Ch 17 Drugs Treating Psychotic Disorders & Dementia Flashcards
What is the primary neurotransmitter related to thought processing?
Dopamine
It is secreted by neurons originating in the midbrain that function in coordination, emotion, and voluntary decision making.
What is the highest functional area of the brain
The cerebrum it is concerned with activities such as creative thought judgment memory and reason it is divided into two hemispheres
What secretes acetylcholine?
Many areas of the brains secrete acetylcholine.
Reductions in the amount of this neurotransmitter result in cognitive changes.
What are the functions of acetylcholine?
Acetylcholine has a number of functions including arousal, coordination of movement, memory acquisition and memory retention.
What is schizophrenia?
Schizophrenia is a particular kind of psychosis that is characterized. Mainly by a clear sensorium but a marked disturbance in thinking
It is a complex illness with uncertain etiology.
Schizophrenia interferes with a persons ability to think clearly, manage emotions, make decisions, and relate to others.
It is considered to have multiple causes.
What is dementia?
It is a clinical syndrome of progressive, degenerative loss of memory & one of more of theses abilities;
1. Language skills
2. Higher level skills such as judgement, comprehension, problem solving.
3. Ability to recognize or identify objects despite intact sensory function.
4. Ability to perform motor skills.
Mood and behavior may also be affected in dementia
Agitation or withdrawal, hallucinations, delusions, insomnia, emotional apathy and loss of inhibitions are also common.
What is Alzheimer’s disease?
It is one form of progressive dementia
Alzheimer’s disease is the most common cause of dementia among ppl 65 & older
It can cause a gross, diffuse atrophy of the cerebral cortex
It is assoc with extra cellular plaques with beta- amyloid protein deposits and neurofibrillary tangles in the cortical neurons.
It typically begins with short term memory loss.
What is vascular dementia?
Vascular dementia results from damage to brain tissues caused by cerebrovascular events such as transient ischemic attacks.
The areas that experience infarcts are assoc with specific neurological functions. Although vascular dementias and AD differ in cause, many of the symptoms are similar.
What are other things that dementia can be caused from?
It can also be caused by a variety of medical conditions
The primary mechanism of diagnosis is the presence of or a. Opted history of either diseases such as, AIDS, PARKINSONS DISEASE, HUNTINGTON CHOREA, & others.
What are IRREVERSIBLE risk factors/ causes of dementia?
Age over 65 yrs Cerebral infarction or ischemia Diseases such as cardiovascular disorders type 1 diabetes Male gender Genetic factors
What are reversible risk factors / causes of dementia?
Depression
Diseases such as type 2 diabetes, hyperlipemia, hypertension, infections, metabolic disorders,nutritional disorders, toxins, trauma.
What is delirium?
Delirium is a sudden disruption in cognitive functioning, most often caused by physical changes in the body.
The physical changes prevents the brain from receiving some critical element that it needs to function efficiently.
There is a disturbance in the level of consciousness that comes and goes throughout the days or days When Delirium is present.
To treat delirium, the underlying cause must first be identified.
Typical antipsychotics
We’re the 1st antipsychotic drugs created.
They are sometimes referred to CONVENTIONAL ANTIPSYCHOTICS
What is the prototype drug of typical antipsychotics?
haloperidol (Haldol)
Name some typical antipsychotic drugs.
haloperidol fluphenazine (Prolixin) Loxapine perphenazine chlorpromazine thioridazine thiothixene
What is the core drug knowledge of haloperidol?
- Used to treat psychotic disorders
- Protein bound, delayed onset of action
- Blocks the dopamine ( specifically D2), alpha and serotonin receptors
Effective: decreases in movement disorders, relief of hallucinations, delusions and psychosis.
What are the contraindications and precautions of haloperidol?
Hypersensitivity and Parkinson’s disease
Extrapyramidal symptoms, drowsiness, sedation, somnolence, lethargy and dysphoria.
There are few drug interactions, smoking decreases serum levels
What are cultural and inherited traits to consider when administering haloperidol?
Asians have 50% higher serum level than whites
What pregnancy category level is haloperidol?
C
Regarding haloperidol, how can a nurse minimize adverse effects?
Educate the client that EPS is more likely to occur if the pr. Repeatedly stops and restarts therapy.
Advise pt. To avoid alcohol while taking the drug.
Name a side effect of haloperidol?
Extrapyramidal symptoms
The cause of these symptoms is the relative lack of dopamine stimulation and the relative excess of cholinergic stimulation.
How do atypical antipsychotic MEDS differ from the typical antipsychotics?
Atypical antipsychotics differ from typical antipsychotics in that they target only specific dopamine receptors.
This specificity creates a much lower adverse effect profile.
Another advantage of atypical. Antipsychotics is that they treat both the negative and positive symptoms of schizophrenia.
What is the prototype drug of atypical antipsychotics?
olanzapine ( Zyprexa)
Others include;
risperidone ( Respiradol)
quetiapine ( Seroquel)
What is the core drug knowledge of olanzapine?
- used to treat psychotic symptoms In schizophrenia & for short term treatment of acute bipolar disorder.
Highly protein bound
Half life 21-54 hours
What is the pharmacodynamics of olanzapine?
Works by blocking several neuroreceptor sites, including serotonin, dopamine, muscarinic, histamine-1 (H1) and alpha 1.
What are contraindications and precautions of olanzapine?
Hypersensitivity
What are the adverse effects of olanzapine?
Drowsiness, insomnia, agitation, nervousness, hostility, Tardive dyskinesia, and neuroleptic malignant syndrome.
What drug interactions occur with olanzapine?
Centrally acting drugs, alcohol, Omerprazole, rifampin, and carbamazepine.
What pregnancy category is olanzapine?
C
What should a nurse evaluate before administering olanzapine?
Baseline assessment including lab studies
Evaluate caffeine intake and diet
Assess climate where drug is given.
How can a nurse minimize adverse effects of olanzapine?
Assess fasting blood sugar before drug therapy is initiated and during therapy
To Minimize daytime drowsiness you can Give the entire daily dose at night.
What can a nurse teaching family and patient regarding Olanzapine?
- Teach signs of hyperglycemia
- Therapeutic response will not be immediate
- Stress the importance of continuing drug therapy
What is the advantage of olanzapine over other atypical antipsychotics?
There is. O risk for agranulocytosis.
olanzapine does not cause agranulocytosis, which is a common side effect with other atypical antipsychotics.
acetylcholinesterase enzymes
Acetylcholine is a neurotransmitter for several CNS circuits in the brain
By inhibiting the action of AChe, acetylcholine erase inhibitors prolong activity of acetylcholine on cortical cholinergic receptors in the synapse.
These agents increase concentrations of the memory regulating and cognition regulating neurotransmitters acetylcholine by reversible inhibiting the enzyme cholinesterase
What is the prototype drug of acetylcholinesterase
rivastgmine ( Exelon)
What is the Pharmacotherapeutics of rivastgmine? (Exelon)
Treating mild to moderate dementia Administered: orally Distribution: throughout the body Metabolism: liver Excreted: in the urine Carbamate derivative enhances cholinergic function.
What are the contraindications and precautions of rivastgmine?
Hypersensitivity
Adverse effects: GI effects. Dizziness, chest pain, peripheral edema, vertigo, joint pain, agitation, and coughing.
What are drug interactions of rivastgmine? (Exelon)
Succinylcholine, similar neuromuscular blocking agents or cholinergic agonists.
What are core pt. Variables regarding rivastgmine?
Assess body systems: assess for cardiac dysfunction.
