 6 months.
AGRANULCYTOSIS IS A MAJOR SIDE EFFECT OF CLOZAPINE
Weight gain and Hyperglycemia
- Common in atypical anti-psychotics
- Monitor weight, blood sugar, and fasting lipids before administering
Neuroleptic Malignant Syndrome
- MEDICAL EMERGENCY STOP MEDICATION IMMEDIATELY
- Check VS
- Check for fever, tachycardia, tachypnea, diaphoresis, stupor, coma, blood pressure changes, rapid deterioration of mental status, muscle rigidity
- Typically occurs more often with injectables so ORAL MEDICATIONS SHOULD BE USED FIRST
Pseudoparkinsonism
- Stooped posture
- Shuffling Gait
- Rigidity
- Bradykinesia
- Tremors at Rest
- Pill-Rolling Motion of the Hand
