Antipsychotic medications Flashcards
What are typical antipsychotics?
aka ‘first generation’ antipsychotics-developed in the 1950s
When were atypical antipsychotics developed and what are they otherwise known as?
aka ‘second generation’ or ‘novel’ antipsychotics developed from 1970s onwards
In what conditions are antipsychotics used?
Mainly in;
- schizophrenia
- psychosis
Also in;
- mood disorders with psychotic symptoms
- torretes
- dementia with psychotic symptoms
Explain the action of antipsychotic medications
- also known as Neuroleptics
= target and block dopamine rceptors
What are the four main dopamine pathways that are effected by antipsychotics?
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
What is the main target of antipsychotic medications?
D2
What are some examples of typical antipsychotic medications? And what are common suffixs
- Chlorpromazine (Largactil)
- Pericyazine (Neulactil)
- Droperidol (Droleptan)
- Flupenthixol (Fluanxol)
- Haloperidol (Serenace)
- Zuclopenthixol dihydrochloride (Clopixol)
- Fluphenazine (Modecate)
??ol - Trifluoperazine (Stelazine)
What are some examples of atypical antipsychotic medications? And what are some common side effects?
- Clozapine (Clopine/Clozaril)
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Ziprasidone (Zeldox)
- Aripiprazole (Abilify)
- Quetiapine (Seroquel)
- Amisulpride (Solian)
- Paliperidone (Invega)
What are some examples of long-acting injectable antipsychotics?
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
What is the action of typical antipsychotics?
= 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.
What are some additional side effects of typical antipsychotics?
- postural hypertension
What are the two categories of antipsychotics? and what are their characteristics?
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
What is the action of atypical antipsychotics
= mainly block D2 receptors and serotonin receptors to;
- extrapyramidal symptoms
- decrease negative side effects
- increase cognition
What are the side effects of atypical antipsychotics?
- weight gain
- Hyperglycaemia
- Dyslipidaemia
- Sedation
- Orthostatic hypotension
What is the ideal antipsychotic medication choice?
Atypical
*(other than Clozapine (Clopine/Clozaril))
- recommended as the first line of treatment in people newly diagnosed with schizophrenia.
What is Clozapine (Clopine/Clozaril) used for?
- shown to be useful in treating people with treatment resistive schizophrenia.
- only antipsychotic that can cause the life-threatening diagnosis of Agranulocytosis
What is the main side effect of Clozapine (Clopine/Clozaril) and what are the necessary nursing managements?
Agranulocytosis
Need to have;
- Clozapine protocol
- blood cell count
- haemodynamic monitoring
- monitor heart rhythm
What are the main side effects of ?atypical ?
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
What are other more general side effects of ?atypical antipsychotics? and what is the nursing management?
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
What is NMS? when does it occur, what are the presentations and what si the management?
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
