Psychotherapeutic Agents Flashcards
What do psychotherapeutics do and do not do for perceptual and behavioral disorders?
- Help patients function in a more acceptable manner
- Carry on ADLs
- DO NOT CURE the disorder
What is schizophrenia?
Hallucinations, paranoia, delusions, speech abnormalities, absence of typical social behaviors
- Tends to run in families
- May reflect a fundamental biochemical abnormality
What is bipolar disorder?
Extremes of depression followed by hyperactivity and excitement
* Strong genetic component
* May reflect a biochemical imbalance then overcompensation by neurons and the inability to reestablish stability
Considerations for Pyschotherapeutic Agents
In children
- Often used in combo with other CNS drugs
- Long term effects not known
- Monitor carefully for adverse effects and developmental progress
- Lithium is not typically used
- Treatment should be part of an interdisciplinary approach
Considerations for Pyschotherapeutic Agents
In Adults
- Regular followup
- Some meds require prior ECG to look for prolonged QT interval
- Cautiously used during pregnancy/lactation
- Lithium can cause SERIOUS congenital abnormalities - contraception for women of child bearing age
Considerations for Pyschotherapeutic Agents
In Older Adults
- More susceptible to adverse effects
- Need a reduced dose
- Monitor closely for toxicity
- Should not be used with dementia pts (Increased risk of death)
- Renal impairment + Lithium = monitor closely; decreased dose; maintain hydration and salt intake
- Some need ECGs due to prolonged QT interval
Typical Antipsychotic
Drug Names
“-azine”
* Prochlorperazine
* Thioridazine
* Chlorpromazine
Haloperidol
Atypical Antipyschotics
Drug Names
“-piprazole”
* Aripiprazole
* brexpiprazole
“-apine”
* Quetiapine
* Olanzapine
* Clozapine
“-idone”
* risperidone
* Ziprasidone
* iloperidone
Antipsychotic/Neuroleptic Drugs
Mechanism of Action
- Typical: block dopamine receptors, preventing the stimulation of the postsynaptic neurons by dopamine
- Depress the RAS, limiting the stimuli coming into the brain
- Atypical: block both dopamine and serotonin receptors
Antipsychotics
Indications
- schizophrenia
- hyperactivity
- combative and agitated behavior
- severe behavioral problems in children
- Adjunct thereapy to major depressive disorder
What to remember with antipsychotics and IM route?
IM route provides 4 to 5 times the active dose as oral doses
give a much smaller dose by IM
Antipsychotics/ Neuroleptics
Contraindications
Absolute:
Allergy
Relative:
* CNS depression
* Blood dyscrasias
* Parkinson’s Disease
* Prolonged QT interval
* Black Box warning: serious CV events, including death in pts with dementia
Cautions:
* conditions worsened by anticholinergeic effects (glaucoma, urinary retention, BPH)
* Seizure disorder (decrease seizure threshold)
* Liver, renal, cardiac disease
Antipsychotics/ Neuroleptics
Adverse Effects
- CNS: drowsiness, sedation, weakness, tremors, extrapyramidal effects, neuroleptic malignant syndrome
- Anticholinergic: constipation, dry mouth, nasal congestion, urinary retention, blurred vision
- Gynecomastia
- CV: prolonged QT interval, hypotension, orthostatic hypotension
- Bone marrow suppression
- Atypical antipyschotics: diabetes and weight gain
What are extrapyramidal effects?
- Pseudoparkinsonism (drooling, shuffling gait)
- Dystonia (spasm of tongue, neck, back)
- Akathisia (restlessness)
- Tardive Dyskinesia (lip smacking, abnormal movements)
What is Neuroleptic Malignant Syndrome?
- high fever
- muscle stiffness
- potentially irreversible
