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69:252 Psychopharmacology > Lecture 4 > Flashcards

Lecture 4 Flashcards

1
Q

are any action that occurs other than the desired effect of the drug.

A

Side Effects

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2
Q

have numerous side effects. This is a result of the action that they have on the:
A) Nervous System
B) Endocrine System
C) Cardiovascular System
D) Exocrine System
E) Miscellaneous Systems

A

Antipsychotics

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3
Q

Due to:
1. Dopamine antagonism (block dopamine from binding)
2. Blockade of muscarinic cholinergic receptors
3. Blockade of Histamine receptors
4. Blockade of adrenergic receptors

A

Side Effects

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4
Q

Extrapyramidal Side Effects
Tardive Dyskinesia
Anticholinergic Side Effects
Neuroleptic Malignant Syndrome
Sedation
Confusion
Headaches
Seizures
Sleep Disturbances

A

Nervous System Side Effects

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5
Q

Akathisia, Akinesia, Pseudo parkinsonism, and Dystonia
- Group of motor disturbances caused by Dopamine being blocked in the Nigrostriatal Pathway
- Typical Antipsychotics are the most likely to cause
- Some symptoms can be controlled with the use of Antiparkinsonian medication

A

EPS Nervous System

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6
Q

Most common of the EPS
Onset is 5- 60 days from the start of drug therapy
Characterized by motor- restlessness, or an inability to sit still
Condition is completely outside voluntary control (which differentiates it from agitation)

A

Akathisia

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7
Q

Akathisia usually improves with a reduction in medications or the addition of a _______ or _______

A

benzodiazepine or propranolol

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8
Q

Immobility or weakness
Complaints of fatigue
Lack of muscle movement
Can be confused with the negative symptoms of Schizophrenia
Increased dose of medication will increase the symptoms

A

Akinesia/Bradykinesia

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9
Q

Onset is the first week after the initiation of drug therapy
Loss in muscle movement (Akinesia)
Mask like facial expression
Stooped posture
Shuffling gait
Pin rolling movement between finger and thumb,
Muscle rigidity (cogwheel)
Tremors

A

Pseudo parkinsonism

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10
Q

Onset is very sudden within 1- 5 days of initiation or increase in drug therapy
Characterized by sudden uncoordinated prolonged abnormal tonic contractions of muscle groups

A

Acute Dystonic Reactions

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11
Q

Torticollis or Retrocollis
Opisthotonos or Pleurthotonus (Pisa Sign)
Oculogyric Crisis
Thickening or protrusion of the tongue

A

Acute Dystonic Reactions

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12
Q

spasm of the sternocleidomastoid muscle (not looking up)

A

Torticollis

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13
Q

spasms of the muscles surrounding the spine

A

Opisthotonos or Pleurthotonus (Pisa Sign)

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14
Q

eyes roll upwards
Severe muscle spasms

A

Oculogyric Crisis

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15
Q

Thickening or protrusion of the tongue causes

A

difficulty swallowing

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16
Q

Onset occurs late in psychopharmacological treatment
Most prominent with high potency and high doses of Typical antipsychotics
Believed to be caused by a chronic exposure to dopamine receptor blocking agents in the nigrostriatal pathway
Usually is IRREVERSIBLE and has no effective treatment

A

Tardive Dyskinesia (TD)

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17
Q

However, monitoring for symptoms of Tardive Dyskinesia can be completed through the

A

Abnormal Involuntary Movement Scales (AIMS)

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18
Q

Constant chewing
Facial and tongue movements
Facial grimacing
Limb movements

A

Signs of Tardive Dyskinesia

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19
Q

In the nigrostriatal pathway – dopamine blocks cholinergic receptors

A

Anticholinergic Side Effects

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20
Q

Dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate and decreased sweating

A

Peripheral Anticholinergic Side Effects

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21
Q

Impaired concentration, confusion, attention deficit, disorientation, and memory impairment

A

Central Anticholinergic Side Effects

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22
Q

Dopamine is blocked at the D2 receptor sites… this causes an increase stimulation of _______ release

A

acetylcholine

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23
Q

Onset can occur hours to months after the initial start of drug therapy
Hypodopaminergic state (severe low dopamine)
Extremely rare (about 1 % of people) however can be fatal

A

Neuroleptic Malignant Syndrome

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24
Q

Risk Factors
Initiation or increase of antipsychotic medication
Dehydration, physical exhaustion, malnutrition
Clients with underlying brain damage and dementia
Higher doses of antipsychotics or use of multiple antipsychotics

A

Neuroleptic Malignant Syndrome

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25
Q

Symptoms:
Extrapyramidal side effects (muscle rigidity)
Increased body temperature (diaphoresis)
Change in consciousness (delirium, confusion, coma)
Fluctuating BP, Tachycardia, decrease respirations
Elevated CPK and myoglobin (causes damage to the liver and kidneys)
Tremor
Progresses over days to weeks if untreated

A

Neuroleptic Malignant Syndrome

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26
Q

Treatment is:
Immediate discontinuation of drug
Physician may prescribe a dopamine AGONIST (Bromocriptine)
Supportive treatment is required (fluids, electrolytes)

A

Neuroleptic Malignant Syndrome

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27
Q

5) Sedation - usually related to anti- histaminic action of antipsychotics
6) Confusion – difficulty with concentration, disorientation
7) Headache
8) Seizures – Caution with clients that have a history of seizure disorder and disorders such as dementia
9) Sleep Difficulties – vivid dreams and nightmares

A

Other Nervous System Side Effects

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28
Q

Antipsychotic medications _____ the seizure threshold – All can but Clozapine (unless dose above 600 mg) – worst, Seroquel and Risperidone lower risk

A

lower

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29
Q

Metabolism
Sexual Hormone Dysregulation

A

Endocrine System Side Effects

30
Q

Antipsychotics can cause weight gain and increased appetite
There is also a risk for diabetes (T2DM) and metabolic syndrome with antipsychotics.

A

Metabolism side effects

31
Q

which includes:
Weight
Fasting bloodwork [Blood sugar, triglycerides, cholesterol],
Waist circumference
Vital Signs

Olanzapine and Clozapine have a higher risk for metabolic side effects than other drugs

A

Metabolic monitoring

32
Q

Younger age at treatment initiation
First exposure to antipsychotics
Non-smoking status
Female sex
Family history of high BMI
Use of specific antipsychotics

A

Predictors of Increased Weight Gain

33
Q

Include:
Cardiovascular Disease
Gall bladder disease
Type 2 Diabetes
Cerebrovascular disease
Hypertension
Sleep Apnea

A

Health Risks Associated with Increased Weight

34
Q

Blocking dopamine in the Tuberoinfundibular Dopamine pathway causes an increase in prolactin concentrations
This leads to hyperprolactinemia

A

Sexual Hormone Dysregulation

35
Q

Side Effects are:
Disturbances in menstruation – delayed or amenorrhea
Lactation in women (galactorrhea)
Gynecomastia (male breast enlargement) in men and women
Rapid demineralization of bones (in post menopausal women not on estrogen therapy)
Sexual dysfunction

A

Sexual Hormone Dysregulation

36
Q

increases prolactin – good to do a baseline measure and monitor

A

Risperidone

37
Q

Orthostatic Hypotension
QT Interval
Agranulocytosis

A

Cardiovascular System side effects

38
Q

Caused by blocking the adrenergic receptors
Most common side effect of antipsychotics (Typical and Atypical)
Orthostatic hypotension (postural hypotension) the sudden drop of blood pressure from lying to sitting, lying to standing or sitting to standing
Causes: Tachycardia and Dizziness

A

Orthostatic Hypotension

39
Q

Antipsychotics can prolong the QT interval
This is a marker for arrhythmic risk
Can lead to cardiac arrest or transient loss of consciousness

A

QT Intervals

40
Q

Serious side effect
Failure of bone marrow to make enough granulocytes (specifically neutrophils)
Leaves the body susceptible to serious infections

A

Agranulocytosis

41
Q

Symptoms include:
Fatigue for more than 3 days
Sore throat
Ulcers in mouth or throat
Fever and severe chills
Signs of infection
Hyperthermia
Treatment is: blood test to determine current white blood cell count; discontinuation of drug that is causing the problem; infection control procedures.

A

Agranulocytosis

42
Q

Benefits:
Extremely good effectiveness compared to other antipsychotics
Effective in decreasing hallucinations and delusions
FDA- Approved for the treatment of recurring suicidal behaviour
Can diminish symptoms of aggression and violence
Low incidence of EPS and akathisia
Almost no tardive dyskinesia

A

Clozaril Benefits

43
Q

Risks:
May cause agranulocytosis
Can interact with other drugs that decrease WBC Count
Some deaths have been reported from myocarditis (inflammation of the heart muscle)
Over sedation
Weight gain and risk for other metabolic issues
Can cause urinary incontinence
Can cause constipation
Seizures at higher doses (above 600mg/day are common)

A

Clozaril Risks

44
Q

needs to be titrated up slowly.
If a client is non-compliant for a period of time, titration (and monitoring) needs to start again requires weekly blood levels (WBC) within the first 6 month of treatment
After the first 6 months of treatment biweekly blood work occurs
Client prescriptions/blood work levels are monitoring through National Data Bases
Clients need to stay on the specific brand of___ that the doctor has prescribed in order to keep up to date with mandatory blood work.

A

Clozapine protocol

45
Q

Photosensitivity
Dermatological/ Temperature Regulation Effects

A

Exocrine System Effects

46
Q

Sensitivity to the sun
Can cause redness, blisters and abnormal skin pigmentation

A

Photosensitivity

47
Q

Hyperthermia
Polydipsia - Water Intoxication
Dermatitis
Steven Johnson Syndrome – beings with flu-like symptoms and is followed by painful red or purplish rash

A

Temperature Regulation Effects

48
Q

Change in appetite
Antiemetic
Gastric irritation (nausea/vomiting)
Hypersalivation
Glossitis (inflammation of the tongue)
Dysphagia (choking)

A

Gastrointestinal

49
Q

Granular deposits
Retinopathy
Blurred Vision

A

Ocular

50
Q

Increases the clearance of:
Haloperidol
Perphenazine
Thiothixene
Chlorpromazine
Fluphenazine
Clozapine
Olanzapine

A

Smoking

51
Q

Approx. ___ of ppl diagnosed w schizophrenia smoke

A

60%

52
Q

Smoking (nicotine) enhances ______ (increases)
Smoking can help alleviate EPSE but may increase other side effects

A

dopamine

53
Q

All _______ are possible with all antipsychotics. However, the severity of the risk of the symptoms increases with different types of antipsychotics.

A

side effects

54
Q

The ______ of risk also increases when dosages reach their upper limit or surpass their recommended dosages.

A

severity

55
Q

Known hypersensitivity
Acute myocardial infarction (MI)
History of myeloproliferative diseases
Uncontrolled epilepsy
CNS depression , stroke or comatose states
Significant liver or renal diseases
Hx severe side effects

A

Contraindications

56
Q

means that the drug should not be used with these conditions because it could be extremely harmful to the person.

A

CONTRAINDICATION

57
Q

means that risk versus benefit should be considered prior to initiation of the drug.

A

Caution

58
Q

may also be described as an allergy (ex Haldol allergy)

A

Hypersensitivity

59
Q

Parkinson’s Disease
Medical conditions such as glaucoma, peptic ulcers, and urinary or intestinal obstructions
Seizure disorders
Alcohol misuse

A

Cautions

60
Q

_______ (alcohol, barbiturates, benzodiazepines, narcotics, antihistamines, anesthetics and pain medication)

A

CNS Depressants (Drug Interactions)

61
Q

Antidepressants (MAOIs and Tricyclic Antidepressants)

A

(Drug Interactions)

62
Q

Dopamine Agonists (levodopa carbidopa)

A

Drug Interactions w/ Antipsychotics

63
Q

Antihypertensive

A

Drug Interaction w/ Antipsychotics

64
Q

______ and Lithium - Encephalopathy

A

Haldol

65
Q

Many antipsychotics react poorly with:
Kava Kava Root
Gotu Kola-
St. Johns Wort
Valerian
Evening Primrose

A

Herbal Contraindications w/ Antipsychotics

66
Q

causes liver damage (is currently banned in Canada)

A

Kava Kava Root

67
Q

increase the effect of numerous antipsychotics

A

Gotu Kola

68
Q

increase the effect of numerous antipsychotics

A

St. Johns Wort

69
Q

acts like a sedative – increases the effect of numerous antipsychotics

A

Valerian

70
Q

increases the symptoms of schizophrenia

A

Evening Primrose

71
Q

spasm of the sternocleidomastoid muscle (looking up)

A

Retrocollis

69:252 Psychopharmacology (14 decks)

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