Antipsychotic medications Flashcards

1
Q

What are typical antipsychotics?

A

aka ‘first generation’ antipsychotics-developed in the 1950s

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2
Q

When were atypical antipsychotics developed and what are they otherwise known as?

A

aka ‘second generation’ or ‘novel’ antipsychotics developed from 1970s onwards

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3
Q

In what conditions are antipsychotics used?

A

Mainly in;
- schizophrenia
- psychosis

Also in;
- mood disorders with psychotic symptoms
- torretes
- dementia with psychotic symptoms

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4
Q

Explain the action of antipsychotic medications

A
  • also known as Neuroleptics
    = target and block dopamine rceptors
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5
Q

What are the four main dopamine pathways that are effected by antipsychotics?

A

Meso-limbic
- thought to be hyperactive in schizophrenia and to mediate the positive symptoms of schizophrenia.

Meso-cortical
- thought to be under active in schizophrenia and to cause the negative symptoms.

Nigro-striatal
- controls motor function and movement

Tubero-infundbular
- controls prolactin secretion

Dopamine receptors D1 and D2 are found in highest density in each of these pathways

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6
Q

What is the main target of antipsychotic medications?

A

D2

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7
Q

What are some examples of typical antipsychotic medications? And what are common suffixs

A
  • Chlorpromazine (Largactil)
  • Pericyazine (Neulactil)
  • Droperidol (Droleptan)
  • Flupenthixol (Fluanxol)
  • Haloperidol (Serenace)
  • Zuclopenthixol dihydrochloride (Clopixol)
  • Fluphenazine (Modecate)
    ??ol
  • Trifluoperazine (Stelazine)
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8
Q

What are some examples of atypical antipsychotic medications? And what are some common side effects?

A
  • Clozapine (Clopine/Clozaril)
  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa)
  • Ziprasidone (Zeldox)
  • Aripiprazole (Abilify)
  • Quetiapine (Seroquel)
  • Amisulpride (Solian)
  • Paliperidone (Invega)
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9
Q

What are some examples of long-acting injectable antipsychotics?

A

Risperidone Consta: 2 weekly
Fluphenazine Decanoate: 2-4 weekly
Flupenthixol Decanoate: 2-4 weekly
Zuclopenthixol Decanoate: 2-4 weekly
Olanzapine Decanoate: 2-4 weekly
Paliperidone extended-release: 4 weekly
Haloperidol Decanoate: 4 weekly

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10
Q

What is the action of typical antipsychotics?

A

= D2 antagonists= block D2 receptors in almost all 4 of the dopamine pathways
- this has both positive and negative outcomes
- good at blocking the negative effects of schizophrenia

Blocking D2 receptors in the;
meso-limbic: reduces positive symptoms such as hallucinations
- desired effect

Meso-cortical: worsening of negative symptoms including lethary, social withdrawal

Nigro-striatal: extrapyramidal disorders; tardive dyskinesia and Parkinson’s like symptoms

Tubero-infundibular: increase blood prolactin levels leads to galactorrhea and sexual dysfunction.

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11
Q

What are some additional side effects of typical antipsychotics?

A
  • postural hypertension
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12
Q

What are the two categories of antipsychotics? and what are their characteristics?

A

High potency
- Stronger antipsychotic effect at low doses
- Tend to cause more extrapyramidal side effects and higher prolactin levels.
E.g.- Haloperidol, Fluphenazine, Trifluoperazine

Low potency
- Low affinity to D2 receptors
- Affects other receptors such as alpha-adrenergic, cholinergic & histamine
- Side effects;
- orthostatic hypotension
- dry mouth
- blurred vision
- difficulty urinating
- constipation
- sedation
- weight gain
E.g.-Chlorpromazine

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13
Q

What is the action of atypical antipsychotics

A

= mainly block D2 receptors and serotonin receptors to;
- extrapyramidal symptoms
- decrease negative side effects
- increase cognition

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14
Q

What are the side effects of atypical antipsychotics?

A
  • weight gain
  • Hyperglycaemia
  • Dyslipidaemia
  • Sedation
  • Orthostatic hypotension
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15
Q

What is the ideal antipsychotic medication choice?

A

Atypical
*(other than Clozapine (Clopine/Clozaril))
- recommended as the first line of treatment in people newly diagnosed with schizophrenia.

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16
Q

What is Clozapine (Clopine/Clozaril) used for?

A
  • shown to be useful in treating people with treatment resistive schizophrenia.
  • only antipsychotic that can cause the life-threatening diagnosis of Agranulocytosis
17
Q

What is the main side effect of Clozapine (Clopine/Clozaril) and what are the necessary nursing managements?

A

Agranulocytosis

Need to have;
- Clozapine protocol
- blood cell count
- haemodynamic monitoring
- monitor heart rhythm

18
Q

What are the main side effects of ?atypical ?

A

Extrapyramidal side effects (occur due to dopamine blocking on the Nigro-striatal pathway)

Acute dystonia (immediately- 3hrs)
= early signs of extrapyramidal side effects
- kneck stiffness
- Oculogyric crises= eyes roll up into head

Bradykinesia (pseudo-parkinsonism) (3 days- 3 weeks)
- look like limited expression, slow movements, termmor

Akathisia (3 months)
- internal sense of restlessness
manifests as restlessness e.g. tapping foot, pacing

Tardive Dyskinesia (3 years)
- abnormal movements e.g. smacking lips, moving tongue in and out
- most cases are irreverable

19
Q

What are other more general side effects of ?atypical antipsychotics? and what is the nursing management?

A

Metabolic dysregulation
- Alteration in glucose
- insulin
- lipids
- Type 2 diabetes
- cardiovascular disease
- weight gain > 7 %
Management= Metabolic monitoring protocol

Hormone imbalance (increased prolactin levels)
- Gynaecomastia (can be seen in males too)
- Galactorrhea (can be seen in males too)
- sexual dysfunction
- menstrual disturbances
- Osteoporosis
Management= Review the medication, reassure the client, ?reduce or stop meds

20
Q

What is NMS? when does it occur, what are the presentations and what si the management?

A

Neurooleptic Malignant Syndrome (NMS)

= a rare condition and is fatal in 5-20% affected
cases. Can occur with typical or atypical antipsychotics

Clinical presentations
- Rigidity
- Fever > 38* C
- Alteration in mental state (Confusion – comma)
- Autonomic dysfunction
- tachycardia
- tachypnoea
- diaphoresis
- labile BP

Management
- Early recognition is the key!
- Stop the medication immediately
- Control hyperthermia, rigidity, airway management and fluid balance
- Intensive medical and nursing care