Schizophrenia Pharmacology Flashcards
psychological treatment modalities for schizophrenia
- psychotherapy
- group therapy (group lead needs to make sure dynamic is helping and focusing on participants
- behavior therapy (rewards and punishments)
- social skills training
social treatment modalities for schizophrenia
- milieu therapy (therapeutic community that promotes respect for all individuals)
- family (helps understand family dynamics)
- community programs
unwanted effects of medications
side effects
unwanted effects w/ serious physiologic consequences
adverse reactions
what is the main NT antipsychotics have an effect on
Dopamine
used to decrease agitation and psychotic sxs
antipsychotics
explain “typical” antipsychotics
- aka neuroleptics or conventional
- only block dopamine
- more side effects
- help reduce positive sxs (not great for long-term tx)
explain “atypical” antipsychotics
- second generation drugs effective in treating negative and positive sxs
- less side effects
- block dopamine and serotonin
How long does it take for antipsychotic drugs to effect a change in sxs
- 1 to 2 weeks
- usually used for 6 to 12 weeks before any changes are made
What drug is used only when no other second-generation antipsychotic drugs are effective
Clozapine
examples of typical antipsychotics
- haloperidol (Haldol)
- fluphenazine (Prolixin)
- perphenazine
examples of atypical antipsychotics
- Aripiprazole (Abilify)
- Clozapine (Clozaril)
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Paliperidone (Invega)
Which typical antipsychotics are injectable
- Haloperidol (Haldol)
- Fluphenazine decanoate
Which atypical antipsychotics are injectable
- Paliperidone (Invega)
- Resperdal (Constra)
- Aripiprazole (Aristada)
side effects of Risperidone (Risperdal)
- 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
side effects of Clozapine (Clozaril)
- agranulocytosis (decreased production of WBC -> infection)
blood draw schedule for Clozapine
- 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
side effects of Geodon (atypical)
- 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)
what is important to assess with pts taking Geodon
food security (must be able to eat w/ medication)
side effects of Olanzapine (Zyprexa)
- 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
general side effects of antipsychotics
- 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
side effects of typical antipsychotics
- extrapyramidal side effects (EPS)
- anticholinergic
- tremors
- orthostatic hypotension
- metabolic side effects (weight gain due to slowed metabolism)
- lower seizure threshold
- QTc prolongation
EPS with involuntary muscle contractions including facial grimacing, muscle spasms, and laryngeal spasms
dystonia
what can dystonia progress to
oculogyric crisis: pt experiences episode where eyeballs stuck in fixed position towards the ceiling
side effects of atypical antipsychotics
- metabolic (weight gain)
- less extrapyramidal sxs (EPS) than typical
- sedation
- orthostatic hypotension
- anticholinergic
- QTc prolongation
3 examples of acute extrapyramidal syndromes
- 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
EPS that involves tremors, mask like face, drooling, rigidity, bradykinesia and stiff gait
psuedoparkinsonism
EPS that involves restlessness and the inability to sit still; pt may pace the floor and feet in constant motion (rocking back and forth)
akathisia
example of chronic extrapyramidal syndrome
tardive dyskinesia
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
tardive dyskinesia
most important identifiers for tardive dyskinesia
protruding tongue deviating to one side; affects ability to talk, eat, and drink
how to start patients on antipsychotic meds
- start at lowest dose and titrate up
- start one medication at a time to know which med causes which side effects
12 item scale used to identify tardive dyskinesia and rates its severity
abnormal involuntary movement scale (AIMS)
what medication is given to help w/ EPS
- Benztropine (Cogentin);
- Benadryl can be given if Benztropine not available
life-threatening condition due to OD or sensitivity to drugs w/ anticholinergic properties
anticholinergic crisis (aka anticholinergic delirium)
sxs of anticholinergic crisis
- 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
treatment for anticholinergic crisis
- discontinuation of medication
- physostigmine (AChE inhibitor)
- gastric lavage, charcoal, catharsis for intentional OD
sudden life-threatening emergency associated w/ use of neuroleptic agents (antipsychotics and anti-emetic agents)
neuroleptic malignant syndrome (NMS)
sxs of NMS
- mental status changes (agitated delirium w/ confusion)
- muscle rigidity
- fever
- dysautonomia (malfunction of ANS)
describe muscle rigidity associated w/ NMS
- 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
describe the autonomic instability associated w/ NMS
- tachycardia
- labile or high BP
- tachypnea
- dysrhythmias
- diaphoresis is often profuse
lab values associated w/ NMS
- 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
treatment of NMS
- 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)
prognosis of NMS
- most episodes resolve in 2 weeks
- some cases last for 6 months w/ catatonia
guidelines for restarting neuroleptics after NMS
- wait at least 2 weeks before restarting
- use lower dose and titrate up
- avoid concomitant lithium
- avoid dehydration
- carefully monitor for sxs of NMS
complications that can occur w/ NMS
- dehydration
- electrolyte imbalances
- acute renal failure (due to rhabdo)
- MI
- respiratory failure
- DVT
- thrombocytopenia
- seizures (from fever)
- hepatic failure
- sepsis
