Psychotropic Medications Flashcards by Gretchen Dettlinger

Classifications

Antipsychotics 
Antidepressants
Mood Stabilizers (Bipolar Drugs)
Sedative-Hypnotics
Anxiolytics (Antianxiety Meds)
CNS Stimulants
ADHD Meds

How well did you know this?

Not at all

Perfectly

Schizophrenia

A chronic psychotic disorder which has a positive, negative & cognitive symptoms. Disordered thinking and reduced ability to comprehend reality.

How well did you know this?

Not at all

Perfectly

Schizophrenia Symptoms

Delusions
Hallucinations
Difficulty Processing Information
Incoherence

How well did you know this?

Not at all

Perfectly

Positive Symptoms (add to)

Characterized by exaggeration (increase) or distortion of normal function

How well did you know this?

Not at all

Perfectly

Positive Symptoms Examples

Delusions
Hallucinations
Paranoia
Agitation

How well did you know this?

Not at all

Perfectly

Hallucination

Experiencing things with your 5 senses that aren’t there.

How well did you know this?

Not at all

Perfectly

Delusion

False thought

How well did you know this?

Not at all

Perfectly

Negative Symptoms

Characterized by a decrease or lessening of function and motivation

How well did you know this?

Not at all

Perfectly

Negative Symptom Examples

Poverty of speech 
Poor Self Care 
Social Withdrawal 
Flat Affect 
Avolition (lack of movement)

How well did you know this?

Not at all

Perfectly

Cognitive Symptoms

Thinking difficulties

How well did you know this?

Not at all

Perfectly

Cognitive Symptom Examples

Disordered thinking
Inability to focus attention
Prominent learning
Memory Difficulties

How well did you know this?

Not at all

Perfectly

Antipsychotic Medications INDICATIONS

Schizophrenia 
Bipolar Disorder 
Tourette's Syndrome 
Prevention of emesis 
Delusional disorders 
Dementia 
Organic Mental Disorder

How well did you know this?

Not at all

Perfectly

Categories of Antipsychotic Meds

First Generation/Conventional/Traditional
(PHENOTHIAZINES & NONPHENOTHIAZINES)

Second Generation/Atypical

How well did you know this?

Not at all

Perfectly

Antipsychotic MOA

Block Actions of Dopamine
5 Receptors: D1-D5
ALL block D2 (dopaminergic) receptor - promotes EPS resulting in pseudoparkinsonism
Atypicals have weak affinity to D2 receptors - cause fewer EPS

How well did you know this?

Not at all

Perfectly

What would happen if you gave an Antipsychotic to someone with Parkison’s?

Would worsen Parkinson’s because of the lack of dopamine

How well did you know this?

Not at all

Perfectly

Antipsychotic A/E

Extrapyramidal Side Effects
Anticholinergic Effects - can’t see, can’t pee, can’t spit, can’t sh*t
CV Effects
Rare & Toxic Effects (Neuroleptic Malignant Syndrome)

How well did you know this?

Not at all

Perfectly

Extrapyramidal Side Effect (EPS)

Pseudoparkinsonism
Acute Dystonic Reactions
Akathisia
Tardive Dyskinesia

Pseudoparkinsonism

Rigidity
Masklike faces
Stooped posture
Drooling
Shuffling gait 
"Pill-rolling"
Tremor

What do you treat Pseudoparkinsonism with?

Trihexyphenidyl

Benztropine

Acute Dystonic Reactions

Opisthotonos
Oculogyric Crisis
Torticollis

What do you treat Dystonic Reactions with?

Diphenhydramine hydrochloride (Benadryl) 25-50 mg IM/IV 
Congentin 1-2 mg IM/IV may be SECOND choice

Opisthotonos

Tetanic spasm of the back muscles causing the trunk to arch forward while the head and lower limb thrust backward

Akathisia

Motor inner driven restlessness 
Motor: 
- Pacing 
- Tapping
- Squirming 
- Crossing/uncrossing legs

What do you treat Akathisia with?

Propanolol

Benzodiazepines

Tardive Dyskinesia

``` Facial: - Protruding tongue - Smacking - Licking spastic facial distortion - Smacking movements Limbs: - Choreic - Athetoid Trunk: - Pelvic thrusts - Neck & Shoulder movements ```

Anticholinergic S/E

``` Dry Mouth Urinary Retention Constipation Blurred Vision Photosensitivity Dry Eyes Impotence ```

CV Effects

Hypotention & Postural hypotention | Tachycardia - QT prolongation

Rare and Toxic Effects

``` Agranulocytosis Low # WBCs Jaundice Neuroleptic Malignant Syndrome: - Hyperpyrexia - Severe muscle rigidty - Elevated BP - Tachycardia - Diaphoresis - Incontinence: can be fatal if temp goes high enough - Cognitive alterations ```

First Generation Agents

``` Haloperidol Fluphenazine Trifluoperazine Thiothixene Pimozide Loxapine Perphenzazine Chlorpromazine Thioridazine ```

Haloperidol Indications

Schizo Acute psychosis Tourettes severe behavioral problems in children

Haloperidol A/E

``` EPS QT-interval Neuroendocrine S/E - Galactorrhea - Gynecomastia - Menstrual Irregularities ```

Chlorpromazine Indications

``` Schizo Psychotic D/O Vomiting Intractable hiccups Severe childhood behavioral problems ```

Chlorpromazine A/E

``` Sedation Ortho hypotention Anticholinergic Neuroendocrine Photosensitivity EPS (low risk) Lowers seizure threshold QT Interval ```

Second Generation (Atypical) Agents

Clozapine - MOST EFFECTIVE

Clozapine

Schizophrenia Bipolar D/O Levodopa-induced psychosis

Clozapine A/E

``` Serious agranulocytosis Reserved for other drug failures Common: - Sedation - Weight gain - Ortho hypotention - Anticholinergic effects - Tachycardia Minimal: - Neuroendocrine (gynecomastia) effects - Sexual dysfunction METABOLIC EFFECTS - Weight gain in excess of 30 pounds, DM, increase lipids - Seizures - EPS (relatively low) - Myocarditis - Double death rate in elderly with dementia ```

Second Generation Agents

``` Risperidone Paliperidone Olanzapine Ziprasidone Quetiapine Aripiprazole Iloperidone Lurasidone ```

Risperidone Indications

``` Schizo Bipolar Autism Improves (+) symptoms SE generally infrequent and mild ```

Olanzapine

``` Schizo Bipolar Bipolar mania Agitation with schizo Major depression (not 1st line) ```

Quetiapine

``` Schizo Depression Acute mania Depression in bipolar SEDATION! ```

Aripiprazole

``` Schizo Acute bipolar mania Depression Agitation Autism ```

Antipsychotic Information

- 1st & 2nd generation are equally effective except for CLOZAPINE - 1st = more EPS - 2nd = metabolic effects - Symptoms start resolving in 1-2 days, significant improvement 1-2 weeks - Continue therapy x12 months, then 25% can stop