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Pharmacology II Quiz 6 > Psychosis > Flashcards

Psychosis Flashcards

0
Q

Who is more likely to have schizophrenia?

A

Men = Women

Disorders pop up in 20s and 30s.

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1
Q

What is psychosis?

A

A disturbance in the perception of reality (hallucinatoins, delusions, or thought disorganization) and periods of high risk for agitation, aggression, impulsivity, and other forms of behavior dysfunction.

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2
Q

What may you see with psychotic disorders?

A

Hallucinations - false sensory perceptions.

Delusions - false beliefs versus evidence to the contrary (bizarre or nonbizarre)

Thought disorganization - disruption of the logical process of thought.

Agitation - acute state of anxiety, heightened emotional arousal, and increased motor activity.

Aggression - acts or threats of violence.

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3
Q

Negative symptoms for schizophrenics

A

negative affect - lessened personality

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5
Q

Psychotic disorders

A

schizophrenia

schizoaffective disorder

affective disorders with psychotic features - psychotic features of bipolar mania, bipolar depression, and unipolar depression

delirium

brief psychotic disorder - resolves quickly with treatment or removal of stressor.

delusional disorder

psychosis secondary to a medical condition

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5
Q

Acute disturbance of consciousness and cognition

A

Delirium

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6
Q

Periods of active psychosis and persistent deterioration in social, occupational, scholastic, and personal functioning

A

Schizophrenia

Severe, chronic disorder

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7
Q

What are examples of psychosis secondary to a medical condition?

A

Neurologic problems; CNS infection, neoplasms, vascular events, cognitive disorders and seizures.

Endocrine dysfunction; thyroid, parathyroid or adrenal abnormalities.

Metabolic issues: hypoxia………..

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8
Q

Psychotic disorders seen in Alzheimers

A

Delusions

Visual hallucinations

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9
Q

Psychotic issues seen with substance induction

A

Ingestion or withdrawal from prescription medications, alcohol or illicit drugs

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10
Q

What do you use when diagnosing for psychotic disorders?

A

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

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12
Q

Schizophrenia - characteristic symptoms of DSM-IV

A 
Delusions
Hallucinations
Disorganized speech
Catatonic behavior
Negative symptoms

DSM-5 requires at least one of the following regardless of the presence of other characteristic symptoms
delusions
hallucinations
disorganized speech

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12
Q

What is the MOA of psychosis?

A

Too much dopamine.

Glutamate and seratonin also involved.

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13
Q

Isolated delusions in an otherwise high-functioning person

A

Delusional Disorder

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14
Q

Typical Antipsychotics - First Generation (FGA)

A 
Chlorpromazine (Thorazine)
Mesoridazine (Serentil)
Fluphenazine (Prolixin)
Thiothixene (Navane)
Loxapine (Loxitane)
Molindone (Moban)
Thioridazine (Mellaril)
Trifluoperazine (Stelazine)
Perphenazine (Trilfon)
Haloperidol (Haldol)
Pimozide (Orap)
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15
Q

Do all first generations have same effect?

A

YES!! Same effect and side effects!

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16
Q

Which dopamine receptors are good?

A

D-2 (D-1 Bad!) Look for drugs specific to D-2 receptor.

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17
Q

Which antipsychotic is the class drug?

A

Haloperidol (Haldol)

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18
Q

Approved indications for Haldol

A

Management of schizophrenia.

Control of tics and vocal utterances of Tourette’s disorder in children and adults.

Severe behavioral problems in children.

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19
Q

Unapproved indications for Haldol

A

Treatment of nonschizophrenia psychosis.

Emergency sedation of severely-agitated or delirious patients.

Treatment of ICU delirium.

Adjunctive treatment of ethanol dependence.

Postoperative nausea vomiting.

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20
Q

Dopamine blockade for Haloperidol

A

D2>1>D4>5-HT2a>D1>H1

21
Q

Which antipsychotic is the high potency drug?

A

Haldol - reduced sedation and reduced anticholinergic effects versus low potency.

Clinical effect is exactly the same.

22
Q

Kinetics of typical antipsychotics

A

Lipophilic
High binding
Large volume of distribution

23
Q

Cardiac class effect for phenothiazines

A

Q-T Prolongation

24
Q

What must you get before patients are prescribed antipsychotics?

A

EKG!!

QTc cannot be greater than 0.44 miliseconds

25
Q

What is a risk of typical antipsychotics in elderly patients with dementia?

A

Risk of death!

26
Q

ADRs of Haldol

A 
Tachycardia
Dizziness
Hypotension
Impotence
Hypoprolactinemia / gynecomastia

Weight gain seen in kids.

Risk of death.

27
Q

What movement disorders can develop when on typical antipsychotics?

A

Extrapyramidal Symptoms

Tardive dyskinesias

28
Q

Types of extrapyrmidial symptoms

A

Akathisia
Parkinsonian Syndrome
Dystonias

29
Q

Motor restlessness

A

Akathisia

30
Q

Mask-like facial expression, resting tremor, cogwheel rigidity, shuffling gait, and psychomotor retardation.

A

Parkinsonion Syndrome

31
Q

Haloperidol

A

Haloperidol
5 mg
twice a day

32
Q

Haloperidol IV

A

Haloperidol IV
5 mg

Can go up to 10 mg (2.5 - 10 mg)

33
Q

How many doses of Haldol can you Rx?

A

One dose! Must then move on to discover the underlying cause.

These should only be used on an as needed basis until you can get a psych consult.

34
Q

In psychosis you may see disturbances in the:

A

Perception of reality - evidenced by hallucinations, delusions or thought disorganization.

Periods of high risk for aggression, impulsiveness, and other forms of behavioral dysfunction.

35
Q

Major mood disorder

Prominent psychotic symptoms, but patient also experiences psychosis in the absence of mood symptoms

A

Schizoaffective disorder

36
Q

Psychosis secondary to a medical condition

A

Neurologic problems; central nervous system infection, neoplasms, vascular events, cognitive disorders and seizures

Endocrine dysfunction; thyroid, parathyroid or adrenal abnormalities

Metabolic issues; hypoxia, hypoglycemia, fluid or electrolyte abnormalities

Hepatic and renal disorders

Autoimmune disorders; systemic lupus erythematosus

37
Q

Alzheimer’s dementia
Delusions, and visual hallucinations

Substance induced psychotic disorder
Ingestion or or withdrawal from prescription medications, alcohol or illicit drugs

A

Psychotic disorders

38
Q

How do typical antipsychotics work?

A

Block the D-1 and D-2 receptors.

39
Q

Atypical Antipsychotics

A 
Aripiprazole (Abilify)
Clozapine (Clozaril)
Lucrasidone (Latuda)
Paliperidone (Invega)
Risperidone (Risperdal)
Asenapine (Asendin)
Iloperidone (Fanapt)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
40
Q

MOA atypical antipsychotics

A

Block the D-2 receptors

41
Q

Atypical antipsychotics differences in dopamine blockade

A

Clozapine - D4=a1>5-HT2A > D2 = D1
Olanzapine 5-HT2a>H1>D4>D2>1>D1
Aripiprazole D2=5-HT2A>D4>a1=H1»D1
Quetiapine H1>a1>M1,3>5-HT2A

42
Q

Are atypicals superior to typicals?

A

No evidence of superiority in acute schizophrenia

Side effect profile (depending) may favor atypicals

Numerous long-acting injectable dosage form

43
Q

Is there an increased risk of death in the elderly seen with the atypical antipsychotics?

A

Yes :-(

44
Q

Metabolic effects of atypical antipsychotics

A

Weight gain

Hyperlipidemia

Hyperglycemia

45
Q

ADRs of atypical antipsychotics

A 
Prolactin elevation
Seizure risk
Orthostatic hypotension
Neuroleptic malignant syndrome
QT prolongation
And then there’s …
46
Q

Atypical Antipsycotics class drug

A

Abilify

47
Q

Abilify

A

Abilify
15 mg
once a day

48
Q

Adherence of anti psychotics are improved by use of

A

Sustained action injectable products
Haloperidol decanoate
Oil-based intramuscular given every 2 to 4 weeks

Abilify® Maintena
Once monthly

Invega® Sustenna
Ramped up to eventually once a month

Risperdal® Consta
Every two weeks

Pharmacology II Quiz 6 (5 decks)

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