Anti-Psychotics Part I Flashcards
What is meant by the term psychosis?
Schizophrenia
A large percentage of what population is schizophrenic?
Homeless patients
Differentiate positive and negative symptoms of schizophrenia.
Positive (I’m positive the person has schizophrenia): delusions, paranoia, hallucinations
Negative (historically difficult to resolve with treatment): apathy, withdrawal, blunt affect
Which class of anti-psychotics are better at treating negative symptoms of schizophrenia?
Newer, 2nd generation medications
What is the goal of schizophrenia treatment?
Reduce DA in the frontal lobe in the brain –> schizophrenia is too much DA
As anti-psychotic medications reduce DA, what other neurotransmitter will increase?
Acetylcholine
What disease may be induced by anti-psychotic medications?
Parkinson’s aka pseudo-parkinsonism or extrapyramidal symptoms –> caused by DA-Ach imbalance
What is a potential treatment of extrapyramidal symptoms and what are the AEs?
Anti-cholinergic medication –> AE = C-DUST (constipation, dry mouth, urinary retention, sedation, tachycardia)
What hormone is affected by anti-psychotic medications decreasing dopamine?
Prolactin increases
Other than anti-psychotic medications, what is a common cause of hyperprolactinemia?
Posterior pituitary tumor
Differentiate between typical and atypical anti-psychotics.
Typical: older medications
Atypical: newer, aka 2nd generation anti-psychotics
T/F: Typical anti-psychotic medications have very few AEs
False: typical anti-psychotics are dirty drugs –> they bind many more receptors than just the DA receptor
What is the most significant AE associated with typical anti-psychotic medications.
Weight gain –> big reason for non-adherence
What is another name for an anti-psychotic medication?
Neuroleptic –> “anti-psychotic” has a poor social stigma
T/F: Anti-psychotic medications all have about the same level of potency.
False: Each drug exhibits different levels of potency –> sometimes a function of dose
What determines the potency of an anti-psychotic medication?
Binding affinity for DA receptor –> the more potent, the more likely the drug is to block the DA receptor
What AE is more likely to be present in an anti-psychotic with higher potency?
Extrapyramidal Symptoms (EPS) –> more blocking of DA means more Ach
What are the S/S known as Extrapyramidal Symptoms (EPS)?
AKA pseudo-parkinsonism –> tremor at rest, lip smacking, rigidity, drooling, akinesia, “mask-like” face
T/F: EPS is reversible.
True (sort of): EPS is typically reversible. But, if they take the medication long enough, EPS may become irreversible
What is the term used to describe irreversible EPS?
Tardive dyskinesia –> stiff, jerky movements that can’t be controlled
What are three ways to manage a patient that experiences EPS?
- Switch to a second generation anti-psychotic –> less likely to cause EPS
- Switch to an agent that is less potent or has more anti-Ach properties
- Add an anti-Ach drug
List three anti-Ach medications added to an anti-psychotic to manage EPS
Trihexyphenidyl, Benztropine, Diphenhydramine
What are two disadvantages of adding an anti-Ach drug to manage EPS?
More side effects –> C-DUST
Adherence –> adding another tablet
Describe an acute dystonic reaction and state how it is managed.
- First dose phenomenon where patients develop acute EPS when they start an anti-psychotic.
- Treated with IV benztropine or diphenhydramine
Describe neuroleptic malignant syndrome (NMS).
Rare, life-threatening syndrome characterized by hyperpyrexia, cogwheel rigidity, rhabdo s/p rigidity.
What are four treatment options for NMS.
D/C the anti-psychotic
Bicarb and fluids for rhabdo if present
Dantrolene (direct acting skeletal muscle relaxant)
Bromocriptine (DA agonist)
Differentiate direct from indirect skeletal muscle relaxers
Direct: stops release of calcium inside muscle cells to inhibit muscle contraction
Indirect: hyperpolarizes the neurons that feed major muscle groups –> inhibits innervation of muscles
What are two uses for bromocriptine other than NMS?
Parkinson’s
Pituitary tumors that produce too much prolactin (DA hates prolactin)
What are the four pharmacological options mentioned in class for calming an agitated patient?
Benzodiazepines
Haloperidol
Quetiapine
Valproic Acid
List the advantages and disadvantages of first generation (aka typical) anti-psychotics
Adv: lower cost, multiple dosage forms (increases adherence)
Disadv: EPS/tardive dyskinesia, negative symptoms not treated well, AEs tend to decrease adherence (esp weight gain)
What is a potentially life-threatening precaution associated with all antipsychotics?
QT prolongation –> can result in torsades
List the high, medium, and low potency 1st generation anti-psychotics discussed in class
High: haloperidol, fluphenazine, thiothixene
Medium: loxapine
Low: thioridazine
What is the most common use of haloperidol?
Agitation in Alzheimer’s, psychosis, or ICU patients
How is haloperidol administered?
PO, IM, or IV (bolus or infusion)
What is a precaution associated with haloperidol?
Decreases seizure threshold
What is a precaution associated with thioridazine?
Photosensitivity –> (thio = sulfa = photosensitivity)
