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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
Q

interaction: antihypertensive

A

antipsychotics INCREASE hypotension

26
Q

interaction: levodopa

A

antipsychotics COUNTERACT effects

27
Q

interaction: smoking

A

smoking INCREASES metabolism of antipsychotics

smoking DECREASES medication-induced parkinsonism

28
Q

interaction: SSRI

A

SSRI INCREASES antipsychotic levels
SSRY INCREASES EPSE

CAUTION

29
Q

interaction: lithium

A

lithium DECREASES antipsychotic effect
antipsychotic may MASK lithium toxicity

CAUTION

30
Q

interaction: tca

A

INCREASED serum levels of both!!

CAUTION

31
Q

typical antipsychotics: aka + how classified

A

“first generation antipsychotics” (fga)
“traditional”

classified by potency in antagonizing CNS D2 receptors

32
Q

typical antipsychotics: moa

A
  • block D2 receptor sites
  • in mesolimbic pathway: impact positive symptoms
  • partial histamine antagonism
  • partial acetylcholine blockage
  • antagonism of alpha-1-adrenergic
33
Q

typical antipsychotics: structural types (2)

A

phenothiazine

non-phenothiazine

34
Q

typical antipsychotics: routes of administration

A

oral, IV, IM (depot available)

35
Q

typical vs atypical antipsychotics

A

atypical: effectively treats positive AND negative sx
- EPSE unlikely

typical: not effective in treatment of negative symptoms

36
Q

chlorpromazine (thorazine)

A

typical antipsychotic

  • phenothiazine
  • low potency
  • target sx: antiemetic, hiccup relief
  • more anticholinergic SE
  • sedation, hypotension common
37
Q

haloperidol (haldol)

A

typical antipsychotic

  • nonphenothiazine (butyrophenone)
  • high potency
  • target sx: agitation, aggression
  • unlikely anticholinergic SE
  • more EPSE
38
Q

extrapyramidal side effects (EPSE) + onset

A

acute dystonia (days/hours)
parkinsonism (first month)
akathisia (first 2 months)
tardive dyskinesia (months to years)

39
Q

AD
P
A
TD

mnemonic

A

always discuss
parkinsonism
at
the diagnosis

acute dystonia
parkinsonism
akathisia
tardive dyskinesia

40
Q

acute dystonia

A 
severe muscle spasm: 
face, tongue, neck, back
facial grimacing
abnormal, involuntary upward eye movement
laryngeal spasms

pseudo parkinsonism (epse)

41
Q

parkinsonism

A

major side effect of typical; chronic neurological disorder affecting extrapyramidal motor tract (controls posture, balance, locomotion)

PSEUDO in antipsychotics

42
Q

akathisia

A

trouble sitting still: restless, pacing, constant motion

pseudo parkinsonism (epse)

43
Q

tardive dyskinesia

A

protrusion/rolling of tongue
sucking, smacking of lips
chewing
involuntary movement of body, extremities

pseudo parkinsonism (epse)

44
Q

akinesia

A

absence of movement

CAREFUL - NOT akathisia

45
Q

epse: treatment

A

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
Q

dopamine deficiency causes

A

central cholinergic excess effects

dopamine INVERSE RELATIONSHIP acetylcholine

47
Q

atypical antipsychotics: aka + moa

A 
"second generation antipsychotics"
\+ positive AND negative symptoms! 
---- superior re: neg
\+ weak affinity to D2 receptors 
\+ stronger affinity to D4 
\+ block serotonin (5HT-2)
48
Q

atypical antipsychotics: routes of administration

A

oral + quick dissolve, IM

** NO IV **

49
Q

negative symptoms and dopamine pathway theory

A
  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
Q

atypicals + metabolic syndrome

A 
insulin resistance
hypertension
high serum lipids
obesity
coagulation abnormalities
product label warning for: hyperglycemia, diabetes
51
Q

clozapine (clozaril)

A

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
Q

risperidone (risperdol)

A

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
Q

olanzepine (zyprexa)

A

moa:

  • positive effects: dopamine, 5HT
  • negative effects: NE, histamine
side effects (mild)
somnolence 26%
hypotension
anticholinergic effects
** longterm use: weight gain **
54
Q

aripiprazole (abilify)

A

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
Q

seroquel (quetiapine fumarate)

A

atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms

common SEs: sedation, hypotension, dizziness, weight gain

OTHER

56
Q

geodon (ziprasidone)

A

atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms

historically associated with cardiac side effects

OTHER

57
Q

saphris (asenapine)

A

atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms

sublingual

OTHER

58
Q

fanapt (iloperidone)

A

atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms

approved for schizophrenia only

OTHER

59
Q

latuda (lurasidone)

A

atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms

primarily have D2, 5HT2 actions

OTHER

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