Pharm II, neuroleptics Flashcards
who should never be given antipsycotic medications
dementia patients or older population
what are antipsycotics used for?
schizophrenia, delirium, mania, sever aggitation
psycosis
distorted reality, disorganized thinking hallucinations
hallucinations
sensory perception in absence of external stimuli - any of the sences
what is secondary psychosis
psychosis from non psychological cnditons like neurological disorders, electrolyte disorders, multiple medical conditons and drugs
neuro disorders than can cause psycosis
frontal lobe tumors, syphilis
what is more deadly, hypo or hyperglycemia
hypoglycemia
medical conditnos that cause psycosis
Lyme, AIDS lupis etc
what OTC drugs can cause psycosis
dextromethorphan and antihistamines
what do neuroleptic drugs do
they do not cure, they permit patient to function more effectively
two categories of neuroleptic
Typical/first generation or Atypical/second generation
what is neuroleptic another word for
antipsycotic
what is the MOA of both the typical and atypical neuroleptic drugs
both block of dopamine receptors in the brain and have some effect on receptor subtypes NE, ACH and serotonin receptors
what does the atypical neuroleptic dodifferent than typical
atypical are antagonist or partial antagonist of serotonin receptors
what receptor seems to be the one that neuroleptic uses
Dopamine receptor D2 - blocking receptor
what pathway does excess dopamine cause psycosis
mesolimbic pathway
what may cause many of the unwanted side effects of neuroleptics
the non selective dopamine receptor blockaid in pathways other than mesolimbic
common side effects of neuroleptics
Parkinsonian like sx, weight gain, tadive, blurred vision, benedryl , increased prolactin
dyskinesia
involuntary movement ie grimacing, pill rollling
tardive
dyskinesia contiues after drugs have been discontinued
extrapyramidal signs
akinesia/cant initiate movement - akathisia/cant remain motionless
what is neuroleptic malignant syndrome
Rare side effect of neuroleptics - fatal if drug isn’t discontinued and antidoted with dopamine agonist
sx of neuroleptic malignant syndrome
catatonia, fluxuatiing BP dysarthria and fever
antidote for neuroleptic malignant syndrome
dopamine agonist - bromocriptine
what causes most neuroleptic drugs to be antiemetic
Blockage of D2 dopaminergic receptors in the chemoreceptor triggerzone
why are some neuroleptic drugs used in chemo
antiemetic effects reducing nausea of chemo
typical neuroleptic /block dopamine receptor D2
Chlorpromazine/thorazine
chlorpromazine /thorazine MOA
typical neuroleptic - Primary a D2, alpah and HI blockaide
side effects of chlorpromazine/thorazine
typical neuroleptic- increased prolactin from dopamine blockate causing galactorrhea amenorrhea and infertility
indication for chlorpromazine/thorazine
typical neuroleptic- mania - schizophrenia - hiccoughs
moa for prochlorperazine/compazine
typical neuroleptic - primary HI receptor antagonist, D2 receptor agonist
indication for prochlorperazine/compazine
typical neuroleptic- verdigo - nausea vomiting from migraines
what is the difference in the moa or thorazine and compazine
Thorazine primary D2 receptor antagonist/ Compazine primary and H1 receptor antagonist
what is the safer typical neuroleptic
Compazine has the greatest anti-emetic effect and is concidered safer than thorazine
side effects of prochlorperazine/compazine
benedryl like sx with lower of seizure threshold*
what is haloperidol/haldol
typical neuroleptic that chiefly blocks D2 receptor
why must you be careful with haloperidol/halodol administration
to prevent excessive setation and tardive dyskinesia
side effects of haloperidol/haldol
typical neuroleptic: extrapyramidal/parkinsonian and neuroleptic malignant syndrome is possible
indication for haloperidol/haldol
typical neuroleptic huntingtons dz, tourettes, acute agitate behavior
typical neuroleptics
chlorpromazine/thorazine (D2) - Prochlorperazine/compazine (H1) - Haloperidol/Haldol (D2 blocker)
atypical neuroleptics
Clozapine/clozaril (D2-5HT20 - Respiradone/risperdal (dop ser block)
atypical neuroleptic for schizo when other meds have failed
Clozapine/clozaril(D2-5HT2) - Olanzapine/zyprex (D2-5HT2)
Why is atypical neuroleptic clozapine/clozaril (D2-5HT) not first line treatment for schizo
because of the side effects:
side effects of clozapin/clozaril(D2-5HT2)
agranulocytosis 1-2% and myocarditis and weight fain and diabetes
what is a problem with all atypical neuroleptics
weight gain and increased diabetes
atypical neuroleptic just for psychosis with unknown MOA
Respiradon/risperdal : dopamine serotonin receptor blockade
what atypical neuroleptic must you adjust dose if patient has liver dysfunction
Respiradone/risperadal: metabolized by CYP 450
when would you specifically not use respiradone/risperadal side effects
those with dementia and combative behavior: risks of wt gain, high sugar and increased risk of stroke in elderly
side effects of olanzapine/zyprexa
atypical neuroleptic: extream weight gain, diabetes,stroke
what neuroleptic has diminished extrapyramidal effects compaire to the others
atypical neuroleptic - Olanzapine/zyprex (D2-5HT2)
what is mania
elevated or irritable mood with increased activity, speech thought etc
what are lithium salts used for
prophylactically in bipolar and manic episode treatment
MOA or lithium
unknown - dampen transmission NE and diminish glutamate respones
what is signifigant about Lithium carbonate/eskalith
very small therapeudic index effective dose is close to toxic dose - must monitor blood
side effects of lithium
weight gaoin, cognitive impairment- memory deficits, renal impairment
What is the most common renal effect of lithium
diabetes insipidus due to reduce renal response to ADH 20%
what is the thyroid problem with Lithium carbonate Eskalith
hypothyroidism that is not autoimmune in 5-35% its not reversable
