Antipsychotics & Antiepileptics Flashcards
What are Neuroleptics used for?
Used to normalize behavior and thinking during acute psychotic episodes by altering levels of dopamine & serotonin. Prevent recurrence of psychosis. Do NOT cure
What is occurring in Schizophrenia?
Over activity of dopamine pathways. May also be attributed to increased serotonin, glutamate or GABA. Certain genetic & environmental factors likely play a role as well.
What are the 2 classifications of Antipsychotics?
Traditional & Atypical/Nontraditional
Which dopamine receptor is the most important to block for antipsychotic effects?
D2
Traditional Antipsychotics
Increased incidence of movement disorders due to binding of dopamine receptors including those that influence motor function in BG. More side effects & variability in effectiveness
Examples: Haloperidol (Haldol), Prochlorperazine
Side effects of Traditional Antipsychotics
Sedation, Anticholinergic effects
Nontraditional Antipsychotics
Decreased risk of movement disorders - Do not affect dopamine receptors as strongly. Instead they affect serotonin, ACh, GABA, and glutamate
Less effective, but lower incidence of relapse
Examples: Clozapine, Risperidone, Aripiprazole (Abilify), Lurasidone (Latuda)
What is Aripiprazole (Abilify) commonly used to treat/manage?
Bipolar disorder (combined with Lithium), Alzheimer’s disease and other types of dementia (control agitation/aggression)
What are Extrapyramidal Symptoms?
Abnormal movements occurring as a result of traditional antipsychotics blocking CNS dopamine receptors - Examples include Tardive Dyskinesia, Pseudoparkinsonism, Akathisia, Dyskinesia, Dystonia, & Neuroleptic Malignant Syndrome
What is Tardive Dyskinesia
Most feared side effect due to potential for irreversibility
Involves involuntary & fragmented movements including rhythmic movements of the tongue/jaw and involuntary sucking/smacking
Choreoathetoid movements of extremities and dystonias of neck/trunk
What is Pseudoparkinsonism
Caused by a deficiency of dopamine transmission in the BG.
Resting tremor, bradykinesia, & rigidity
Symptoms normally disappear when dose is adjusted/stopped
Do NOT use antiparkinson drugs to treat - Can exacerbate
What is Akathisia
Motor restlessness, agitation, pacing, insomnia
Effect of newer medications
What is Dyskinesia/Dystonia
Involuntary & uncoordinated movements in the arms, legs, neck and face
What is Neuroleptic Malignant Syndrome
Condition in those taking high doses of traditional antipsychotics
Catatonia, stupor, rigidity, tremors, fever
Can be very severe and lead to death
Seek EMERGENCY treatment & stop medication
What other side effects are common in antipsychotics?
Metabolic (weight GAIN, increased plasma lipids, diabetes mellitus)
Anticholinergic (can’t see, can’t pee, can’t poo)
Rehab Implications for Antipsychotics
Sedation & orthostatic hypotension, bradykinesia, tremor & rigidity can impact therapy
Balance/postural problems
Monitor for signs of Extrapyramidal effects (especially TD)
What is the best treatment for Epilepsy?
Pharmacological intervention
- Effective at eliminating seizures 50% of the time
- Effective at reducing seizures 25% of the time
- Ineffective 25% of the time
Generalized vs Focal Seizures
Generalized: Whole brain
- Tonic clonic or Grand mal, Absence or Petit mal
Focal (Partial): Part of the brain
- Simple (conscious) or Complex (unconscious)
Are seizures self-limiting?
Yes, they will resolve on their own because the brain cannot sustain high levels of synaptic activity for too long
What are the 3 main goals of antiseizure medication?
- Increase activity of CNS inhibitory neurons (GABA)
- Decrease activity of CNS excitatory neurons
- Stabilize opening/closing of neuronal Na/Ca channels
What are the 2 main categories of antiseizure medication?
First generation
Second generation
Six Classes of First Generation Antiseizure Medications
- Barbiturates
- Benzodiazepines
- Hydantoins
- Iminostilbenes
- Succinimides
- Valproates
Barbiturates - Antiseizure
Not as common due to SMALL therapeutic index and overdose
Increase GABA by increasing inhibition in the CNS
Create sedation, HANGOVER effect, ataxia, nystagmus, skin issues
Ex: Phenobarbital
Benzodiazepines - Antiseizure
Can be used for acute attacks; only a few used for long-term epilepsy
Sedation is a limiting factor
Examples: Diazepam (Valium) & Lorazepam (Ativan)
What are Iminostilbenes used for?
Primary agent for partial seizures and tonic-clonic seizures
(Carbamazepine - Tegretol)
Second Generation Antiseizure Drugs
Not more effective than first generation but MILDER side effects
Can be combined with first generation to control symptoms
What are commonly used Second Generation drugs?
Gabapentin (Neurontin) & Pregabalin (Lyrica)
What is Gabapentin used for?
Reducing excessive neuronal activity in seizure disorders and excitation pathways responsible for chronic pain
Side effects: Sedation, fatigue, dizziness and ataxia
What is Pregabalin used for?
Seizures, chronic pain, fibromyalgia, & diabetic peripheral neuropathy
Side effects: Dizziness, drowsiness & peripheral edema
Antiseizure Drug Administration
Doses are divided into 3-4 smaller doses
Women on antiseizure medication while pregnant predispose their child to what?
Birth defects - Cleft palate, cardiac defects, microencephaly, neural tube defects, stillbirth, developmental delays, mental retardation & seizures
Rehab Implications for Antiseizure medication
Decreased arousal & alertness
Headache, dizziness, ataxia, sedation and GI disturbances can all limit therapy
Session times may need to be adjusted
Monitor for cerebellar side effects (postural imbalance), skin conditions, and seizure triggers
