Antipsychotic Medications Flashcards
What do antipsychotic medications do?
effect of blocking dopamine transmission in the brain by blocking D2 receptors.
What do antipsychotic medication cause undesirable side effects?
antidopamine effects are not specific to the tracts associated with schizophrenia but instead travel to all dopamine receptor sites throughout the brain.
Name all the typical (1st Gen) antipsychotic medications.
generic and Trade name
Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Fluphenazine (Prolixin)
What might you give a patient who is acutely ill with their first episode of schizophrenia?
Any antipsychotic medication EXCEPT for:
- clozapine
- olazapine
How long does it take for an antipsychotic medication to work? How long should the trial last?
Takes 1 to 2 weeks for the medication to work.
Trial should last 6 to 12 weeks before considering a change in drug prescription
When should clozapine be prescribe to a patient?
When no other 2nd generation drug works
Under what circumstances can antipsychotic meds be discontinued?
- NMS
- Agranulocytosis
- Tardive dyskenisia (sometimes)
How should antipsychotics be discontinued, other than in circumstances of a medical emergency?
doses should be gradually lowered over time because this diminishes the likely hood of withdrawal symptoms (dyskinesia and withdrawal psychosis)
Name all the early and late extrapyramidal side effects that may occur with the use of antipsychotics
Early:
- Parkinsonism or pseudoparkinsonism
- Acute dystonia
- Akathisia
Late:
- Tardive dyskinesia
- Tardive akathisia
- Tardive dystonia
What is parkinsonism (pseudoparkinsonism)?
mask-like face
akinesia
resting tremor
shuffling-gait
How to treat parkinsonism (pseudoparkinsonism)?
- reduce dosage
* increase dopamine activity - adding anticholinergic like benzotropine (Cogentin) or trihexyphenidyl (Artane)
* decrease acetylcholine activity
What is a dystonic reaction? What are the two things that occur?
muscles tense and body contorts.
- oculogyric crisis (eye muscles movements tense pulling eyeballs towards ceiling)
- torticollis (neck muscles pull head to the side) “i was waiting for you at the door!”
- retrocollis (pulls neck muscles back)
Who are more vulnerable to dystonic rxns and how must we treat them?
young men are most vulnerable
must be treated:
- 1 to 2 mg of benztropine (Cogentin)
- Or 25 to 50 mg of diphenhydramine (Benadryl) IM or IV
- daily admin of anticholinergics
- maybe decrease antipsycho meds
What is akathisia? How is it treated?
patients feel restless, uncomfortable and feel driven to keep moving
treated:
- beta blocker like 20 to 120 mg propranolol
Failure to treat akathisia may lead to what?
patient ceasing to take antipsychotic medications
What is tardive dyskinesia? “ “ dystonia? “ “ akathisia?
tardive dyskinesia - abnormal dyskentic movements of face, mouth, and jaw
tardive dystonia - sustained abnormal posture of face, eyes, tongue, neck, trunk
tardive akathisia - persisting, unbating sense of subjective and objective restlessness
How is tardive symptoms treated and prevented?
Treated: Atrovan **AIRWAY huge issue!** Prevented: Cogentin (benzotropine) Artane (trihexyphenidyl) Symmetrol (amantadine)
What other side effects may occur due to antipsychotic medications? Intervention for each?
- Orthostatic hypertension: rise slowly, monitor BP
- Hyperprolactemia: includes gynecomastia and galactorrhea associated w/ haloperidol and risperidone
- Sedation: watch for falls
- Weight gain: diet teaching and monitoring.
- Onset DM: monitor for symptoms and FBG tests
- Arrythmias: prolonged QT. baseline ECG
- Agranulocytosis: drop in circulating granulocytes. puts pt @ risk for infection. usually occurs w/ clozapine use. med should be stopped and monitored for signs of infection.
Cardiac arrythimias are more likely to occur with which medication?
ziprasidone (Geodon)
What anticholinergics administered for? What are pts at risk for when taking these meds?
parkinsonism and dystonia
@ risk for: abuse
List TWO complications that can occur when taking antipsychotic medications
- Neuroleptic Malignant Syndrome
2. Anticholinergic Crisis
What is neuroleptic malignant syndrome?
rxn to antipsychotic medications. pts develop serious muscle rigidity w/ elevated temperature and rapidly accelerating cascade of symptoms.
What are some of the cascade of symptoms that can occur with NMS?
HTN tachycardia tachypnea diaphoresis incontinence mutism leukocytosis changes in LOC (confusion or coma) high creatinine
Who is at risk for NMS?
pts taking haloperidol or any dopamine blocking medication
Treatment for pts with NMS?
- give Dantrolene (muscle relaxant)
- cooling blanket
- antipyretic
- monitor fluid hydration and kidney function
What is anticholinergic crisis?
potentially life threatening med emergency caused by overdose or sensitivity to anticholinergics.
What is ACC characterized by?
“Hot as a hare, blind as a bat, mad as hatter, dry as a bone!”
- elevated temp, parched mouth, thristy, hot, dry skin. decreased secretions
- dilated eyes (bright light hurts)
- incr. HR and constipation. difficulty urinating.
- flushed skin
Antidote for anticholinergic crisis?
1 to 2 mg of physostigmine IV slowly over 5 minutes.
*rapid injection may cause seizures, bradycardia, heart block
Name all the ATYPICAL antpsychotics
- aripiprazole (Abilify)
- clozapine (Clozaril)
- risperidone (Risperdal)
- olanzapine (Zyprexa)
- quetiapine (Seroquel)
- ziprasidone (Geodon)
List 4 anticholinergics
- benzotropine (Cogentin)
- Artane (trihexyphenidyl)
- Symmetrol (amantadine)
- dyphenhydramine (Benadryl)
