Week 8: Psychopharmacology, Psychoeducation in Treatment Concordance, the Nurse & Physical Health Promotion Flashcards
What are the common neurochemical actions of psychotropic medications?
Modify reuptake of neurotransmitters into presynaptic neuron
Activate or inhibit postsynaptic receptors
Inhibit enzyme activity in synaptic cleft
What are the common indications for anti-psychotic medications?
Psychotic disorders: schizophrenia, delusional disorder, schizoaffective disorders, schizophreniform disorder, bipolar 1 disorder, major depressive disorder with psychotic features
Tourettes syndrome: adjunct for involuntary movements
Aggressive/disruptive behaviour: sedative, particularly when illicit drugs involved
What are examples of typical anti-psychotic medications?
Haloperidol (PO or IMI)
Fluphenazine (IMI)
What are examples of atypical anti-psychotic medications?
Olanzapine
Clozapine
How do anti-psychotic medications work?
Medications target neurotransmitters related to dopamine to produce and increase function to improve negative symptoms
Two pathways implicated: mesocortical and mesolimbic tracts
Antagonists at dopamine receptor inhibit overproduction and over absorption at receptor site (presynactic and post-synactic)
What are the extra-pyramidal side effects related to anti-psychotic medications?
Dystonia Akathisia Parkinsonian-like symptoms Tardive dyskinesia Neuroleptic malignant syndrome
When is the onset of dystonia after administration of anti-psychotic medication?
24 hours, especially in the case of high doses and IMI
What are the forms of dystonia?
Oculogyric crisis: involuntary upward deviation of the eyes
Torticollis or retrocollis: neck spasms, respectively tilted or twisted sideways or backwards
Laryngeal spasm: compromises airway
What is the treatment for dystonia?
Anti-cholinergic (benzotropine) IMI then low PO doses
Review anti-psychotic dose
Lower dose
What is akathisia?
Intense feeling of inner restlessness (mentally) or experienced as restlessness of the lower limbs
What is the treatment for akathisia?
Lower dose of anti-psychotic
Assess and manage suicidal ideation
Short term Propanolol/Diazepam
What are Parkinsonian-like symptoms?
Reduced movement
Cogwheel rigidity of peripheries
Drooling
Tremors
When is the onset of parkinsonian-like symptoms after administration of anti-psychotic medication?
Within 1-2 weeks
What is tardive dyskinesia?
Syndrome of abnormal involuntary movements of face, eyes, mouth, tongue, trunk and peripheries
Irreversible
When is the onset of tardive kinesia after administration of anti-psychotic medication?
Within 1-2 weeks, gradual
What is the treatment for tardive dyskinesia?
Cease or reduce anti-psychotic medicatino dose
What is neuroleptic malignant syndrome?
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What are the features of neuroleptic malignant syndrome?
Fever
Muscular rigidity
Autonomic instability
When is the onset of neuroleptic malignant syndrome after administration of anti-psychotic medication?
Rapid, after large or rapidly titrated increase in anti-psychotic medication dose
What is the treatment for neuroleptic malignant syndrome?
Cease anti-psychotic medications
Consider hospitalisation for rehydration and monitoring
ECT
What are non-EPSE side effects of anti-psychotic medications?
Metabolic syndrome: Central obesity High BP High triglycerides Low HDL cholesterol Insulin resistance
Cardiovascular related problems:
Tachycardia
Arrhythmia
Cardiomyopathy
What are the benefits of using an atypical anti-psychotic medication over typical?
Same efficacy Lower potential for EPSEs Improved tolerability Improvement in negative symptoms Improvement in cognitive functioning Reduction in relapse
What is the indication for Clozapine?
Treatment resistant schizophrenia
