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Adv Pharm > Chapter 26: Antipsychotics -use in Schitzophrenia > Flashcards

Chapter 26: Antipsychotics -use in Schitzophrenia Flashcards

1
Q

antipsychotic agents

A

Chemically diverse group of compounds​

Used for diverse spectrum of psychotic disorders​

Schizophrenia, delusional disorders, bipolar disorders, depressive psychoses, and drug-induced psychoses​

Also used to suppress emesis and to treat Tourette syndrome and Huntington chorea​

Should not be used to treat dementia in the older adult

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2
Q

FGA

A

First-generation antipsychotics (FGAs) or conventional antipsychotics​

Block receptors for dopamine in the central nervous system (CNS)​

Cause serious movement disorders known as extrapyramidal symptoms (EPS)

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3
Q

SGA

A

Second-generation antipsychotics (SGAs) or atypical antipsychotics​

Produce only the moderate blockade of dopamine receptors; stronger blockade for serotonin​

Fewer EPS

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4
Q

schitzo clinical presentation

A

Disordered thinking and reduced ability to comprehend reality ​

Three types of symptoms

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5
Q

positive schitzo s/sx

A

Exaggeration or distortion of normal function​

Hallucinations​

Delusions​

Agitation​

Tension​

Paranoia

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6
Q

neg schitzo s/sx

A

Loss or diminution of normal function​

Lack of motivation​

Poverty of speech​

Blunted affect​

Poor self-care​

Social withdrawal​

​

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7
Q

cognitive schitzo s/sx

A

Disordered thinking​

Reduced ability to focus attention​

Prominent learning and memory difficulties​

Subtle changes may appear years before symptoms become florid​

Florid changes: Thinking and speech may be completely incomprehensible to others

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8
Q

schizo clinical presentation: acute episodes

A

Delusions (fixed false beliefs) and hallucinations are frequently prominent

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9
Q

schizo clincal presentation: residual s/sx

A

Suspiciousness; poor anxiety management; and diminished judgment, insight, motivation, and capacity for self-care

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10
Q

schizo long-term course

A

Acute exacerbations separated by intervals of partial remission

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11
Q

etiology of schizo

A

Genetic​

Perinatal​

Neurodevelopmental​

Neuroanatomic factors ​

Excessive activation of CNS receptors for dopamine​

Insufficient activation of CNS receptors for glutamate​

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12
Q

FGA classification

A

Classification by potency​:
Low potency: Chlorpromazine​
Medium potency​
High potency: Haloperidol

Chemical classification​
Five major chemical categories​
Phenothiazines and butyrophenones​
Drugs in all groups equivalent with respect to antipsychotic actions

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13
Q

FGA MOA

A

Conventional antipsychotic drugs block a variety of receptors within and outside of the CNS​

Suppress symptoms of psychosis by blocking dopamine2 receptors in the mesolimbic area of the brain​

Adverse effects are a result of blocking receptors for dopamine, acetylcholine, histamine, and norepinephrine

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14
Q

FGA therapeutic actions

A

Schizophrenia is the primary indication for antipsychotic drugs ​

These drugs suppress symptoms during acute psychotic episodes ​

Continued use reduces the risk of relapse

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15
Q

FGA ADR: EPS

A

Acute dystonia​

Oculogyric crisis: upward dievation of eyes ​

Opisthotonus ​

Joint dislocation ​

Impaired respiration​

Anticholinergic medication (e.g., benztropine and diphenhydramine)​

Some manifestations of EPS are IRREVERSIBLE​

It is crucial to monitor patients treated with antipsychotics for EPS

Parkinsonism: Bradykinesia, mask-like facies, drooling, tremor, rigidity, shuffling gait, cogwheeling, and stooped posture

Akathisia: Pacing and squirming brought on by an uncontrollable need to be in motion

Tardive dyskinesia: Choreoathetoid movements of the tongue and face; lip-smacking movements; tongue flicks out in a “fly-catching” motion; slow, worm-like movement of the tongue; and involuntary movements of the limbs, toes, fingers, and trunk

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16
Q

FGA ADR: NMS

A

Rare but serious reaction​

Risk of death without treatment​

“Lead pipe” rigidity, sudden high fever, sweating, autonomic instability, dysrhythmias, fluctuations in blood pressure, altered level of consciousness, and seizures or coma may develop​

Death can result from respiratory failure, cardiovascular collapse, dysrhythmias, and other causes

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17
Q

nms TX

A

Supportive measures​

Drug therapy: Dantrolene and bromocriptine​

Immediate withdrawal of antipsychotic medication

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18
Q

FGA ADR: other

A

Other adverse effects​

Anticholinergic effects​:
Dry mouth, blurred vision, photophobia, urinary hesitancy, constipation, and tachycardia​

Orthostatic hypotension​:
Antipsychotic drugs promote orthostatic hypotension by blocking alpha1-adrenergic receptors on blood vessels

Sedation​

Neuroendocrine effects​

Seizures​

Sexual dysfunction​

Dermatologic effects​

Agranulocytosis​

Severe dysrhythmias

19
Q

FGA physical and psychologic dependence

A

Development of physical and psychologic dependence is rare​

Abrupt withdrawal of antipsychotics can precipitate a mild abstinence syndrome

20
Q

FGA drug interactions

A

Anticholinergic drugs​
Intensify the anticholinergic effect​

CNS depressants​
Can intensify the depressant effect​

Levodopa and direct dopamine receptor agonists​
May counteract the antipsychotic effects of neuroleptics

21
Q

FGA toxicity

A

Conventional antipsychotic drugs are very safe​

Death by overdose is extremely rare​

Overdose produces hypertension, CNS depression, and EPS​

Treatment​
Intravenous fluids, alpha-adrenergic agonists, and gastric lavage​
Emetics not effective: Neuroleptics block the antiemetic action

22
Q

high potency agents: haloperidol (Haldol)

A

Butyrophenone family​

Principal indications: Schizophrenia and acute psychosis​

Preferred agent for Tourette syndrome​

Adverse effects​:
Extrapyramidal reactions ​
Neuroendocrine effects​
Can prolong the QT interval and cause dysrhythmias​

​

23
Q

high potency agents: Fluphenazine

A

Piperazine subclass of phenothiazines​

Principal indications: Schizophrenia and other psychiatric disorders​

Adverse effects​:
Early EPS​
Acute dystonia​
Parkinsonism​
Akathisia​
Sedation, orthostatic hypotension, anticholinergic effects, gynecomastia, galactorrhea, and menstrual irregularities ​

24
Q

low potency agents: chlorpromazine

A

Therapeutic uses: Schizophrenia, schizoaffective disorder, and the manic phase of bipolar disorder​

Other uses: Suppression of emesis, relief of intractable hiccups, and control of severe behavioral problems in children​

Adverse effects: Sedation, orthostatic hypotension, and anticholinergic effects (e.g., dry mouth, blurred vision, urinary retention, photophobia, constipation, and tachycardia)

Drug interactions: Intensifies responses to CNS depressants (e.g., antihistamines, benzodiazepines, and barbiturates) and anticholinergic drugs (e.g., antihistamines, tricyclic antidepressants, and atropine-like drugs)

25
Q

low potency agent: therioridazine

A

Prolongs the QT interval and can cause fatal cardiac dysrhythmias​

Reserved for treating schizophrenia in patients who have not responded to safer agents​

Most common adverse effects: Sedation, orthostatic hypotension, anticholinergic effects, and weight gain​

26
Q

atypical antipsychotic agents

A

Introduced during the 1990s​

Less risk of EPS than FGAs​

Increased risk of weight gain, diabetes, and dyslipidemia

27
Q

clozapine

A

Mechanism of action​:
Blocks dopamine and serotonin​

Therapeutic use​:
Schizophrenia​
Levodopa-induced psychosis

atypical

28
Q

clozapine ADRS

A

Agranulocytosis​

Seizures​

Extrapyramidal symptoms​

Diabetes​

Dyslipidemia ​

Weight gain​

Myocarditis​

Effects in older adult patients with dementia​

About double the mortality rate

29
Q

risperidone (risperdal)

A

atypical

Mechanism of action​
Binds to multiple receptors​

Adverse effects​
Generally infrequent and mild​

Preparations, dosage, and administration​
Schizophrenia, oral therapy​
Schizophrenia, intramuscular therapy​
Bipolar disorder

30
Q

paliperidone

A

Approved for the acute therapy of schizoaffective disorder and for the acute and maintenance therapy of schizophrenia​

Active metabolite of risperidone (9-hydroxy-risperidone) with the same adverse and therapeutic effects as for risperidone itself​

Dosed once a day​

Can prolong QT interval

atypical

31
Q

olanzapine (zyprexa)

A

Approved for schizophrenia, maintenance therapy of bipolar disorder, acute agitation associated with schizophrenia and bipolar mania, and treatment-resistant major depression (in combination with fluoxetine)​

Adverse effects: Carries a low risk of EPS but a high risk of metabolic effects

atypical

32
Q

ziprasidone (geodon)

A

SGA indicated for schizophrenia and acute bipolar mania​

Mechanism of action​
Blocks multiple receptors: dopamine2, 5-hydroxytryptamine2, and histamine1​

Adverse effects: Generally well tolerated ​

Most common side effects: Somnolence, orthostatic hypotension, and rash

33
Q

Quetiapine [Seroquel]

A

atypical

SGA indicated for schizophrenia, major depression, and acute episodes of mania and depression in patients with bipolar disorder​

Adverse effects: Moderate risk of serious metabolic effects, cataracts, and prolonged QT interval​

Drug interactions -multiple

34
Q

Aripiprazole [Abilify]

A

atypical

Dopamine system stabilizers​

Indications: Schizophrenia, acute bipolar mania, major depressive disorder, agitation associated with schizophrenia or bipolar mania, and irritability associated with autism spectrum disorder​

Adverse effects: Headache, agitation, nervousness, anxiety, insomnia, nausea, vomiting, dizziness, and somnolence​

35
Q

Asenapine [Saphris]

A

Indications: Acute and maintenance therapy of schizophrenia in adults and acute monotherapy or acute adjunctive therapy (with lithium or valproate) of manic or mixed manic episodes associated with bipolar disorder ​

Adverse effects: Drowsiness, hypotension, and prolonged QT interval

36
Q

Iloperidone [Fanapt]

A

atypical
Efficacy equal to that of risperidone and haloperidol​

Better tolerated than some other SGAs​

Still carries a significant risk of weight gain, hypotension, and QT effects

37
Q

depot prep

A

Depot antipsychotics: Long-acting, injectable formulations used for the long-term maintenance therapy of schizophrenia​

No evidence that depot preparations pose an increased risk of side effects

38
Q

3 major objectives for schizo drug therapy

A

Suppression of acute episodes​

Prevention of acute exacerbations​

Maintenance of the highest possible level of functioning

39
Q

schizo drug therapy route

A

Oral (tablets, capsules, and liquids)​ -preferred

inhaled -Loxapine [Adasuve]

Intramuscular

40
Q

FGA vs SGA

A

Most FGAs and SGAs are equally effective, except for clozapine, which is more effective than the rest​

FGAs: Significant risk of EPS​

SGAs: Risk of metabolic effects​

FGAs: Cost less than SGAs

41
Q

schizo dosing

A

Highly individualized​

Older adult patients require relatively small doses​

Size and timing of dose likely to be changed over course of therapy

42
Q

schzio drug therapy

A

Initial therapy​

Maintenance therapy​

Adjunctive drugs​
Benzodiazepines​
Antidepressants

43
Q

schizo promoting adherence

A

Ensure that the medication is taken​

Encourage family members to oversee medication for outpatients​

Provide patients with instructions​

Inform patients and their families that antipsychotics must be taken on a regular schedule

Inform patients about side effects of treatment​

Assure patients that antipsychotic drug use does not lead to addiction​

Establish a good therapeutic relationship with patient​

Use an intramuscular depot preparation for long-term therapy

44
Q

schizo non drug therapy

A

Counseling for the patient and family​

Behavioral therapy​

Vocational training

Adv Pharm (76 decks)

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