Ch. 4 Pharm: Mood stabilizing agents + Antipsychotics Flashcards
Mood stabilizing agents: Indications
- Ind: Prevention and treatment of manic episodes associated with bipolar disorder
- Examples: Lithium. Anticonvulsant meds, and second-gen atypical antipsychotics.
Mood stabilizing agents: Lithium
- Gold standard for mood stabilization
- Never take if pregnant
- Never take long term
- Know this med! Definitely will be on the Kaplan.
Mood stabilizing agents: action of Lithium
- Lithium is thought to modulate the effects of norepinephrine, serotonin, dopamine, glutamate, and GABA, which may contribute to the symptoms of bipolar
- the role of anticonvulsants, verapamil, and antipsychotics in the treatment of bipolar mania is not fully understood.
Mood stabilizing agents: Interactions w/ Lithium & one contraindication
- Because lithium is an imperfect substitute for sodium, anything that depletes sodium will make more receptor sites available to lithium and increase the risk for lithium toxicity.
- Therefore, sweating can cause lithium toxicity. Stay consistent + talk with doctor if training etc.
- Avoid with kidney damage.
Mood stabilizing agents: Planning & implementation. Lithium’s therapeutic ranges??
- Lithium toxicity is very possible
- Ranges:
1. 1.0 - 1.5 mEq/L (acute mania)
2. 0.6 - 1.2 mEq/L (Maintenance) - MUST have periodic blood level monitoring
Mood stabilizing agents: Lithium toxicity
- Initial symptoms: Feeling sick. Blurred vision, tinnitus, nausea & vomitting, severe diarrea
- Escalates to: Tremors, sedation, confusion, delirium, seizures, coma, cardio collapse, death
Many providers now choose to prescribe ____ or ____ _____ as first line treatment instead of lithium
Anticonvulsants or Atypical Antipsychotics
Antipsychotics: Indications
Used for the treatment of schizophrenia and other psychotic disorders: selected agents are also used in the treatment of intractable hiccoughs, and for control of tics and vocal utterances in Tourette’s disorder.
- Basically: They help decrease psychosis
Antipsychotics: Action of typical antipsychotics (1st generation - FGA)
- Blocks dopamine receptors
- These are the older types of antipsychotics
- They work well, but they’re sedating
Antipsychotics: Action of Atypical antispychotics (second generation - SGA)
- More metabolic disorders like diabetes occur with these meds
- Weaker dopamine receptor antagonists than typicals
- Potent antagonists of serotonin receptors
- Some antagonism for cholinergic, adrenergic, and histaminic receptors.
Antipsychotics: Contraindicated
- In hypersensitive, comatose, or severly depressed patients.
- Elderly patients with dementia related psychosis
- certain meds for hist of QT prolongation and other heart issues
Antipsychotics: Caution
- With elderly or debilitated patients
- Patients with cardiac, hepatic, or renal insufficiency
- pts with hist of seizures, diabetes, temp extremes, hypotension, pregnant people, or children
Antipsychotics: Are they addictive?
No. But it can take years to find the right med for the client.
Antipsychotics: Clozapine (Clozaril) details
- Good for suicidal pts.
- Used for “the sickest”
- S/E that causes death via a drop in neutrophil count. Needs constant blood monitoring, for in and out patient. Very rare but can happen.
- Some antipsychotics come in long-acting shot forms. Works for a month or a few months. Most are A-Typical, some typical.
Antipsychotics: List of common Typical Meds
- Chlorpromazine (Thorazine)
- Fluphenazine ( Prolixin)
- Haloperidol (Haldol)
- Perphenazine (Trilafon)
- Thiothixene (Navane)
Antipsychotics: 4 from the long list of common ATYPICALS
- Aripiprazole (Abilify)
- Asenapine (Saphris)
- Lloperidone (Fanapt)
- Lurasidone (Latuda)
Antipsychotics: S/E…there are MANY but some to note:
- Deanna: for dry mouth and eyes just get eye drops or water + ice chips
- Study them over time
- Nausea, GI upset, skin rash, sedation, orth. hypotension, tardive dyskinesia
Issues in antipsychotic maintenance therapy
- Clozapine (Clozaril) and agranulocytosis risk
- Extrampyramidal side effects (next slide)
- Hormonal side effects
Extrapyramidal S/E (EPS) & what med to give to help
- EPS is possible with any antipsychotic
- Pseudoparkinsons’s (tremor, shuffling gait, drooling, rigidity)
- Akinesia (Muscle weakness)
- Akathisia (Continual restlessness)
- Dystonia and oculogyric crisis - can be life threatening (Rigid muscles)
- GIVE: benztropine (oral or shot) to help reverse effects
Antipsychotics: Neuroleptic malignant syndrome
- NMS: rare but life threatening complication of neuroleptic drugs. Fever is the first sign.
- Symptoms: Muscle rigidity, high fever, tachycardia, bp fluctuations, panting and sweating, stupor, coma
Antipsychotics: Tardive dyskinesia
- TD can occur with long-term use of antipsychotics
- symptoms can be permanent
- Abnormal involuntary movement scale (AIMS) developed to screen for TD by NIMH.
Antipsychotics: Tardive dyskinesia + treatment
- Traditionally treatment for TD is to stop antipsychotics immediately
- FDA approved 1st med for tx of TD in 2017:
- Valbenazine (Ingrezza)
- Deutetrabenazine (Austedo)
These two meds are not tested on in 331
