Part 7-2 (Psychotropic Medications)

Question 1

Psychotropic Medications

Answer 1

Sedative hypnotics
Anti-anxiety drugs
Antipsychotics
Treatment of dementia

Question 2

Psychosis

Answer 2

Much more severe form of mental illness than depression

Question 3

Psychosis cause

Answer 3

Increased dopamine activity in specific CNS pathways

Other NTs may be involved (Seratonin, Glutamate, ACh)

Question 4

Antipsychotics characteristics

Answer 4

Block CNS dopamine receptors, especially D2 receptors

Question 5

Common antipsychotics

Answer 5

Classified as traditional vs newer “atypical” agents

Atypical agents may be preferred d/t fewer/milder effects

Question 6

Traditional antipsychotic examples

Answer 6

Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Prochlorperazine (Compazine)

Question 7

Atypical antipsychotic examples

Answer 7

Clozapine (Clozaril)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)

Question 8

Atypical antipsychotic characteristics

Answer 8

Weak blockers of D2 receptors
Strong blockers of serotonin receptors
-Normally better tolerated

Question 9

Traditional Antipsychotic adverse effects

Answer 9

Orthostatic hypotension
Sedation
Anticholinergic effects (Inc. HR, GI problems, dry throat)

Question 10

Atypical antipsychotic adverse effects

Answer 10

Weight gains
Increased blood lipids
Increased gluten sensitivity

Question 11

Primary concern of all antipsychotics

Answer 11

Extrapyramidal (motor) side effects

Question 12

Extrapyramidal side effects

Answer 12

Tardive Dyskinesia (Oral facial movements)
Pseudoparkinsonism
Akathisia
Other dystonias/dyskinesias

Question 13

Tardive Dyskinesia

Answer 13

25% of patients on long term traditional antipsychotics
Cause: Denervation supersensitivity (post-synaptic neuron makes more receptors)
Can be permanent

Question 14

Tardive Dyskinesia best treatment

Answer 14

Early recognition and change in type or dose of drug.

Question 15

Tardive Dyskinesia Risk factors

Answer 15

Advanced age
Genetic predisposition
Affective mood disorders
Diabetus Mellitus
Hx of alcohol abuse
>6 months continuous use of antipsychotic

Question 16

Neuroleptic Malignant syndrome

Answer 16

Can occur with all antipsychotics

• Catatonia, rigidity, tremors, fever
• increased risk if high dose, agitated patient, impaired mental function
• Can be fatal; need to detect early

Question 17

Dementia

Answer 17

Irreversible dementia: Alzheimer disease

Degenerative changes in neuronal structure and function

Question 18

Goals of drug therapy in dementia

Answer 18

Improve cognitive and intellectual function

Improve/modify behavior

Question 19

Improving cognitive function

Answer 19

Neuronal changes lead to decreased ACh activity in brain

Cholinergic stimulants: increased ACh activity

Question 20

Indirect Cholinergic stimulants: dementia

Answer 20

Drug inhibits cholinesterase enzyme
ACh breakdown is inhibited
ACh activity/effects are prolonged

Use in early stages when brain still produces ACh

Question 21

Cholinergic stimulants in Alzheimer

Answer 21

Donepezil (Aricept)
Galantamine (Razadyne)
Rivastigmine (Exelon)
Tacrine (Cognex)

Question 22

Memantine (Namenda)

Answer 22

Blocks NMDA-glutamate receptors in brain
Normalizes glutamate influence
Slows progression; may be combined with traditional

Question 23

Drugs used to improve or modify behavior

Answer 23

Antidepressents
Antianxiety drugs
Antipsychotics

Question 24

Behavior modification in Alzheimer’s

Answer 24

Government regulations curb use of antipsychotics
More emphasis on using symptom-specific meds
Consider nonpharmacologic interventions