Schizophrenia Flashcards
co-morbid conditions w/ schizophrenia
HTN, DM, cardiac, STDs, substance abuse, smoking
positive symptoms of schizophrenia
hallucinations
delusions
bizarre behavior
paranoia
negative symptoms w/ schizophrenia
avolition alogia affective flattening asociality anhedonia attentional impariemnt
cognitive symptoms w/ schizophrenia
difficulties w/ concentration
memory
executive function
decision making
how does doapmine antagonism help w/ schizophrenia
improvement of positive symptoms
but lead to EPS and hyperprolactinemia
worsens negative symptoms
2 types of first generation antipsychotics
phenothiazines
non-phenothiazies (haloperidol)
less potent antipsychotics have what
less potent D2 antagonistm
more ach, alpha-antagonisms, sedation
what drugs ahve low potency antipsychotics
chlorpromazine
thioridazine
mesoidazine
what drugs are medium potency antipsychotics
Perphenazine, loxapine, molindone
what drugs are high potency first gen antipsychotics
Fluphenazine, haloperidol, thiothixene, trifluoperazine
what are the 2nd generation antipsychotics
Aripiprazole (Abilify®) Clozapine (Clozaril®) Olanzapine (Zyprexa® Quetiapine (Seroquel®) Risperidone (Risperdal®) Ziprasidone (Geodon®)
second generation atypical block what more than dopamine
5-HT which is good for positive symptoms
also release dopamine which helps w/ positive sx
what other pathways do antipsychotics block
adrenergic
cholinergic
and histamine-binding receptors
how well an antipsychotic works at ___ receptor indicates how well it works
dopamine (but really narrow window)
saturates 5-HT2 receptors; therefore, at clinical doses, muscarinic M1 and histaminergic H1 also likely saturated
olanzapine
first atypical antipsychotics. benefits of good occupancy at 5-HT, no extra-pyramidal symptoms and still control positive symptoms
clozapine
benefits of second gen antipsychotics (atypicals)
efficacy for positive symptoms
possible enhanced efficacy for negative and cognitive symptoms
minimal or no effect ton prolactin (except risperidone)
with first gen. antipsychotics what should you begin
prophylactic anticholingerics (high potency meds)
it patient has agitation w/ antipsychotics what can you add
lorazepam
ADRs w/ antipsychotics (neuro)
extrapyramidal symptoms
what are alpha-adrenegic effects w/ antipsychotics
orthostasis
EKG
hematologic effects w/ antipsychotics
angranulocytosis
problem w/ atypical antipsychotics
causes a lot of the none neuro effects
what are EPS?
acute dysnotnia parkinson-like symptoms akathisia tardive dyskinesia neuroleptic malignant syndrome
Muscle spasm face, neck, trunk, eye, larynx
Early in Tx., young males
acute dystonias
tx for acute dystonias
benadryl or cogentin
prevention- bneztropine
Subjective feeling of restlessness
Unable to sit still, pacing
akathisia
tx for akathisia (SSRI can cause this too)
propranolol (not in asthma, DM)
Slow choreo-athetotic movements
Oro-facial muscles
Tardive Dyskinesias
Medical Emergency, mortality 20% (now 4%)
1. Fever >100.4F / 37.5C
2. Severe EPS: lead-pipe/cogwheel rigidity, sialorrhea, oculogyric crisis
3. Autonomic Dysfunction: BP fluctuations, tachycardia, tachypnea, diaphoresis
Also: Alt. consciousness, delirium, leukocytosis (>15.000 WBC), CPK > 300, seizures, arrhythmias, mioglobinuria, ARF
Neuroleptic malignant syndrome
risks of NMS
multiple IM injections
high dose of meds or rapidly increased
dehydrated
lithium use
Tx for NMS
stop ALL antipsycotics
give dantrolene (muscle relaxant)
bromocriptine (DA agonist)
supportive Tx- IV fluids, antipyretics, cooling blanket
what anitpsychotics doesn’t have an antiemtic effects
thioridazine
antimuscarinic effects w/ antipsycthoics (more common in lower potency)
Anticholinergic effects include blurred vision, dry mouth, sedation, confusion, inhibit GI and urinary tract smooth muscle constipation and urinary retention
what does alpha-adrenergic blockade cause
orthostatic HPOTN
light-headeness
poikilothermia (body temp varies)
what 2 drugs antagonize H1 receptorsedation
chlorpromazine
cloazpine
with antipsychotics how long does it take to get steady state
5-7 days
1/2 life of 24 hours
what is the main atypical antipsychotic
clozapine
what does clonzapine block
blocks 5-HT and alpha but weak dopamien blocker
benefits of clonzapine
lack of ECP symptoms
help w/ negative symptoms
BBW w/ clonzapine
agranulocytosis- need to monitor CBC
when do you stop clonzapine
If WBC <2000
what can’t you combine clonzapine w/?
carbamazepine or other bone marrow suppressors
ADRs w/ clozapine
seation dizziness, orthostatis HPOTN hypersalivation wt. gain lower seizure threshold
low EPS at doses <6 mg/d; Treat agitation in the elderly; Elevates PRL; minimal sedation
Risperidone
need bid, tid
t1/2 5 hrs; low EPS; contraindicated in pts with cardiac arrhythmias; minimal weight gain
Ziprasidone
positive and negative Sx, low EPS, sedation, wt gain, mood stabilizer [dose: 5-20 mg/day]
Olanzapine
consistant ADR w/ atypical neuroleptics
weight gain
