Antipsychotics Flashcards
Paranoid schizophrenia
one or more delusions or frequent auditory hallucinations, someone is trying to “get them” hurt them, steal from them
Disorganized schizophrenia
speech and behavior oriented
Catatonic schizophrenia
stupor, posturing, mutism, fetal position
Residual
absence of prominent sx but evidence of illness and functional impairment
Epidemiology of schizophrenia
prevalence remarkably similar among most cultures, most common in late adolescence or early adulthood, prevalence in males and females, lifetime prevalence of .6-1.9%
Etiology of schizophrenia
abnormalities in brain structure an dysfunction, changes not consistent among all individuals, multifactorial causes, neurodevelopmental model, utero disturbance, schizophrenic lesions, genetics
Positive symptoms
hallucinations, delusions, false beliefs, disorganized speech, cannot follow train of thought, psychomotor agitation, bizarre behavior
Negative symptoms
alogia-poverty of speech, brief responses, lack of thought; flattened affect, avolition- lack in self initiated goal-directed activity, socially isolated; anhedonia- lack of interest and motivation in other people/activities, attentional impairment- psychomotor slowing
Clinical course
onset (acute/gradual), acute stabilization, stabilization, maintenance
approaches to therapy
individual- supportive/ counseling, personal therapy, social skills therapies, rehab; group- interactive/ social, cognitive behavioral- cog behavior therapy, compliance therapy
MOA of treating schizo
blockade of DA receptors in mesolimbic area, D2 blockade- affinity for this receptor accounts for antipsychotic activity, D1 blockade- partially responsible for antipsychotic activity, responsible for EPS sx, 5HT blockade- improve neg sx and motor ADRs
Receptor activity
D1-D5: relief of psychosis, EPS; 5HT2: helps suppress DA activity, protect from EPS, wt gain; a1: orhto hypo, dizziness, M1: ACh ADRs, may protect against EPS, drowsiness, dry mouth, blurred vision, constipation, H1: wt gain, drowsiness
Popular atypical antipsychotics
Quetiapine (Seroquel), Risperidone (Risperdal), ziprasidone (Geodon), Olanzapine (Zyprexa), Aripiprazole (Abilify)
Nausea and vomiting typical antipsychotics
Prochlorperazine (Compazine), Chlopromazine (Thorazine), Droperidol (Inapsine)
Antipsychotics typical
Haloperidol (Haldol), Thioridazine (Mellaril), Thiothixene (Navane), Loxapine (Loxitane), Perphenazine (Trilafon), Fluphenazine (Prolixin), Trifluoperazine (Stelazine)
Typical antipsychotic pearls
all have equal efficacy, MOA- non-selective blockade of D2 receptors, effective at treating positive sx, major concern is EPS
Haloperidol (Haldol) dosing forms
Available IM or PO, IM-fast acting, also available as Depot shot, given once monthly, IVP is linked to increased risk of arrythmias
Haloperidol (Haldol) Pearls
drug of choice for ICU psychosis, used occasionally for CI for EtOH withdrawals, watch for QTc prolongation, higher potensity for EPS and anticholinergic ADRs, many DI
Chlorpromazine (Thorazine)
available PO or IM (IM used in peds for acute mania), off label- retractable hiccups (DOC), migraines, also used for N/V
Droperidol (Inapsine)
N/V migraines, major concern being proarrhythmic
ADRs or antipsychotics
sedation, ACh- dry mouth, constipation, blurry vision, antiadrenergic- orthstatic hypotension, wt gain, prolongation of QT interval, inc prolactin secretion (menstrual changes)
EPS
related to blockade of D1 receptor in substantia nigra, reversible if discovered early, associated w/ all typicals and some atypicals, includes- dystonia, pseudoparkinsonism, akathisia
Prolonged QT
typicals increase Qt interval, inc risk of torsades/ ventricular arrythmia, medications- typical antipsychotics, antibiotics, antifungals, low mag/K, CHF, renal/ hepatic d, CVA
Treatment of Acute dystonia
diphenhydramine (Benadryl), benztropine (Cogentin), must be given right away for quick reversal, usually IV, follow w/ PO agent x 1-2 wks to prevent recurrence, will worsen tardive dyskinsias