Pharm2 6 Neuro pt5 Flashcards
Major psychosis characterized by abnormal thoughts and thought processes, disordered communication, environmental withdrawal, suicidal tendencies
Schizophrenia
Schizophrenia
Commonly manifests when?
___ drift over time
Associated with (4)
Commonly manifest in teens and twentys
“Downward drift” over time
Associated with substance abuse, homelessness, depression, dementia
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
Schizophrenia
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?)
Convential anti-psychotics, older, more side effects
Atypical antipsychotics, newer, less side-effects
Prototypical Conventional Anti-psychotic:
Haloperidol (Haldol®)
Haloperidol (Haldol®)
Indications
Mechanism of action
Indications: Severe psychosis, dementia
Mechanism of action: Blockade of dopaminergic receptors throughout the brain
Haloperidol (Haldol®)
Adverse Effects
Contraindications
Caution
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)
Prototypical Atypical Anti-psychotic:
Risperidone (Risperdal®)
Risperidone (Risperdal®)
Indications
Mechanism of action
Indications: Psychosis, dementia with agitation
Mechanism of action: Combination of dopaminergic receptor blockade throughout the brain and a selective serotinin re-uptake inhibitor
Risperidone (Risperdal®)
Adverse Effects
Contraindications
Caution
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
Hot New Atypical Anti-psychotic:
Ziprasidone HCl (Geodon®)
Ziprasidone HCl (Geodon®) Indications Mechanism of action
Indications: Schizophrenia, psychosis-induced agitation
Mechanism of action: Combination of serotonin and dopaminergic antagonist
Only atypical antipsychotic available IM and PO
Ziprasidone HCl (Geodon®)
Psychiatrists perceive __ as superior to __;
Emergency Department staff perceive __ and __ as superior
Psychiatrists perceive Geodon as superior to Haldol
Emergency Department staff perceive Haldol and Ativan as superior
Ziprasidone HCl (Geodon®)
Adverse Effects
Contraindications
Caution
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
Antipsychotics may all cause:
b/c…
Neuroepileptic Malignant Syndrome
b/c they all hit the Dopamine receptor (it occurs in any drug that does this)
A patient has Lip smacking, parkinsonian-like sx, shuffling gait. What drug have they been on for years?
Haldol
you try to move their arm, it moves and stops, moves and stops. what is this and what types of drugs?
cogwheel syndrome due to Neuroepoileptic malignant Syndrome
from drugs that hit dopamine receptor (antipsychotics)
Tx of Neuroepileptic Malignant Syndrome
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.
Diff btwn Geodon and other antipsychotics:
it doesn’t cause the same degree of somnolence
If a patient has lots of psychotic thoughts, and get aggressive and agitated. You chemically restrain them. How?
Haldol and Ativan – IM. – to get them to stop breathing, intubate them, and deal w/ ‘em the next day
