Neuroleptic agents Flashcards
Symptoms of Schizophrenia:
A. Duration of at least 6 mo.
B. Social / occupational dysfunction
C. 2 or more of the following, each persisting for at least a 1-month period:
1) Delusions
2) Hallucinations
3) Disorganized speech
4) Grossly Disorganized OR Catatonic behaviour
5) Negative Symptoms (eg. affective flattening, avolition)
D. EXCLUSION of schizoaffective or mood disorder.
E. CAUSE: not due to medical disorder or substance use.
What are key therapeutic Goals?
- Minimize:
- THREAT to self and others.
- Minimize acute Sx. - Prevent relapse.
- Adherent to Medication.
- Optimize dosing and manage AE.
- Improving functioning.
How would you manage a cooperative Schizophrenic patient?
LRHQO - ORAL agents
Lorazepam
Risperidone
Haloperidol
Quetiapine
Olanzapine
how would you manage an Uncooperative Schizophrenic patient?
IM route
Lorazepam
Olanzapine
Aripiprazole
Haloperidol
Promethazine
Combi of Lora + Halo / Halo + Prom
how to overcome poor Treatment Adherence?
- IM long-acting injections
- Community psych nurse
- Patient and Family Education
how do Positive and Negative symptoms arise?
Positive - overactivity of Mesolimbic tract.
Negative - hypofunction of Mesocortical tract.
describe the impact of Dopamine blockade in each of the dopamine tracts:
1) Mesolimbic tract
2) Mesocortical tract
3) Nigrostriatal tract
4) Tuberoinfundibular tract
Mesolimbic - reduction of (+) symptoms
Mesocortical - manifestation of (-) symptoms
Nigrostriatal - EPSE
Tuberoinfundibular - hyperprolactinemia (increased prolactin secretion)
when will you initiate Clozapine for Schizophrenia?
After failing >= 2 adequate trials (2-6 wk) of antipsychotics.
what do you need to monitor when initiating Clozapine?
Efficacy - may take 3 mo.
FBC, Metabolic (FBG, weight gain, hyperlipidemia), Seizure, Neuroleptic Malignant Syndrome,
S&S of Neuroleptic Malignant Syndrome
Fever, muscle rigidity;
autonomic dysfunction (Tachycardia, labile BP, sweating);
altered consciousness;
[Unique] Raised CK, hyporeflexia, “lead-pipe” rigidity, normal pupils, normal GI
Due to antipsychotics, sudden cessation of dopaminergic agents.
S&S of Serotonin Syndrome
Fever, flushing, rigidity
autonomic dysfunction (Tachycardia, sweating)
Confusion, coma,
Respiratory failure
[Unique] Hyperreflexia, clonus, tremor; Dilated pupils; Diarrhoea
Due to ssri, snri, maoi, tca, synthetic opioids, ilicit drugs.
List 3 CYP1A2 substrate interactions w/ Fluvoxamine.
Theophylline
Amiodarone
Warfarin-R
Clozapine
Phenothiazines
Agomelatine
List 3 CYP2C19 substrate interactions w/ Fluvoxamine.
Warfarin-R
Omeprazole
Sulphonylurea: Tolbutamide
List 3 CYP2D6 substrate interactions w/ Fluoxetine, Paroxetine, Bupropion.
Codeine
Hydrocodone
Oxycodone
Tramadol
Metoprolol
ROBA anti-psychotics (Risp, Olan, Brex, Arip)
ROBA (and Cariprazine, Lurasidone) has interactions with:
CYP2D6 - Fluoxetine, Paroxetine, Bupropion
CYP3A4 -
Macrolides,
Ritonavir,
Itraconazole,
Grapefruit juice,
Rifampicin
Carbamazepine
Phenytoin
St. John’s Wort
