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Pharmacology ATI > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

First-generation Antipsychotics

Prototype

A

Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Fluphenazine (Prolixin)
Thiothixene (Navane)
Perphenazine (Trilafon)
Loxapine (Lotxitane)
Trifluoperazine (Stelazine)

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2
Q

First-generation Antipsychotics

Indication

A

Controls positive manifestations of psychotic disorders:
Schizophrenia
Bipolar
Tourette
Agitation
Nausea prevention (blocks dopamine in CTZ)

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3
Q

First-generation Antipsychotics

MOA

A

Blocks dopamine (D2), acetylcholine, histamine, and norepinephrine receptors in the brain and PNS
Inhibition of positive symptoms due to blockade of dopamien receptors

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4
Q

First-generation Antipsychotics

Adverse effects

A
  • Acute dystonia (potential crisis)
  • Parkinsonism (bradykinesia, rigidity, tremors, shuffling gait)
  • Akathisia (unable to sit or stand still)
  • Tardive dyskinesia (involuntary movements of face and tongue, limbs, or trunk)
  • Neuroleptic malignant syndrome (sudden high fever, dysrhythmias, blood pressure fluctuations, muscle regidity, diaphoresis, tachy, LOC change)
  • Anticholinergic effects (dry mouth, blurry vision, urinary retention)
  • Neuroendocrine effects (gynecomastia, menstrual irregularities)
  • Seizures
  • Photosensitivity
  • Orthostatic hypotension
  • Sedation
  • Sexual dysfunction
  • Agranulocytosis
  • Liver impairment
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5
Q

First-generation Antipsychotics

Nursing actions for neuroleptic malignant syndrome

A
  1. Stop medication
  2. Monitor VS
  3. Use cooling blankets
  4. Administer antipyretics (tylenol)
  5. Administer dantrolene
  6. Administer diazepam for anxiety
  7. Administer antiarrhythmic if indicated
  8. Increase fluids
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6
Q

First-generation Antipsychotics

Tardive dyskinesia

A
  • Long term use
  • Monitor after 12 months and then every 3 months thereafter
  • Valbenazine treats TD
  • Can be permanent
  • Prevention: use lowest dosage
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7
Q

First-generation Antipsychotics

Nursing actions for acute dystonia

A
  • Monitor for symptoms (severe spasm of tongue, neck, face, or back) between a few hours to 5 days after first dose
  • Treat with anticholinergic agents (diphenhydramine)
  • Improvement in 5-20 min with IV or IM routes
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8
Q

First-generation Antipsychotics

Contraindications

A

Coma
Parkinson’s
Liver damage
Breast cancer
Severe hypotension
Dementia

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9
Q

First-generation Antipsychotics

Interactions

A
  • Increases effect of Anticholinergic agents
  • Increases effect of CNS depressants (alcohol, opioids, antihistamines)
  • Reduced effect when taken with Levadopa
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10
Q

First-generation Antipsychotics

Admin

A
  • only used if tolerated or patient is violent
  • IV, IM, or oral
  • Improvements can start in a few days
  • Assess for EPSs
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11
Q

Second and third generation Antipsychotics

Prototype

A

Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Clozapine (Clozaril)
Asenapine (Saphris)
Lurasidone (Latuda)
Paliperidone (Invega)
Iloperidone (Fanapt)

3rd Gen:
Aripriprazole (Abilify)
Brexpiprazole (Rexulti)
Cariprazine (Vraylar)

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12
Q

Second and third generation Antipsychotics

Indications

A
  • First-line treatment for schizophrenia for negative and positive symptoms
  • Psychotic episodes caused by levodopa
  • Bipolar
  • Impulse control disorder
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13
Q

Second and third generation Antipsychotics

MOA

A

2nd gen: block serotonin and dopamine receptors to a lesser degree. Also block NE, histamine, and acetylcholine receptors

3rd gen: Stabilize dopamine system as agonist and antagonist

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14
Q

Second and third generation Antipsychotics

Therapeutic effects

A
  • Relieves positive and negative symptoms
  • Reduces deprssion, anxiety, and suicidal ideation
  • Improves cognitive issues (poor memory)
  • Fewer EPSs because of less dopamine inhibition
  • Fewer anticholinergic effects
  • Less relapse
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15
Q

Second and third generation Antipsychotics

Adverse effects

A
  • Diabetes
  • Weight gain
  • High cholesterol
  • Orthostatic hypotension
  • Anticholinergic effects
  • CNS effects: agitation, dizziness, sedation, sleep disturbance
  • Mild EPSs - tremor or akathisia
  • Elevated prolactin
  • Sexual dysfunction
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16
Q

Second and third generation Antipsychotics

Contraindications

A
  • Pregnancy risk category C
  • Dementia - can cause death related to CVA or infection
  • Alcohol
17
Q

Second and third generation Antipsychotics

Interactions

A
  • Increased action of Immunosuppressants
  • Additive CNS effects with alcohol, opioids, antihistamines
  • Antipsychotic effects reduced by levadopa
  • Prolonged QT and dysrhythmias when taking tricylic antidepressants, amiodarone
18
Q

Second and third generation Antipsychotics

Admin

A
  • PO, IM
  • Long acting options: administered IM every 2 weeks or 28 days
  • Use oral disintegrating tablets for patients who cheek

Pharmacology ATI (19 decks)

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