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Pharmacology Sem 3 > antipsychotics2 > Flashcards

antipsychotics2 Flashcards

1
Q

Neurotransmitters in psychosis

A

majorly dopamine. Seratonin, norepinephrine, GABA (gamma-aminobutyric acid), Glutamate

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2
Q

Antipsychotics tx what, can be an antiemetic,

A

schizophrenia

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3
Q

Typical antipsychotics

A

Phenothiazines & nonphenothiazine

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4
Q

Phenotiazines and Navane thiothixene (nonpheno) do what?

A

block norepinephrine, causing sedative + hypotensive effect early in tx.

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5
Q

List 3 typical phenothiazine antipsychotics

A

thorazine chlorpromazine, prolixin fluphenazine, mellaril thioridazine

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6
Q

List 2 typical nonphenothiazine antipyschotics?

A

Haldol haloperidol, Navane thiothixene

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7
Q

Action of typical phenothiazine antipsychotic

A

block dopamine receptor; more dopamine extracellular

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8
Q

What happens when dopamine is blocked?

A

Extrapyramidal symptoms of parkinsonism; so you need add’tl drugs to tx these s/s

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9
Q

Uses for thorazine

A

this typical phenotazine antipsychotic tx neuro-induced hiccups, decrease BP

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10
Q

EPS with which typical phenothiazine

A

prolixin flupheanzine

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11
Q

Who to give mellaril thioridazine

A

given to children with psychosis; this drug is milder

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12
Q

what s/s of psychosis do typical antipsychotics tx?

A

positive s/s of psychosis

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13
Q

what s/s of psychosis do Atypical antipsychotics tx?

A

negative and positive s/s of psychosis

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14
Q

typical nonphenothiazine like butyrophenones (e.g. haldol haloperidol) do what?

A

block only dopamine.

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15
Q

Herbal consideration with antipsychotics

A

Kava kava + typical phenothiazine (or fluphenazine) increases risk and severity of dystonic reactions

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16
Q

EPS with which typical NONphenothiazines?

A

Haldol haloperidol, Navane thiothixene

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17
Q

List 2 A/D of antipsychotics?

A

Extrapyramidal Syndrome + Neuroleptic Malignant Syndrome

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18
Q

List 4 types of Extrapyramidal syndromes?

A

tardive dyskinesia, pseudoparkinsonism, acute dystonia, akathesia

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19
Q

What is the risk with Tardive dyskinesia (TD)?

A

few doses can cause potentially irreversible TD; so catch early before TD is permanent

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20
Q

how do you assess EP tardive dyskinesia?

A

AIMS (abnormal involuntary movement scale (standard, observation, interview)

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21
Q

S/s of tardive dyskinesia

A

rolling tongue, smacking lips, chewing, facial dyskinesia, involuntary movements of body and extremities.

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22
Q

what to do if pt have tardive dyskinesia

A

this is a late s/s. stop drug, give Vit E

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23
Q

s/s of pseudoparkinsonsim

A

stooped posture, shuffling gait, drooling, rigidity, pill rolling, tremors, bradykinesia

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24
Q

What is the risk with Pseudoparkinsonism?

A

fall risk d/t shuffling gait and stooped posture. Teach pt to put hands behind back to correct center of gravity.

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25
Q

s/s acute dystonia?

A

oculogyric crisis (rotating eyeball), laryngospasm, facial grimacing, involuntary mm movements of tongue, face, neck, and back, cogwheel rigidity of arm, micrographia

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26
Q

What is the risk with acute dystonia?

A

airway d/t larygospasm, risk for injury d/t rolling eyes and involuntary mm movements

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27
Q

What to do if pt have acute dystonia?

A

only takes days to see; give Benadryl/anticholinergic, Cogentin, or Ativan.

28
Q

S/s of Akathisia

A

restless, trouble standing still, pacing, feet constant motion, rolling back and forth

29
Q

What to do if pt have akathesia?

A

give lorezepam or BB propanolol

30
Q

s/s of antipsychotics?

A

Anticholinergic effects

31
Q

s/s of anticholinergic effects

A

dry mouth, blurred vision, constipation, urinary retention, confusion/worsening psychosis, high temp, flushed skin (very pink/red)

32
Q

what to do if pt have anticholinergic effect?

A

candy, oral moisturizer, hydrate, stay out of sun, colace, report worsening psychosis to MD.

33
Q

A/D of typical antipsychotics

A

NMS (neuroleptic malignant syndrome)

34
Q

what is the risk with Neuroleptic malignant syndrome?

A

potentially fatal

35
Q

How do you tx Neurleptic malignant syndrome?

A

Give bromocriptine Parlodel or dantrolene (dantrium–a muscle relaxer) ; stop the antipsychotic, hydrate, hypothermic blanket, give antipyretic, benzodiazipine and muscle relaxer.

36
Q

s/s of neurleptic malignant syndrome?

A

muscle rigidity, sudden high fever, AMS, blood pressure fluctuations, tachycardia, dysrrhythmias, seizures, RHABDOMYOLYSIS, acute renal failure, respiratory failure, coma.

37
Q

Other s/e of antipsychotics?

A

sedation (esp. thorazine), orthostatic hypotension, photosensitivity, hormonal effects (increase prolactin/breast milk, gynomastia in men; facial hair in women); prolonged QT interval (arrhythmia/die); hypersalvation

38
Q

How do you initiate rapid tranquilization of pt?

A

in ER situations only; team approach (never solo), Give Haldol 5mg, Ativan 2mg, Benadryl 50mg (5-2-50)

39
Q

s/s of phenothiazine OD

A

no arousal, BP fluctuation, tachycardia, agitation, delirium, convulsion, dysrhythmia, NMS, EP, renal/cardia/resp failure.

40
Q

how to tx phenotiazine OD?

A

airway, gastric lavage, activated charcoal administration, adequate hydration, anticholinergic, and norepinephrine

41
Q

when do you see full tx effect of antipsychotics?

A

3-6 wks

42
Q

prolixin fluphenazine a/e

A

AGRANULOCYTOSIS; hyper/hypotension, tacycardia, EP tardive dyskinesia, impaired thermoregulation, convulsion

43
Q

prolixin fluphenazine cautions

A

not for glaucoma pt, additive hypotensive effect with hypotensive rx

44
Q

Phenothiazine + sedative hypnotics =

A

additive CNS depression

45
Q

Antacid should be given 1hr before or 2hr after giving phenothiazine because

A

antacids decrease rate of absorption

46
Q

List 5 Atypical antipsychotics

A

CLOZARIL CLOZAPINE, zyprexa olanzepine, seroquel quetiapine, geodon ziprasidone, risperidol riperidone

47
Q

CLOZARIL CLOZAPINE

A

1ST atypical antipsychotic for schizophrenia, who do not respond to traditional tx; has a black box warning

48
Q

A/E OF CLOZARIL CLOZAPINE

A

Agranulocytosis; if below 3000mm WBC, d/c it; Seizures ***BLACK BOX WARNING***

49
Q

pros and cons zyprexa olanzepine

A

does not cause EP or agranulocytosis; but causes DM and weight gain

50
Q

s/e of risperidol riperidone

A

vivid nightmare (so don’t give to elderly dementia related psychosis), sedation, weight gain, HA, dry mouth, photosensitivity, urinary retension, sexual dysfunction, hyperglycemia

51
Q

a/d of risperidol riperidone

A

Neuroleptic malignant syndrome, orthostatic hypotension, tachcardia, EPS, ECG changes, convulsions.

52
Q

a/d geodon ziprasidone

A

prolonged QT interval

53
Q

Which atypical antipsychotics cause DM and weight gain

A

CLOZARIL CLOZAPINE, zyprexa olanzepine, seroquel quetiapine, geodon ziprasidone, risperidol riperidone

54
Q

Which do NOT cause agranulocytosis

A

risperidol risperidol, olanzapine zyprexa

55
Q

Atypical antipsychotics work on what neurotransmitters

A

Seratonin 5HT, Dopamine D2, Acetylcholine (Ach), Alpha-adrenergic (target of catecholine), histamine H1 (work on smooth muscle and CNS/brochonconstrict, vasodilat, nausea

56
Q

Typical Phenothiazine and Nonphenothiazine take how long for full clinical effect?

A

6+ wks

57
Q

Do typical phenothiazine pass onto breast milk?

A

Yes. It’s teratogenic.

58
Q

How often to check WBC for pt taking clozaril clozpine, prolixin fluphenazil, haldol haloperidol?

A

q3 mon, see if pt leukopenic

59
Q

Teach pt what about phenothiazine and nonphenothiazine?

A

EPS, photosensitive, orthostatic hypotension, harmless PINK/REDBROWN urine with thorazine chlopromazine; irregular mences for women, gynecomastia/impotence for men; hand candy losenge for dry mouth; report dry mouth if more than 2 wks; avoid extreme in te

60
Q

what antispychotic cause pink/redbrown urine?

A

Typical phenothiazine thorazine chlorpromazine

61
Q

which cause agranulocytosis?

A

proxilin fluphenazine, Haldol haloperidol, clozaril clozapine

62
Q

s/e of haldol haloperidol

A

sedation, EP, orthostatic hypotension, HA, photosensitivity, dry mouth, blurred vision.

63
Q

a/e if haldol haloperidol

A

tachycardia, seizures, urinary retention, laryngospasm, respiratory depression, cardiac dysrrhythmias, neuromalignant syndrome, agranulocytosis

64
Q

Why use Atypical antipsychotics

A

less EPS, better tolerated, used as adjunct in mood disorders

65
Q

why we don’t use atypical antipsychotics

A

black box warning, weight gain, not for dementia related psychosis in elderly, so expensive, not all brain structure the same so not effective in all.

Pharmacology Sem 3 (26 decks)

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