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Meds Exam Uni of Surrey end of year 1 MENTHEALTHNURs (PGDip) > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What are antipsychotics indicated for?

A
  • Psychosis
  • Schizophrenia
  • BiPolar Disorders
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2
Q

Name 2 typical Antipsychotics

A
  • Haloperidol (Haldol)
  • Flupentixol Decanoate (Depixol)
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3
Q

Name 5 A-typical Antipsychotics

A
  • Olanzapine
  • Quetiapine
  • Risperidone
  • Aripiprazole
  • Clozapine
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4
Q

Talk to me about the DA theory of Sz?

A
  • Based on the Dopamine Theory of Schizophrenia that Sz caused by high levels of DA
  • discovered by accident (amphetamine psychosis and parkinson medication Levadopa which lead to increased DA showed similar side effects)
  • BUT neurochemical changes in brain occur immediately after taking APs, yet it can take days/weeks to see observable (‘behavioural’) changes (epigenetics?)
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5
Q

What is the mechanism of action of Typical Antipsychotics?

A
  • Act predominantly by blocking (antagonising) D2 receptors in the brain.
  • Not selective for any of the four dopamine pathways in the brain, hence side effects.
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6
Q

What is the mechanism of action of Atypical Antipsychotics?

A
  • Similar to Typical APs
  • However do not exclusively block DA but act on a range of receptors, including;
  • D1, D2, 5-HT, H-1 R and alpha-adrenoceptor antagonists
  • This could explain why Atypicals have an effect on negative symptoms when typicals do not
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7
Q

Which Atypical Antipsychotic has a slightly different mechanism of action?

A

Aripiprazole is a partial D2 agonist;

  • acts as an antagonist where high concentration of DA
  • acts as an agonist where low concentrations of DA

It also has weak 5-HT partial agonism

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8
Q

What is specific to Olanzapine and Clozapine?

A
  • Mechanism of action; also antagonise muscarinic receptors (Acetylcholine-GPCRs, excitatory/inhibitory)
  • increased risk of metabolic syndrome (more than just via increase in body weight)
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9
Q

What are the shared side effects of Antipsychotics, and main differences between the two types?

A
  • Sleepiness and feeling ‘slowed down’ in thinking
  • Constipation
  • Hypotension (and linked dizziness)
  • Main concern with Typicals is EPSEs
  • Main concern with Atypicals is metabolic syndrome
  • but both share both!
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10
Q

What are the shared side effects of Typical Antipsychotics?

A
  • EPSEs
  • Sexual side effects (reaching climax, difficulty achieving arousal for both)
  • Hyperprolactinaemia (sexual dysfunction, reduced bone density, menstrual disturbances)-n.b. DA inhibits prolactin release!
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11
Q

What are the shared side effects of Atypical Antipsychotics?

A
  • dry mouth
  • weight gain (suggested average long term weight increase of >25%)-NOT Aripiprazole
  • increased risk of metabolic syndrome (more than just via increase in body weight)-particularly Olanzapine and Clozapine
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12
Q

What are some of the side effects specific to Aripiprazole?

A
  • Insomnia
  • blurred vision
  • restlessness
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13
Q

What are the four main types of Extra Pyramidal Side Effects?

A
  • Dystonia (sudden involuntary movement and muscle contractions, hypersalivation, mouth/tongue movements, abnormal eye rolling ‘oculogyric crisis’). Usually within 1st week
  • Akathisia (motor restlessness, inability to sit still)
  • Pseudo Parkinsonism (cogwheel rigidity, drooling, shuffling gait, tremors). stop if drug withdrawn.
  • Tardive Dyskinesia (irregular/jerky movements, lip smacking, chewing, slow and aimless arm movements). Usually after 6+ months and are hard to reverse
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14
Q

What are the nursing actions for EPSEs?

A

For Dystonia/Akathesia/Pseudo Parkinsonism;

  • Reducing dose
  • Switching to atypical
  • anticholinergic medication-procyclidine
  • use of a benzodiazepine

Diskenesia

  • discontinuation
  • increase vitamin e
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15
Q

Dangerous complications of all Antipsychotics

A
  • High risk of cardiac complications
  • Neuroleptic Malignant Syndrome
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16
Q

Tell me more about the cardiac complications linked with Antipsychotics?

A
  • APs can interfere with electrical rhythm of heart, especially QTc interval.
  • There is also a link between APs and Sudden Arrhythmic Death Syndrome (SADS).
  • Therefore ECGs before starting/dose changes and every 1-3 months.
17
Q

Tell me more about the risk of Neuroleptic Malignant Syndrome?

A
  • APs affect bone marrow and lead to decrease in white blood cells
  • in rare cases the body can suddently stop producing any-NMS crisis! Ireeversible
  • 10-15% mortality rate!
  • Symptoms? Sudden increase in temp and sweating, muscle pain, rigidity/stiffness, irregular pulse, increase/decrease bp, high resps, severe confusion.
  • More likely to occur at start of AP, change of AP, change of dose or change of administration.
18
Q

What are the contraindications of Typical Antipsychotics?

A
  • Cancer
  • CNS depression
  • Children
  • Parkinsons
19
Q

What are the contraindications of Atypical Antipsychotics?

A
  • Overweight
  • Diabetes
  • Dementia-related psychosis
20
Q

What is metabolic syndrome?

A

A group of risk factors which, taken together, increase the risk of T2DM and heart disease

  • Key features: insulin resistance, visceral obesity and increased cholesterol levels
  • Signs: High BMI, increased BP, increased blood glucose and increased waist measurement (>40 inches)
  • Specifics: excess fat creates an additionally metabolic organ, free radicals, oxidative stress, inflammation (and IR)
21
Q

What are some of the side effects specific to Clozapine?

A
  • hypersalivation (consider using anticholinergic such as hyascine)
  • blurred vision
  • increased heart rate and linked increased sweating
22
Q

What are the blood test requirements for Clozapine and what is a normal range?

A
  • weekly for 18 weeks
  • fortnightly for rest of year (<52 weeks)
  • monthly forever (and one month after discontinuation)
  • White cell count less than 3.5 x10^9/L=cause for concern!
23
Q

When should Clozapine use be considered?

A
  • When two other APs have been trialled (including at least one atypical)
  • (People should receive APs for 4-6 weeks before deemed ineffective)
  • Clozapine is effective in 30-60% of such ‘treatment-resistant’ cases! And prolongued use can increase insight!
24
Q

Patient Education points for Clozapine?

A
  • continued blood tests (holidays, needles etc)
  • smoking-the hydrocarbons in smoke speed up the body’s ability to metabolise clozapine therefore smokers need higher doses-therefore changes in smoking or even caffeine consumption can have a big effect
  • Fall in neutrophil levels at any time, more likely in 18 weeks (neutropenia = 2%, agranulocytosis = <1%) Need to be alert for signs of infection! (Differences in ethnic backgrounds, for example Afro-Caribbean naturally lower)
    *
25
Q

What drug interactions can influence effectiveness and safety of most Antipsychotics?

A
  • Carbamazepine
  • Lithium
  • Clozapine/other antipsychotic use
  • Many react with ADs
26
Q

What are some nursing actions for constipation?

A

This can quickly lead to bowel blockages, blood poisoning and death.

  • Bristol stool chart
  • Fibre (fruit/veg)
  • Exercise (stimulates bowel)
  • Consider natural sedative (e.g. Senna)
27
Q

Which Antipsychotic may be the safest to use during pregnancy?

A

Olanzapine

  • however evidence of gestational diabetes
  • and NO breastfeeding
28
Q

What could you use in conjunction with APs regarding side effects and why?

A
  • Glasgow Antipsychotic Side-effect Scale
  • Specific Clozapine monitoring tools
  • Side effects are most common reason for non-concordance
  • May be an indication of non-concordance (if no side effects)
  • May be an indication of need to stop medication

Meds Exam Uni of Surrey end of year 1 MENTHEALTHNURs (PGDip) (8 decks)

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