antipsychotics2 Flashcards
Neurotransmitters in psychosis
majorly dopamine. Seratonin, norepinephrine, GABA (gamma-aminobutyric acid), Glutamate
Antipsychotics tx what, can be an antiemetic,
schizophrenia
Typical antipsychotics
Phenothiazines & nonphenothiazine
Phenotiazines and Navane thiothixene (nonpheno) do what?
block norepinephrine, causing sedative + hypotensive effect early in tx.
List 3 typical phenothiazine antipsychotics
thorazine chlorpromazine, prolixin fluphenazine, mellaril thioridazine
List 2 typical nonphenothiazine antipyschotics?
Haldol haloperidol, Navane thiothixene
Action of typical phenothiazine antipsychotic
block dopamine receptor; more dopamine extracellular
What happens when dopamine is blocked?
Extrapyramidal symptoms of parkinsonism; so you need add’tl drugs to tx these s/s
Uses for thorazine
this typical phenotazine antipsychotic tx neuro-induced hiccups, decrease BP
EPS with which typical phenothiazine
prolixin flupheanzine
Who to give mellaril thioridazine
given to children with psychosis; this drug is milder
what s/s of psychosis do typical antipsychotics tx?
positive s/s of psychosis
what s/s of psychosis do Atypical antipsychotics tx?
negative and positive s/s of psychosis
typical nonphenothiazine like butyrophenones (e.g. haldol haloperidol) do what?
block only dopamine.
Herbal consideration with antipsychotics
Kava kava + typical phenothiazine (or fluphenazine) increases risk and severity of dystonic reactions
EPS with which typical NONphenothiazines?
Haldol haloperidol, Navane thiothixene
List 2 A/D of antipsychotics?
Extrapyramidal Syndrome + Neuroleptic Malignant Syndrome
List 4 types of Extrapyramidal syndromes?
tardive dyskinesia, pseudoparkinsonism, acute dystonia, akathesia
What is the risk with Tardive dyskinesia (TD)?
few doses can cause potentially irreversible TD; so catch early before TD is permanent
how do you assess EP tardive dyskinesia?
AIMS (abnormal involuntary movement scale (standard, observation, interview)
S/s of tardive dyskinesia
rolling tongue, smacking lips, chewing, facial dyskinesia, involuntary movements of body and extremities.
what to do if pt have tardive dyskinesia
this is a late s/s. stop drug, give Vit E
s/s of pseudoparkinsonsim
stooped posture, shuffling gait, drooling, rigidity, pill rolling, tremors, bradykinesia
What is the risk with Pseudoparkinsonism?
fall risk d/t shuffling gait and stooped posture. Teach pt to put hands behind back to correct center of gravity.
s/s acute dystonia?
oculogyric crisis (rotating eyeball), laryngospasm, facial grimacing, involuntary mm movements of tongue, face, neck, and back, cogwheel rigidity of arm, micrographia
What is the risk with acute dystonia?
airway d/t larygospasm, risk for injury d/t rolling eyes and involuntary mm movements
What to do if pt have acute dystonia?
only takes days to see; give Benadryl/anticholinergic, Cogentin, or Ativan.
S/s of Akathisia
restless, trouble standing still, pacing, feet constant motion, rolling back and forth
What to do if pt have akathesia?
give lorezepam or BB propanolol
s/s of antipsychotics?
Anticholinergic effects
s/s of anticholinergic effects
dry mouth, blurred vision, constipation, urinary retention, confusion/worsening psychosis, high temp, flushed skin (very pink/red)
what to do if pt have anticholinergic effect?
candy, oral moisturizer, hydrate, stay out of sun, colace, report worsening psychosis to MD.
A/D of typical antipsychotics
NMS (neuroleptic malignant syndrome)
what is the risk with Neuroleptic malignant syndrome?
potentially fatal
How do you tx Neurleptic malignant syndrome?
Give bromocriptine Parlodel or dantrolene (dantrium–a muscle relaxer) ; stop the antipsychotic, hydrate, hypothermic blanket, give antipyretic, benzodiazipine and muscle relaxer.
s/s of neurleptic malignant syndrome?
muscle rigidity, sudden high fever, AMS, blood pressure fluctuations, tachycardia, dysrrhythmias, seizures, RHABDOMYOLYSIS, acute renal failure, respiratory failure, coma.
Other s/e of antipsychotics?
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
How do you initiate rapid tranquilization of pt?
in ER situations only; team approach (never solo), Give Haldol 5mg, Ativan 2mg, Benadryl 50mg (5-2-50)
s/s of phenothiazine OD
no arousal, BP fluctuation, tachycardia, agitation, delirium, convulsion, dysrhythmia, NMS, EP, renal/cardia/resp failure.
how to tx phenotiazine OD?
airway, gastric lavage, activated charcoal administration, adequate hydration, anticholinergic, and norepinephrine
when do you see full tx effect of antipsychotics?
3-6 wks
prolixin fluphenazine a/e
AGRANULOCYTOSIS; hyper/hypotension, tacycardia, EP tardive dyskinesia, impaired thermoregulation, convulsion
prolixin fluphenazine cautions
not for glaucoma pt, additive hypotensive effect with hypotensive rx
Phenothiazine + sedative hypnotics =
additive CNS depression
Antacid should be given 1hr before or 2hr after giving phenothiazine because
antacids decrease rate of absorption
List 5 Atypical antipsychotics
CLOZARIL CLOZAPINE, zyprexa olanzepine, seroquel quetiapine, geodon ziprasidone, risperidol riperidone
CLOZARIL CLOZAPINE
1ST atypical antipsychotic for schizophrenia, who do not respond to traditional tx; has a black box warning
A/E OF CLOZARIL CLOZAPINE
Agranulocytosis; if below 3000mm WBC, d/c it; Seizures ***BLACK BOX WARNING***
pros and cons zyprexa olanzepine
does not cause EP or agranulocytosis; but causes DM and weight gain
s/e of risperidol riperidone
vivid nightmare (so don’t give to elderly dementia related psychosis), sedation, weight gain, HA, dry mouth, photosensitivity, urinary retension, sexual dysfunction, hyperglycemia
a/d of risperidol riperidone
Neuroleptic malignant syndrome, orthostatic hypotension, tachcardia, EPS, ECG changes, convulsions.
a/d geodon ziprasidone
prolonged QT interval
Which atypical antipsychotics cause DM and weight gain
CLOZARIL CLOZAPINE, zyprexa olanzepine, seroquel quetiapine, geodon ziprasidone, risperidol riperidone
Which do NOT cause agranulocytosis
risperidol risperidol, olanzapine zyprexa
Atypical antipsychotics work on what neurotransmitters
Seratonin 5HT, Dopamine D2, Acetylcholine (Ach), Alpha-adrenergic (target of catecholine), histamine H1 (work on smooth muscle and CNS/brochonconstrict, vasodilat, nausea
Typical Phenothiazine and Nonphenothiazine take how long for full clinical effect?
6+ wks
Do typical phenothiazine pass onto breast milk?
Yes. It’s teratogenic.
How often to check WBC for pt taking clozaril clozpine, prolixin fluphenazil, haldol haloperidol?
q3 mon, see if pt leukopenic
Teach pt what about phenothiazine and nonphenothiazine?
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
what antispychotic cause pink/redbrown urine?
Typical phenothiazine thorazine chlorpromazine
which cause agranulocytosis?
proxilin fluphenazine, Haldol haloperidol, clozaril clozapine
s/e of haldol haloperidol
sedation, EP, orthostatic hypotension, HA, photosensitivity, dry mouth, blurred vision.
a/e if haldol haloperidol
tachycardia, seizures, urinary retention, laryngospasm, respiratory depression, cardiac dysrrhythmias, neuromalignant syndrome, agranulocytosis
Why use Atypical antipsychotics
less EPS, better tolerated, used as adjunct in mood disorders
why we don’t use atypical antipsychotics
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.
