Ch 22-23 Flashcards
anxiolytics
(aka antianxiety or sedative-hypnotics) Can be used to treat sleep disorders, seizures, and withdrawal from alcohol or other substances
pschosis
losing contact w/reality manifested in variety of mental/psychiatric disorders characterized by more than one symptom (DIFF P, DIFF C, CHIDA/V)
a. Difficulty processing info/coming to a conclusion
b. Delusions
c. Catatonia
d. Incoherence
e. Hallucinations
f. Aggressive/violent behavior
psychotic symps result from?
imbalance in NT dopamine
schizophrenia
chronic psychotic disorder where symptoms develop in early adulthood or adolescence. 2 groups: positive or negative
a. Positive symtpoms: (EX norm fx, PHID)
i. Exaggeration of normal fx
ii. Incoherent speech
iii. Hallucinations
iv. Delusions
v. Paranoia
b. Negative symptoms:
i. Decrease/loss of fx or motivation
ii. Poor self care
iii. Social withdrawal
schizo (pos) tx with?
typical/traditional antipsychotics
antipsychotics aka?
does what? how?
any drug that modifies psychotic behaviors, exhibits antipsychotic effect.
a. largest group of drugs to treat mental illness/improve thought processes/behavior patterns in patients with psychosis
b. Dopaminergic antagonists: They block the actions of dopamine (block the D2 dopaminergic receptor), promoting presence of EPS, resulting in drug induced pseudoparkinsonism in varying degrees.
NMS
c. Neuroleptic malignant syndrome: rare, potentially fatal adverse rxn of antipsychotic drugs. Predisposed by exhaustion, dehydration, excess agitation.
i. symps incl coma, seizure, tachycardia, dysrhythmia, muscle rigidity, rhabdo, resp failure, acute renal failure, sudden hi fever, AMS, BP fluctuation
how to tx NMS?
tx with antipyretics, benzos, muscle relaxants, hydration, hypothermic protocol, immediate d/c of antipsy
what are the traditional/typical antipsychotics
d. Typical/Traditional antipsychotics:
i. Phenothiazines
1. Aliphatic
2. Piperazine
3. Piperdine
ii. Nonphenothiazines
1. Butyrophenones
2. Dibenzoxazepines
3. Dihydroindolones
4. Thioxanthes
what are adverse rxns of typical antipsychotics
EPS (pseudoparkinsonism): Like parkinson’s: rigidity, bradykinesia, shuffling, mask face, tremors at rest, stooped posture, pill rolling hands
- Early tx with typical antipsys can give 2 other adverse extrapyramidal rxns: dystonia, akathisia
- Dystonia: Muscle spasms in face, tongue, neck, back, facial grimace, abnormal/involuntary upward eye movement, laryngeal spasm; 5% of patients get within days.
- Akathisia: trouble standing still, restless, pacing, constant motion; occurs in 20% of pts
how to tx dystonia?
a. Tx with anticholinergic/antiparkinsonism drugs
how to tx akathisia?
Tx with benzodiazepine or beta blocker
atypical antipsychotics used for?
iv. Atypical (serotonin/dopamine) antipsychotics
1. Effective for schizophrenia (negative symps) or pt who do not respond to/are intolerant of typical antipsychotics
are atypical used more or typical? why?
atypical - 2. Used more than typical – less side effects (less likely to cause EPS, incl tardive dyskinesia)
a. Atypicals have weak affinity to D2 receptors and stronger affinity to D4, blocking serotonin receptor
atypicals may also cause?
weight gain, drowsy, unsteady gait, HA, insomnia, depression SE
atypical adverse rxn?
a. Tardive dyskinesia: chewing motion, protrusion and rolling of tongue, sucking/smacking lips, involuntary body movement; occurs in 20-30% of pt taking atypical antipsy more than 1 yr. prevalence higher in smokers and more frequent/severe in older adults. Probability depends on duration/dosage
i. Immediately discontinue antipsychotic drug
antipsychotics and older adult?
a. Require 25—50% smaller doses than young and middle-aged adults
b. Black-box warning for increased mortality in elderly patients with dementia-related psychosis
chlorpromazine hydrochloride
alphatic phenothiazine typical antipsychotic
strong sedative, lower BP, may cause moderate EPS effects and orthostatic hypotn.
phenothiazines
lower seizure threshold, may need dosage adjust
aliphatic phenothiazines
strong sedative, lower BP, may cause moderate EPS effects and orthostatic hypotn.
fluphenazine(prolixin)
piperazine phenothiazine typical antipsychotic
tx symps of psychosis/schizo by blocking dopamine receptors in brain.
piperazines
produce more EPS symps than other phenothiazines > dry mouth, urinary retention, agranulocytosis
fluphenazine(prolixin) CI, DFL, ad rxn, SE
CI: subcortical brain damage, blood dyscrasia, renal/liver, coma
DFL: etoh/cns depress
ad rxn: HTN, HYPOTN, tachy, EPS, impaired thermoreg, convulsions
SE: sedation, dizzy, headache, dry mouth, congestion, blurry, PHOTOSENSITIVITY, nausea, constipation, URINARY RETNTION, POLYURIA, PERIPHERAL EDEMA
fluphenazine(prolixin) and haloperidol(haldol) NI and PT ED
NI: monitor VS (ortho hypo), ensure pt takes med, observe for EPS and NMS, monitor urine output (retention), monitor serum glucose
8. Pt ed: take drug as ordered, won’t cure but will lessen symps, may take 6wks for effect, don’t take ETOH or other CNS depressants, get serial labs (monitor WBC every 3mos), no breastfeeding (effect on fetus unknown), no smoking (inc metabolism of some antipsy), don’t abruptly stop
