Anti-Psychotics Part I

Question 1

What is meant by the term psychosis?

Answer 1

Schizophrenia

Question 2

A large percentage of what population is schizophrenic?

Answer 2

Homeless patients

Question 3

Differentiate positive and negative symptoms of schizophrenia.

Answer 3

Positive (I’m positive the person has schizophrenia): delusions, paranoia, hallucinations
Negative (historically difficult to resolve with treatment): apathy, withdrawal, blunt affect

Question 4

Which class of anti-psychotics are better at treating negative symptoms of schizophrenia?

Answer 4

Newer, 2nd generation medications

Question 5

What is the goal of schizophrenia treatment?

Answer 5

Reduce DA in the frontal lobe in the brain –> schizophrenia is too much DA

Question 6

As anti-psychotic medications reduce DA, what other neurotransmitter will increase?

Answer 6

Acetylcholine

Question 7

What disease may be induced by anti-psychotic medications?

Answer 7

Parkinson’s aka pseudo-parkinsonism or extrapyramidal symptoms –> caused by DA-Ach imbalance

Question 8

What is a potential treatment of extrapyramidal symptoms and what are the AEs?

Answer 8

Anti-cholinergic medication –> AE = C-DUST (constipation, dry mouth, urinary retention, sedation, tachycardia)

Question 9

What hormone is affected by anti-psychotic medications decreasing dopamine?

Answer 9

Prolactin increases

Question 10

Other than anti-psychotic medications, what is a common cause of hyperprolactinemia?

Answer 10

Posterior pituitary tumor

Question 11

Differentiate between typical and atypical anti-psychotics.

Answer 11

Typical: older medications
Atypical: newer, aka 2nd generation anti-psychotics

Question 12

T/F: Typical anti-psychotic medications have very few AEs

Answer 12

False: typical anti-psychotics are dirty drugs –> they bind many more receptors than just the DA receptor

Question 13

What is the most significant AE associated with typical anti-psychotic medications.

Answer 13

Weight gain –> big reason for non-adherence

Question 14

What is another name for an anti-psychotic medication?

Answer 14

Neuroleptic –> “anti-psychotic” has a poor social stigma

Question 15

T/F: Anti-psychotic medications all have about the same level of potency.

Answer 15

False: Each drug exhibits different levels of potency –> sometimes a function of dose

Question 16

What determines the potency of an anti-psychotic medication?

Answer 16

Binding affinity for DA receptor –> the more potent, the more likely the drug is to block the DA receptor

Question 17

What AE is more likely to be present in an anti-psychotic with higher potency?

Answer 17

Extrapyramidal Symptoms (EPS) –> more blocking of DA means more Ach

Question 18

What are the S/S known as Extrapyramidal Symptoms (EPS)?

Answer 18

AKA pseudo-parkinsonism –> tremor at rest, lip smacking, rigidity, drooling, akinesia, “mask-like” face

Question 19

T/F: EPS is reversible.

Answer 19

True (sort of): EPS is typically reversible. But, if they take the medication long enough, EPS may become irreversible

Question 20

What is the term used to describe irreversible EPS?

Answer 20

Tardive dyskinesia –> stiff, jerky movements that can’t be controlled

Question 21

What are three ways to manage a patient that experiences EPS?

Answer 21

1. Switch to a second generation anti-psychotic –> less likely to cause EPS
2. Switch to an agent that is less potent or has more anti-Ach properties
3. Add an anti-Ach drug

Question 22

List three anti-Ach medications added to an anti-psychotic to manage EPS

Answer 22

Trihexyphenidyl, Benztropine, Diphenhydramine

Question 23

What are two disadvantages of adding an anti-Ach drug to manage EPS?

Answer 23

More side effects –> C-DUST

Adherence –> adding another tablet

Question 24

Describe an acute dystonic reaction and state how it is managed.

Answer 24

• First dose phenomenon where patients develop acute EPS when they start an anti-psychotic.
• Treated with IV benztropine or diphenhydramine

Question 25

Describe neuroleptic malignant syndrome (NMS).

Answer 25

Rare, life-threatening syndrome characterized by hyperpyrexia, cogwheel rigidity, rhabdo s/p rigidity.

Question 26

What are four treatment options for NMS.

Answer 26

D/C the anti-psychotic
Bicarb and fluids for rhabdo if present
Dantrolene (direct acting skeletal muscle relaxant)
Bromocriptine (DA agonist)

Question 27

Differentiate direct from indirect skeletal muscle relaxers

Answer 27

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

Question 28

What are two uses for bromocriptine other than NMS?

Answer 28

Parkinson’s

Pituitary tumors that produce too much prolactin (DA hates prolactin)

Question 29

What are the four pharmacological options mentioned in class for calming an agitated patient?

Answer 29

Benzodiazepines
Haloperidol
Quetiapine
Valproic Acid

Question 30

List the advantages and disadvantages of first generation (aka typical) anti-psychotics

Answer 30

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)

Question 31

What is a potentially life-threatening precaution associated with all antipsychotics?

Answer 31

QT prolongation –> can result in torsades

Question 32

List the high, medium, and low potency 1st generation anti-psychotics discussed in class

Answer 32

High: haloperidol, fluphenazine, thiothixene
Medium: loxapine
Low: thioridazine

Question 33

What is the most common use of haloperidol?

Answer 33

Agitation in Alzheimer’s, psychosis, or ICU patients

Question 34

How is haloperidol administered?

Answer 34

PO, IM, or IV (bolus or infusion)

Question 35

What is a precaution associated with haloperidol?

Answer 35

Decreases seizure threshold

Question 36

What is a precaution associated with thioridazine?

Answer 36

Photosensitivity –> (thio = sulfa = photosensitivity)