CH 19 + 20: Psychiatric Drugs & Bipolar Disorder Flashcards
What is bipolar disorder?
- alternates between extreme feelings of sadness and extreme mania
- significantly impacts social and occupational functioning
- nonadherence = serious problems (d/t highs –> believes they don’t need meds anymore
need to know!
what are some nonpharmacological interventions for bipolar disorder?
need to know!
- identifying triggers: lack of sleep, excessive stress, poor nutrition
- support groups
- ECT
What are some pharmacological interventions for bipolar disorder?
need to know!
- medications
- highly individualized based on severity and predominant symptoms
Lithium - how are they used in BD?
- conventional therapy for tx of BD
- mood stablizers
- traditional treatment = lithium carbonate
lithium - any drug interactions?
- diuretics = incr risk of lithium toxicity (e.g., lasix)
- NSAIDs, thiazide diuretics - can incr lithium levels
- anti-thyroid drugs, drugs containing iodine can incr hypothyroid effect
- halperidol causes incr neurotoxicity
- SSRIs, MAOIs, dextromethorphan may result in SES
- some herbal, food interactions
Lithium - any considerations?
need to know!
- monitor serum levels Q1-3 days initially & 2-3 months after
- assess s/s bipolar disorder before and during treatment
- obtain baseline thyroid, kidney, cardiac function, lyte levels - monitor for s/s lithium toxicity
- assess daily weight changes, edema, changes in skin turgor
- lithium = salt –> dehydration incr lithium & overhydration decr lithium levels (n/v/d, or exercising)
- monitor sodium intake - take table salt to maintain osmotic hydration, but don’t overdo it
what are s/s lithium toxicity?
need to know!
- n/v
- persistent diarrhea
- coarse trembling of hands or legs
- frequent muscle twitching, e.g., pronounced jerking of arms or legs
- blurred vision
- marked dizziness
- difficulty walking
- slurred speech
- irregular heartbeat
- swelling of feet or lower legs
what is the etiology of schizophrenia?
- precise etiology = unknown
- genetic component: 5-10x greater risk if 1st-degree relative has disorder
- neurotransmitter imbalance: overactive dopaminergic pathways in basal nuclei & association w/ dopamine type 2 (D2) receptors (antipsychotic drugs block receptors)
need to know!
what has become the drugs of choice for schizophrenia treatment?
need to know!
2nd generation (atypical) antipsychotics
How to manage pyschoses with medications?
initial treatment
- first doses of antipyschotics may be higher than normal
—> produces sedation if pti is agitated, aggressive, or posing dangers to others - most drugs provided orally
- benzodiazepenes (lorazepam [Ativan]) –> provided IM to relax pt and may allow initial dose of antipsychotic to be reduced
- benzos given oral after under control
- acute symptoms usually resovle in 3-7 days
what is it?
Antipsychotic drugs AEs - Extrapyramidal SEs (EPS)
- refers to locations in CNS associated with postural and automatic movements
includes: - acute dystonia
- akathisia
- parkinsonism
- tardive dyskinesia (TD) common with typical anti-psychotics
What is tardive dyskinesia?
- syndrome of symptoms characterized by bizarre facial and tongue movements, stiff neck, and difficulty swallowing
- result of dopamine blockage
- common with typical antipsychotics
- treatment = discontinue antipsychotics
- include ambulatory tardive dyskinesias & oral tardive dyskinesias
Extrapyramidal SEs (EPS) - what is it? cause?
- variety of responses that originate outside the pyramidal tracts and in the basal ganglion of the brain
- s/s: tremors, chorea, dystonia, akinesia, akasthisia
- result of dopamine blockage
- common w/ typical antipsychotics
- treatment with anticholinergic drugs, e.g., benzotropine (Cogentin)
what is it? s/s? treatment?
Antispychotics AEs: Neuroleptic malignant syndrome (NMS)
- potentially fatal adverse reaction
- symptoms: high fever, diaphoresis, muscle rigidity, tachycardia, BP fluctuations
- condition can deteriorate to stupor or coma without quick, aggressive treatment
- treatment: antipyretics, electrolytes, muscle relaxants
Antipsychotics AEs: adverse effects on reproductive system
- major cause of nonadherence
- sexual, menstrual, breast dysfunction
Nonphenothiazines - what are they? use?
- 1st-gen antipsychotics, same therapeutic applications and similar SEs as phenothiazines
- similar SEs to phenothiazines (less sedation, fewer anticholinergic SEs)
- greater or equal incidence of EPS
nonphenothiazines - prototype drug
haloperidol (Haldol)
- therapeutic: antipsychotic (1st-gen)
- pharmacologic: nonphenothiazine, dopamine antagonist
therapeutic use: high potency antipsychotic, treats acute + chronic psychotic disorders
mechanism of action: anticholinergic effects, alpha1-adrenergic blocking effects, blocks neurotransmission at dopamine D2 receptors
haloperidol - adverse effects
need to know!
- anticholinergic symptoms (blurred vision, dry eyes, glaucoma)
- weight gain
- headache
- anemia
- phototoxicity
- * most likely to produce EPS (> than phenothiazines)
haloperidol - serious adverse effects?
- tachycardia
- cardiac arrest
- laryngospasm
- respiratory depression
- seizures
- agranulocytosis / leukopenia/ leukocytosis
- neuroleptic malignant syndrome (NMS)
what is neuroleptic malignant syndrome (NMS)?
- = life-threatening neurological disorder most often caused by adverse reaction to neuroleptic / antipsychotic drugs
- typically consists of muscle rigidity, fever, sweating, autonomic instability, and cognitive changes
- cognitive changes: delirium, associated with elevated plasma creatine phosphokinase
2nd-gen (atypical) antipsychotics - prototype drug?
- drugs of choice for schizophrenia
prototype drug = risperidone (Risperdal)
- pharmacologic: benzisoxazole & dopamine antagonist
therapeutic effects:
- 1993+: schizophrenia & related psychoses
- 2003: acute mania associated w/ bipolar disorder
mechanism: unknown; blocking binding of dopamine to its receptors? highest affinity for type D2, less on D1
Risperidone: considerations?
- if medications cause drowsiness - take @ bedtime
- watch pt for orthostatic hypotension (rise slowly)
- assess for EPS/ TD / akathesias/ NMS
- educate pt for s/s of SEs + what to watch for, when to contact HCP
- encourage sips of h2o / hard candies for dry mouth & anticholinergic-like symptoms
- avoid alcohol & caffeine
- incr fluids + fibre
- watch liver lab results & educate pt on s/s liver involvement (jaundice/stool)
- tell pt to report significant weight gain (5lb/week)
- ensure pt knows that definite improvement may not be seen for 6-8 weeks
which drugs are similar to risperidone (Risperdal)?
2nd-gen (atypical) antipsychotics
- quetiapine (Seroquel)
- olanzapine (Zyprexa)
- clozapine (Clozari, FazaClo)
need to know!
dopamine system stabilizers (DSS) - what are they?
prototype drug: aripiprazole (Abilify)
- newer class of atypical antipsychotics
- exhibit both antagonist & partial agonist activity on dopamine receptors = decr ADEs
- minimal risk of EPS
- for schizophrenia control & decr s/s
