Pharm2 6 Neuro pt5

Question 1

Major psychosis characterized by abnormal thoughts and thought processes, disordered communication, environmental withdrawal, suicidal tendencies

Answer 1

Schizophrenia

Question 2

Schizophrenia
Commonly manifests when?
___ drift over time
Associated with (4)

Answer 2

Commonly manifest in teens and twentys
“Downward drift” over time
Associated with substance abuse, homelessness, depression, dementia

Question 3

The following are sx of ___
Hallucinations, Delusions, Paranoia, Strange behavior-communicating in an unknown language, Sleeplessness, Indifference or detachment, Deterioration in hygiene, appearance, academic performace

Answer 3

Schizophrenia

Question 4

Schizophrenia Medications
Designed to treat positive symptoms, those that add to normal behavior (hallucinations, delusions, disorganized thought, anhedonia)
Divided into two classes:
(which has more/less sfx?)

Answer 4

Convential anti-psychotics, older, more side effects

Atypical antipsychotics, newer, less side-effects

Question 5

Prototypical Conventional Anti-psychotic:

Answer 5

Haloperidol (Haldol®)

Question 6

Haloperidol (Haldol®)
Indications
Mechanism of action

Answer 6

Indications: Severe psychosis, dementia

Mechanism of action: Blockade of dopaminergic receptors throughout the brain

Question 7

Haloperidol (Haldol®)
Adverse Effects
Contraindications
Caution

Answer 7

Adverse Effects: dizziness, drowsiness, orthostatic hypotension, extrapyramidal symptoms (EPS) including distorted body movemets, lip smacking, Parkinsonian-like symptoms
Contraindications: Allergy
Caution: Neuroleptic Malignant Syndrome (NMS)

Question 8

Prototypical Atypical Anti-psychotic:

Answer 8

Risperidone (Risperdal®)

Question 9

Risperidone (Risperdal®)
Indications
Mechanism of action

Answer 9

Indications: Psychosis, dementia with agitation
Mechanism of action: Combination of dopaminergic receptor blockade throughout the brain and a selective serotinin re-uptake inhibitor

Question 10

Risperidone (Risperdal®)
Adverse Effects
Contraindications
Caution

Answer 10

Adverse Effects: Anxiety, somnolence, EPS, dizziness, constipation
Contraindications: Allergycardiovascular disease, renal/hepatic dysfunction, pre-existing prolonged QT syndrome
Caution: Neuroleptic Malignant Syndrome (NMS) rarer than conventional anti-psychotics, but still occur

Question 11

Hot New Atypical Anti-psychotic:

Answer 11

Ziprasidone HCl (Geodon®)

Question 12

Ziprasidone HCl (Geodon®)
Indications
Mechanism of action

Answer 12

Indications: Schizophrenia, psychosis-induced agitation

Mechanism of action: Combination of serotonin and dopaminergic antagonist

Question 13

Only atypical antipsychotic available IM and PO

Answer 13

Ziprasidone HCl (Geodon®)

Question 14

Psychiatrists perceive __ as superior to __;

Emergency Department staff perceive __ and __ as superior

Answer 14

Psychiatrists perceive Geodon as superior to Haldol

Emergency Department staff perceive Haldol and Ativan as superior

Question 15

Ziprasidone HCl (Geodon®)
Adverse Effects
Contraindications
Caution

Answer 15

Adverse Effects: Somnolence, EPS, GI upset, rash, dystonia, tachycardia, myalgia, QTc prolongation, priapism
Contraindications: Allergy, prolonged QT syndrome, conditions that increase risk of Torsades de Pointe (hypothetical b/c ekg won’t be done on a pt kicking around)
Caution: Neuroleptic Malignant Syndrome (NMS) rarer than conventional anti-psychotics, but still occurs

Question 16

Antipsychotics may all cause:

b/c…

Answer 16

Neuroepileptic Malignant Syndrome

b/c they all hit the Dopamine receptor (it occurs in any drug that does this)

Question 17

A patient has Lip smacking, parkinsonian-like sx, shuffling gait. What drug have they been on for years?

Answer 17

Haldol

Question 18

you try to move their arm, it moves and stops, moves and stops. what is this and what types of drugs?

Answer 18

cogwheel syndrome due to Neuroepoileptic malignant Syndrome

from drugs that hit dopamine receptor (antipsychotics)

Question 19

Tx of Neuroepileptic Malignant Syndrome

Answer 19

First thing to do stop the drug, then you have to take dantrolene sodium – $10,000 a dose. So you have to be absolutely sure it’s NMS before you’d give this drug.

Question 20

Diff btwn Geodon and other antipsychotics:

Answer 20

it doesn’t cause the same degree of somnolence

Question 21

If a patient has lots of psychotic thoughts, and get aggressive and agitated. You chemically restrain them. How?

Answer 21

Haldol and Ativan – IM. – to get them to stop breathing, intubate them, and deal w/ ‘em the next day