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Psych > Schizophrenia Pharmacology > Flashcards

Schizophrenia Pharmacology Flashcards

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1
Q

psychological treatment modalities for schizophrenia

A
  • psychotherapy
  • group therapy (group lead needs to make sure dynamic is helping and focusing on participants
  • behavior therapy (rewards and punishments)
  • social skills training
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2
Q

social treatment modalities for schizophrenia

A
  • milieu therapy (therapeutic community that promotes respect for all individuals)
  • family (helps understand family dynamics)
  • community programs
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3
Q

unwanted effects of medications

A

side effects

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4
Q

unwanted effects w/ serious physiologic consequences

A

adverse reactions

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5
Q

what is the main NT antipsychotics have an effect on

A

Dopamine

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6
Q

used to decrease agitation and psychotic sxs

A

antipsychotics

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7
Q

explain “typical” antipsychotics

A
  • aka neuroleptics or conventional
  • only block dopamine
  • more side effects
  • help reduce positive sxs (not great for long-term tx)
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8
Q

explain “atypical” antipsychotics

A
  • second generation drugs effective in treating negative and positive sxs
  • less side effects
  • block dopamine and serotonin
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9
Q

How long does it take for antipsychotic drugs to effect a change in sxs

A
  • 1 to 2 weeks

- usually used for 6 to 12 weeks before any changes are made

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10
Q

What drug is used only when no other second-generation antipsychotic drugs are effective

A

Clozapine

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11
Q

examples of typical antipsychotics

A
  • haloperidol (Haldol)
  • fluphenazine (Prolixin)
  • perphenazine
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12
Q

examples of atypical antipsychotics

A
  • Aripiprazole (Abilify)
  • Clozapine (Clozaril)
  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)
  • Paliperidone (Invega)
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13
Q

Which typical antipsychotics are injectable

A
  • Haloperidol (Haldol)

- Fluphenazine decanoate

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14
Q

Which atypical antipsychotics are injectable

A
  • Paliperidone (Invega)
  • Resperdal (Constra)
  • Aripiprazole (Aristada)
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15
Q

side effects of Risperidone (Risperdal)

A
  • increased prolactin levels (pts complain about breast enlargement and milk production) -> other drugs have same effect but not to same degree
  • decreased sex drive
  • amenorrhea
  • ED
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16
Q

side effects of Clozapine (Clozaril)

A
  • agranulocytosis (decreased production of WBC -> infection)
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17
Q

blood draw schedule for Clozapine

A
  • weekly blood draws for 6 months after starting (monitor WBC)
  • every 2 weeks from 6 months to a year
  • monthly after a year
  • pt MUST stop taking Clozapine if WBC below 5,000
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18
Q

side effects of Geodon (atypical)

A
  • prolonged QTc interval (need baseline EKG and EKG yearly on medication)
  • pt must consume 500 calories w/ each dose (must bind w/ food in order to work)
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19
Q

what is important to assess with pts taking Geodon

A

food security (must be able to eat w/ medication)

20
Q

side effects of Olanzapine (Zyprexa)

A
  • orthostatic hypotension
  • monitor BP and make sure pt’s get up slowly
  • can cause severe weight gain (20lbs per year) and increased risk of DM -> reason pts stop taking it
21
Q

general side effects of antipsychotics

A
  • anticholinergic (dry mouth, constipation, urinary retention, confusion)
  • weight gain and DM
  • sexual side effects
  • neuroleptic malignant syndrome (NMS)
  • photosensitivity
  • lower seizure threshold
  • movement disorders related to meds
22
Q

side effects of typical antipsychotics

A
  • extrapyramidal side effects (EPS)
  • anticholinergic
  • tremors
  • orthostatic hypotension
  • metabolic side effects (weight gain due to slowed metabolism)
  • lower seizure threshold
  • QTc prolongation
23
Q

EPS with involuntary muscle contractions including facial grimacing, muscle spasms, and laryngeal spasms

A

dystonia

24
Q

what can dystonia progress to

A

oculogyric crisis: pt experiences episode where eyeballs stuck in fixed position towards the ceiling

25
Q

side effects of atypical antipsychotics

A
  • metabolic (weight gain)
  • less extrapyramidal sxs (EPS) than typical
  • sedation
  • orthostatic hypotension
  • anticholinergic
  • QTc prolongation
26
Q

3 examples of acute extrapyramidal syndromes

A
  • dystonia: onset within a few days of initiating therapy
  • psuedoparkinsonism: abrupt onset within first 30 days
  • akathisia: possibly misdiagnosed as agitation or increased psychotic sxs
27
Q

EPS that involves tremors, mask like face, drooling, rigidity, bradykinesia and stiff gait

A

psuedoparkinsonism

28
Q

EPS that involves restlessness and the inability to sit still; pt may pace the floor and feet in constant motion (rocking back and forth)

A

akathisia

29
Q

example of chronic extrapyramidal syndrome

A

tardive dyskinesia

30
Q

pt experiences abnormal movements in face, mouth, jaw, and tongue (sucking/smacking movements, chewing motion, tongue protrusion); due to long-term antipsychotic use (more common in typical); irreversible if untreated

A

tardive dyskinesia

31
Q

most important identifiers for tardive dyskinesia

A

protruding tongue deviating to one side; affects ability to talk, eat, and drink

32
Q

how to start patients on antipsychotic meds

A
  • start at lowest dose and titrate up

- start one medication at a time to know which med causes which side effects

33
Q

12 item scale used to identify tardive dyskinesia and rates its severity

A

abnormal involuntary movement scale (AIMS)

34
Q

what medication is given to help w/ EPS

A
  • Benztropine (Cogentin);

- Benadryl can be given if Benztropine not available

35
Q

life-threatening condition due to OD or sensitivity to drugs w/ anticholinergic properties

A

anticholinergic crisis (aka anticholinergic delirium)

36
Q

sxs of anticholinergic crisis

A
  • hot as a desert: hyperthermia/dry skin
  • blind as a bat: blurred vision
  • mad as a hatter: confusion
  • dry as a bone: dry mucous membranes
  • red as a beet: flushed skin
37
Q

treatment for anticholinergic crisis

A
  • discontinuation of medication
  • physostigmine (AChE inhibitor)
  • gastric lavage, charcoal, catharsis for intentional OD
38
Q

sudden life-threatening emergency associated w/ use of neuroleptic agents (antipsychotics and anti-emetic agents)

A

neuroleptic malignant syndrome (NMS)

39
Q

sxs of NMS

A
  • mental status changes (agitated delirium w/ confusion)
  • muscle rigidity
  • fever
  • dysautonomia (malfunction of ANS)
40
Q

describe muscle rigidity associated w/ NMS

A
  • generalized and extreme
  • increased tone - lead pipe rigidity - cogwheel
  • catatonia
  • tremor
  • dystonia, trismus (lock jaw), chorea and others
  • sialorrhea (excessive salivation)
  • dysarthria (stammering, stuttering)
  • dysphagia
41
Q

describe the autonomic instability associated w/ NMS

A
  • tachycardia
  • labile or high BP
  • tachypnea
  • dysrhythmias
  • diaphoresis is often profuse
42
Q

lab values associated w/ NMS

A
  • elevated CK (> 1000)
  • leukocytosis (10,000-40,000)
  • low Ca and Pi
  • low or high Na
  • high K
  • metabolic acidosis
  • rhabdomyolysis (skeletal muscle breakdown)
  • low iron concentration
43
Q

treatment of NMS

A
  • discontinue neuroleptic meds (including lithium)
  • Dantrolene (relax muscles)
  • Bromocriptine or Amantadine (dopamine agonists)
  • maintain cardiorespiratory stability
  • maintain fluid volume
  • lower fever
  • lower BP
  • use benzos to control agitation
  • heparin (prevent DVT)
44
Q

prognosis of NMS

A
  • most episodes resolve in 2 weeks

- some cases last for 6 months w/ catatonia

45
Q

guidelines for restarting neuroleptics after NMS

A
  • wait at least 2 weeks before restarting
  • use lower dose and titrate up
  • avoid concomitant lithium
  • avoid dehydration
  • carefully monitor for sxs of NMS
46
Q

complications that can occur w/ NMS

A
  • dehydration
  • electrolyte imbalances
  • acute renal failure (due to rhabdo)
  • MI
  • respiratory failure
  • DVT
  • thrombocytopenia
  • seizures (from fever)
  • hepatic failure
  • sepsis

Psych (17 decks)

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