T1 Flashcards
Depot Medication - Advantage
Drug bypasses gastrointestinal absorption
No first-pass metabolism effect
Lower rates of relapse
Depot Medications - Disadvantages
Need to be administered deep into muscle tissue
Can irritate the skin and cause pain at injection site
Hold risk of severe and long lasting side effects if not screened properly
All depot medication should be administered as a deep ____
Intramuscular injection
Preferred sites for depot medications? (unless package indicates differently)
Gluteal sites
T/F - Dosage for short-acting injectable antipsychotic medication differs from therapeutic dosage of a depot medication
True
How can you know the difference between depot vs. other injections (?)
Label
Dosage
Thickness (depot will be thicker)
Nervous System Side Effects
EPS
Tardive dyskinesia
Anticholinergic side effects
Neuroleptic malignant syndrome
Sedation
Confusion
Headaches
Seizures
Sleep disturbances
EPS
Group of motor disturbances caused by dopamine being blocked in the nigrostriatal pathway
Typical antipsychotics are mostly to cause EPS
Some can be controlled with Antiparkinsonian medication
EPS - akathisia
Most common EPS
Motor-restlessness or inability to sit still
Condition is completely outside voluntary control (different from agitation)
Improves with benzodiazepine or propranolol
EPS - bradykinesia
“without movement or slowed movements”
Immobility or weakness
Complaints of fatigue
Lack of muscle movement
Can be confused w/ negative symptoms of schizophrenia
Increased dose of medication will increase symptoms
EPS - Pseudo-parkinsonism
Onset - first week of drug therapy
Loss in muscle movement (akinesia)
Mask like facial expression
Stooped posture
Muscle rigidity (COGHWEEL)
Tremors
EPS - Acute Dystonic Reactions
Sudden, uncoordinated prolonged abnormal tonic contractions of muscle groups
ADR - Torticollis or Retrocollis
Spasm of sternocleidomastoid muscle (muscles in neck)
Retrocollis - straight and constricted
Opisthotonos or Pleurthotonus (Pisa Sign)
Spasm of all muscles surrounding spine
Oculogyric crisis
Eyes roll upwards, severe muscle spasms, thick tongue, protrusion of tongue
Thickening or protrusion of tongue
Difficult to swallow
What do acute dystonic reactions respond well with?
Anticholinergics
Tardive Dyskinesia
Prominent with high potency and high doses of typical antipsychotics
Irreversible and no effective treatment
Caused by: chronic exposure to dopamine receptor blocking agents in nigrostriatal pathway
Can be monitored using Abnormal Involuntary Movement Scales
When is the best time to use AIMS?
After patient’s done sleeping
Signs of Tardive Dyskinesia
Constant chewing, facial grimacing, facial and tongue movement, limb movements
Anticholinergic Side Effects
In nigrostriatal pathway - dopamine blocks cholinergic receptors
Peripheral Anticholinergic Side Effects - dry mouth, constipation, urinary retention, blurred vision
Central Anticholinergic Side Effects - impaired concentration, confusion, attention deficit
Neuroleptic Malignant Syndrome
Hypodopaminergic state (severe low dopamine)
1% can be fatal
Risk
increase of antipsychotic medication
dehydration, physical exhaustion, malnutrition
Symptoms the NMS
EPS (muscle rigidity)
Increased body temperature (diaphoresis)
Change in consciousness
Fluctuating BP, tachycardia, decrease respirations
Treatment of NMS
Immediate discontinuation of drug
dopamine AGONIST bromocriptine
Fluids, electrolytes
Endocrine System
Metabolism
Sexual Hormone Dysregulation
Metabolism
Antipsychotics can cause weight gain, increased appetite
Risk for diabetes and metabolic syndrome
Which two drugs have the highest metabolic side effects?
Olanzapine and Clozapine
Sexual Hormone Dysregulation
Blocking dopamine in the Tuberoinfundibular dopamine pathway - increase in prolactin concentrations = leading to hyperprolactinemia
Side effects of SHD
Disturbances in menstruation
Lactation in women
Gynecomastia (male breast enlargement)
Rapid demineralization of bones
Sexual dysfunction
Cardiovascular System
Orthostatic Hypotension
OT interval
Agranulocytosis
Orthostatic Hypotension
Blocking adrenergic receptors
Sudden drop of BP from lying to sitting, lying to standing, or sitting to standing
QT Intervals
Antipsychotics and prolong QT Intervals
Marker for arrhythmic risk
Lead to cardiac arrest or transient loss of consciousness
Agranulocytosis
SERIOUS side effect
Failure of bone marrow to make enough granulocytes (neutrophils)
Sx include
Fatigue
Sore throat
Ulcers in mouth or throat
Fever and severe chills
Treatment of agranulocytosis
Blood tests to determine WBC count
Clozaril: Double Edged Sword
Benefits:
Good effectiveness compared to other antipsychotics
Effective in decreasing hallucinations and delusions
Treatment for recurring suicidal behaviour
Risks:
May cause agranulocytosis
Can interact with other drugs that decrease WBC count
Weight gain and metabolic issues
Cause constipation
Clozapine Protocol
Titrated up slowly
If client is non-compliant for a period of time, titration needs to restarted
Requires weekly WBC levels within first 6 months - after this period, it will be biweekly
Exocrine System
Photosensitivity
Dermatological/Temperature Regulation Effects
Photosensitivity
Sensitivity to the sun
Redness, blisters, and abnormal skin pigmentation
Dermatological/Treatment Regulation Effects
Hyperthermia
Polydipsia - water intoxication
Dermatitis
Steven Johnson Syndrome
Miscellaneous System Side Effects
Gastrointestinal
Ocular
Gastrointestinal
Change in appetite
Antiemetic
Hypersalivation
Dysphagia
Ocular
Granular deposits
Retinopathy
Blurred vision
Severity
Severity of the risk of symptoms increases different types of antipsychotics
Increases when dosages reach their upper limit or surpass their recommended dosages
Precautions and Drug Interactions
Known hypersensitivity
Acute myocardial infarction
History of myeloproliferative diseases
Uncontrolled epilepsy
CNS depression, stroke, or comatose
Cautions
Parkinson’s disease
Glaucoma, peptic ulcers
Seizure disorders
Alcohol misuse
Drug Interactions
CNS depressants
Antidepressants
Dopamine Agonists
Antihypertensive
Haldol and Lithium - causes encephalopathy
T/F Long term of effect of antipsychotics in children is not known
True
What are children and youth at greater risk of?
Weight gain, neurological side effects, dystonic reactions
Older Adults Considerations
Start dose LOW and titrate SLOW
Watch for: sedation, EPS, TD, Anticholinergic effects
Caution: pre-existing illness and polypharmacy
Pregnancy considers
Antipsychotics in third trimester - risk for abnormal muscle movement/withdrawal in newborn
Risk Category C - cannot be ruled out
Abnormal muscle movements/withdrawal: agitation, tremor, sleepiness
Trepanation
Cutting holes or drilling holes into brain - “letting demons escape”
Treatment for madness, pain, headaches
Hydrotherapy
Warm Baths - used to treat insomnia, suicidal ideation, help to calm agitated clients
Cold Baths - mania and psychosis
Last 3 hours to a few days
Insulin Shock Therapy
Clients received high levels of insulin to induce coma
Metrazol Convulsive Therapy
Synthetic preparation of Camphor
Small doses of camphor produced tachycardia, act as a diuretic, reduce appetite
Large doses are lethal
Used to induce coma in clients w/ schizophrenia
Prefrontal Lobotomy
Severed and damaged prefrontal lobe
Speculated this type of surgery to remove harmful parts of the brain - schizophrenia, depression and anxiety
Electroconvulsive Therapy
Used to stimulate a seizure
Non-pharmacological option for treatment
Pharmacology
Study of drugs that alter functions of living organisms
Drug therapy
Use of drugs to prevent, diagnose or treat signs, symptoms and disease processes
Medications
Drugs given for therapeutic purposes
Prototypes
First drug of a particular drug class to be developed
Regulatory Processes in Canada
Pre Clinical Studies
Clinical trials
Drug submission to health products and food branch
Submission review
Market authorization decision
Public acess
Surveillance and investigation
Ten Rights of Medication
Right medication
Right client
Right dose
Right route
Right time and frequency
Right documentation
Right reason/assessment
Right to refuse
Right evaluation
Right client education
Pharmacokinetics
Movement of drug/medication throughout the body - and how the individual responds to it
Specific processes of pharmacokinetics (4)
Absorption
Distribution
Metabolism
Excretion
Absorption
Factors that affect absorption:
med form
route of admin
admin site
blood flow
gi function and presence of food and other drugs
What does distribution depend on?
Blood circulation
Distribution is affected by:
protein binding
blood-brain barrier
pregnancy
lactation
Metabolism
Method that drugs are inactivated or bio transformed by the body
Drugs are changed to:
active metabolites
inactive metabolites
prodrugs
Excretion
elimination of medication from body
relies on
kidneys and bowels
circulatory system - blood circulation
lungs
skin
Half Life
Length of time it takes for 1/2 the dosage of medication to be metabolized
Pharmacodynamics
What the drug does to the body or how the drug behaves
Receptor theory of Action
Most drugs exert their effect by chemically binding with receptors at cellular level
Psychopharmacology
Impact of drugs on the brain
Impact of diseases on CNS
Behavioural consequences of psychiatric medicine
PNS - Afferent Neurons
Nerve fibers responsible for bringing sensory information from outside world into the brain
PNS - Interneurons
“the ones in between” - connect spinal motor and sensory neurons
PNS - Efferent neurons
Responsible for carrying signals from brain to the PNS in order to initiate an action
- removing hand from a hot pan
Structural Unit of Nervous System
Soma - cell body; command centre
Dendrites - large and small branches; receive msgs from other neurons
Axon - long tube - carries messages from soma to axon terminals; transmits impulses AWAY from soma
Axon Terminals - found at end of axon, hold neurotransmitters
How do nerves send messages?
Action Potential
How do electrical charges occur?
Sodium Potassium Pump
Repolarization
Occur prior to the nerve being able to be depolarized again
Chemical is required between
2 neurons OR between a neuron and a gland/muscle
Post-Synaptic Effector
Proteins that are embedded in cell membrane and have binding sites for endogenous substances
How can post synaptic effector cell be activated again?
Reuptake
Enzymes
Enzyme Alteration
Activation or inactivation in intracellular enzymes
Open or Close Ion Channels
Permeability of cell membrane
Neurohormone Alteration
Modifies release or inactivate neurohormones
Nature’s Pharmacopeia
Brain makes its own antidepressants, anxiolytics and hallucinogens
Pscyhopharmacologic Action
Drugs act on a specific receptor site
When attached to a receptor. the drug can have one of two actions
Agonist
Antagonist
Agonist
produces same biological action as neurotransmitter
Antagonist
blocks an action so more neurotransmitter will be in the synaptic gap
Affinity
Degree of strength in a bond between a drug and receptor
Strong affinity = highly bond
Poor affinity = less bond / means that another medication can “bump” it off and takes its place
Think of the song Jolene
Selectivity
Ability of drug to be specific to a certain receptor
Drug that’s more selective = target treatment, decrease in side effects
Drug that’s NOT selective = cannot target treatment = increase side effects
Intrinsic Activity
Ability of drug to produce a biological response once attached to receptor
Polypharmacy
Multiple medications
Risk to benefit ratio
Fetus is sensitive to drug effects because:
Size of fetus
Few plasma proteins that can bind to drug molecules
Weak capacity for metabolizing and excreting drugs
Thalidomide
Used to treat morning sickness to assist w/ sleep
Banned - caused birth defects; deafness, blindness, cleft palate
Pharmacodynamics differences are caused by:
Difference in body composition
Immature systems
Genetic make up
Effective of drugs are also influenced by:
Total body water - fluid make up
Fat stores
Protein amounts
