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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
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
26
What is the risk with acute dystonia?
airway d/t larygospasm, risk for injury d/t rolling eyes and involuntary mm movements
27
What to do if pt have acute dystonia?
only takes days to see; give Benadryl/anticholinergic, Cogentin, or Ativan.
28
S/s of Akathisia
restless, trouble standing still, pacing, feet constant motion, rolling back and forth
29
What to do if pt have akathesia?
give lorezepam or BB propanolol
30
s/s of antipsychotics?
Anticholinergic effects
31
s/s of anticholinergic effects
dry mouth, blurred vision, constipation, urinary retention, confusion/worsening psychosis, high temp, flushed skin (very pink/red)
32
what to do if pt have anticholinergic effect?
candy, oral moisturizer, hydrate, stay out of sun, colace, report worsening psychosis to MD.
33
A/D of typical antipsychotics
NMS (neuroleptic malignant syndrome)
34
what is the risk with Neuroleptic malignant syndrome?
potentially fatal
35
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.
36
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.
37
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
38
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)
39
s/s of phenothiazine OD
no arousal, BP fluctuation, tachycardia, agitation, delirium, convulsion, dysrhythmia, NMS, EP, renal/cardia/resp failure.
40
how to tx phenotiazine OD?
airway, gastric lavage, activated charcoal administration, adequate hydration, anticholinergic, and norepinephrine
41
when do you see full tx effect of antipsychotics?
3-6 wks
42
prolixin fluphenazine a/e
AGRANULOCYTOSIS; hyper/hypotension, tacycardia, EP tardive dyskinesia, impaired thermoregulation, convulsion
43
prolixin fluphenazine cautions
not for glaucoma pt, additive hypotensive effect with hypotensive rx
44
Phenothiazine + sedative hypnotics =
additive CNS depression
45
Antacid should be given 1hr before or 2hr after giving phenothiazine because
antacids decrease rate of absorption
46
List 5 Atypical antipsychotics
CLOZARIL CLOZAPINE, zyprexa olanzepine, seroquel quetiapine, geodon ziprasidone, risperidol riperidone
47
CLOZARIL CLOZAPINE
1ST atypical antipsychotic for schizophrenia, who do not respond to traditional tx; has a black box warning
48
A/E OF CLOZARIL CLOZAPINE
Agranulocytosis; if below 3000mm WBC, d/c it; Seizures \*\*\*BLACK BOX WARNING\*\*\*
49
pros and cons zyprexa olanzepine
does not cause EP or agranulocytosis; but causes DM and weight gain
50
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
51
a/d of risperidol riperidone
Neuroleptic malignant syndrome, orthostatic hypotension, tachcardia, EPS, ECG changes, convulsions.
52
a/d geodon ziprasidone
prolonged QT interval
53
Which atypical antipsychotics cause DM and weight gain
CLOZARIL CLOZAPINE, zyprexa olanzepine, seroquel quetiapine, geodon ziprasidone, risperidol riperidone
54
Which do NOT cause agranulocytosis
risperidol risperidol, olanzapine zyprexa
55
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
56
Typical Phenothiazine and Nonphenothiazine take how long for full clinical effect?
6+ wks
57
Do typical phenothiazine pass onto breast milk?
Yes. It's teratogenic.
58
How often to check WBC for pt taking clozaril clozpine, prolixin fluphenazil, haldol haloperidol?
q3 mon, see if pt leukopenic
59
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
60
what antispychotic cause pink/redbrown urine?
Typical phenothiazine thorazine chlorpromazine
61
which cause agranulocytosis?
proxilin fluphenazine, Haldol haloperidol, clozaril clozapine
62
s/e of haldol haloperidol
sedation, EP, orthostatic hypotension, HA, photosensitivity, dry mouth, blurred vision.
63
a/e if haldol haloperidol
tachycardia, seizures, urinary retention, laryngospasm, respiratory depression, cardiac dysrrhythmias, neuromalignant syndrome, agranulocytosis
64
Why use Atypical antipsychotics
less EPS, better tolerated, used as adjunct in mood disorders
65
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.

Pharmacology Sem 3 (26 decks)

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