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Undeleted > pharmacology of psychosis > Flashcards

pharmacology of psychosis Flashcards

1
Q

neuroleptic

A

any drug that modifies psychotic behavior and exerts antipsychotic effect

aka antipsychotic

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2
Q

psychotropic

A

any drug used to treat mental illnesses

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3
Q

group of antipsychotics found to be more useful in treating both positive and negative symptoms of schizophrenia

A

atypical

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4
Q

AIMS

A

involuntary movement scale used to monitor for EPSEs and other effects in schizophrenia patients taking antipsychotics

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5
Q

first line treatment for non-psychiatric inpatients experiencing agitation and/or delirium

A

haloperidol (haldol)

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6
Q

depot antipsychotics

A

long-acting, injectable formulations used for long-term maintenance therapy of schizophrenia

subq or IM; releases active compound consistently over long period of time

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7
Q

depot preparations available for (3)

A
  • haloperidol decanoate (haldol dec)
    • typical/traditional
  • fluphenazine decanoate (prolixin dec)
    • typical/traditional
  • risperidone microspheres (risperdal consta) newer
    • atypical
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8
Q

psychosis: definition + s/s

A

total inability to recognize reality

s/s: delusions, hallucinations, incoherence, catatonia, aggression, violence, inability to process information and come to a conclusion

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9
Q

psychotic s/s due to imbalance in…

A

dopamine

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10
Q

schizophrenia (definition)

A

chronic psychotic disorder, major category of psychosis

- positive and negative symptoms!

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11
Q

neuroleptic malignant syndrome

A

rare but potentially fatal condition associated with antipsychotic drugs

primary symptoms caused by D2 blockade

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12
Q

antipsychotics: adverse effects

A
  • agranulocytosis
  • anticholinergic
  • arrhythmia
  • dermatologic
  • gender specific
  • hypotension
  • metabolic
  • neuroleptic malignant syndrome
  • sedation, seizures
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13
Q

side effect: associated anticholinergic effects

A

anti-SLUD!

dry mouth, nasal congestion, blurred vision, urinary hesitancy/retention, constipation, increased heart rate

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14
Q

side effect: agranulocytosis (definition)

A

severely decreased WBC, potentially lethal

possible adverse effect

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15
Q

side effect: hypotension pathophys

A

antipsychotics block alpha-1-adrenergic receptors.

tolerance develops in 2-3 months.

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16
Q

side effect: sedation pathophys

A

some block histamine, some NE

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17
Q

female specific side effects

A

neuroendocrine: galactorrhea, menstrual irregularities
sexual: decreased libido, impaired orgasm

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18
Q

male specific side effects

A

neuroendocrine: gynecomastia
sexual: decreased libido, erectile/ejaculatory dysfunction

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19
Q

side effect: dermatologic

A

pruritic maculopapular rash

jaundice

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20
Q

side effect: metabolic

A

glucose dyscontrol, weight gain

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21
Q

atropine psychosis: definition

A

adverse effect; psychotic delirium caused by excess anticholinergic effects

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22
Q

atropine psychosis: s/s

A

agitation, confusion, tachycardia, dry flushed skin

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23
Q

interaction: cns depressants

A

antipsychotics INCREASE effects

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24
Q

interaction: anticholinergics

A

antipsychotics INCREASE effects

25
interaction: antihypertensive
antipsychotics INCREASE hypotension
26
interaction: levodopa
antipsychotics COUNTERACT effects
27
interaction: smoking
smoking INCREASES metabolism of antipsychotics | smoking DECREASES medication-induced parkinsonism
28
interaction: SSRI
SSRI INCREASES antipsychotic levels SSRY INCREASES EPSE CAUTION
29
interaction: lithium
lithium DECREASES antipsychotic effect antipsychotic may MASK lithium toxicity CAUTION
30
interaction: tca
INCREASED serum levels of both!! CAUTION
31
typical antipsychotics: aka + how classified
"first generation antipsychotics" (fga) "traditional" classified by potency in antagonizing CNS D2 receptors
32
typical antipsychotics: moa
- block D2 receptor sites - in mesolimbic pathway: impact positive symptoms - partial histamine antagonism - partial acetylcholine blockage - antagonism of alpha-1-adrenergic
33
typical antipsychotics: structural types (2)
phenothiazine | non-phenothiazine
34
typical antipsychotics: routes of administration
oral, IV, IM (depot available)
35
typical vs atypical antipsychotics
atypical: effectively treats positive AND negative sx - EPSE unlikely typical: not effective in treatment of negative symptoms
36
chlorpromazine (thorazine)
typical antipsychotic - phenothiazine - low potency - target sx: antiemetic, hiccup relief - more anticholinergic SE - sedation, hypotension common
37
haloperidol (haldol)
typical antipsychotic - nonphenothiazine (butyrophenone) - high potency - target sx: agitation, aggression - unlikely anticholinergic SE - more EPSE
38
extrapyramidal side effects (EPSE) + onset
acute dystonia (days/hours) parkinsonism (first month) akathisia (first 2 months) tardive dyskinesia (months to years)
39
AD P A TD mnemonic
always discuss parkinsonism at the diagnosis acute dystonia parkinsonism akathisia tardive dyskinesia
40
acute dystonia
``` severe muscle spasm: face, tongue, neck, back facial grimacing abnormal, involuntary upward eye movement laryngeal spasms ``` pseudo parkinsonism (epse)
41
parkinsonism
major side effect of typical; chronic neurological disorder affecting extrapyramidal motor tract (controls posture, balance, locomotion) PSEUDO in antipsychotics
42
akathisia
trouble sitting still: restless, pacing, constant motion pseudo parkinsonism (epse)
43
tardive dyskinesia
protrusion/rolling of tongue sucking, smacking of lips chewing involuntary movement of body, extremities pseudo parkinsonism (epse)
44
akinesia
absence of movement CAREFUL - NOT akathisia
45
epse: treatment
benztropin (cogentin) trihexyphenidyl (artane) -- moa (both): anticholinergic - block central cholinergic receptors -- dopamine deficiency causes excess cholinergic effects diphenhydramine (benadryl) - - moa: suppression of central cholinergic activity - - prolongs action of dopamine by inhibiting reuptake and storage
46
dopamine deficiency causes
central cholinergic excess effects | dopamine INVERSE RELATIONSHIP acetylcholine
47
atypical antipsychotics: aka + moa
``` "second generation antipsychotics" + positive AND negative symptoms! ---- superior re: neg + weak affinity to D2 receptors + stronger affinity to D4 + block serotonin (5HT-2) ```
48
atypical antipsychotics: routes of administration
oral + quick dissolve, IM ** NO IV **
49
negative symptoms and dopamine pathway theory
1. negative symptoms = result of hypodopaminergic process (frontal lobe) 2. selective subtypes of 5HT inhibit dopamine 3. drugs antagonizing 5HT subtypes = increase frontal lobe dopamine
50
atypicals + metabolic syndrome
``` insulin resistance hypertension high serum lipids obesity coagulation abnormalities product label warning for: hyperglycemia, diabetes ```
51
clozapine (clozaril)
atypical antipsychotic moa: strong blockade of D1, weaker D2 also blocks 5HT, NE, histamine, ACh common se: sedation, drowsiness, hypersalivation, tachycardia, dizziness, constipation adverse: agranulocytosis 1-2% generalized seizures 3%
52
risperidone (risperdol)
atypical antipsychotic moa: binds to multiple receptors - D2 (weak) - 5HT (strong) - histamine - alpha-adrenergic does NOT block cholinergic receptors side effects (generally infrequent, mild): fatigue, somnolence, dizziness, agitation > see especially in non-psych settings <
53
olanzepine (zyprexa)
moa: - positive effects: dopamine, 5HT - negative effects: NE, histamine ``` side effects (mild) somnolence 26% hypotension anticholinergic effects ** longterm use: weight gain ** ```
54
aripiprazole (abilify)
moa: dopamine antagonist, serotonin agonist “dopamine system stabilizer” nota bene: our book considers this the atypical prototype, other experts think it is TGA (a new category of third generation)
55
seroquel (quetiapine fumarate)
atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms common SEs: sedation, hypotension, dizziness, weight gain OTHER
56
geodon (ziprasidone)
atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms historically associated with cardiac side effects OTHER
57
saphris (asenapine)
atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms sublingual OTHER
58
fanapt (iloperidone)
atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms approved for schizophrenia only OTHER
59
latuda (lurasidone)
atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms primarily have D2, 5HT2 actions OTHER

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