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Mental Illness
Schizophrenia and Antipsychotics
11
Pharmacology
Graduate
07/08/2013

Additional Pharmacology Flashcards

 


 

Cards

Term

1st generation antipsychotics

-Mech. of Action

-Adverse Effects

Definition

Mech of Action:

 -Block dopamine receptors (mainly D2)

-Effective for positive symptoms

-Not as effective for negative symptoms or cognitive symptoms

Adverse Effects:

-Similar to 2nd gen. but usually w/higher incidence

-More EPSE, anticholinergic SE, hyperprolactinemia

Term
Discuss the differences between the 1st and 2nd generation antipsychotics.
Definition

-2nd gen block serotonin & D1 receptors more than D2 receptors, thus lower risk of causing EPSE

-2nd gen relieve positive & negative symptoms

-2nd gen may impove cognitive symptoms

-2nd gen are DOC due to reduced ADRs

Term
List the common therapeutic uses of the antipsychotics.
Definition

FDA approved:

-Schizophrenia, schizoaffective disorder

-Bipolar disorder 

-Treatment-resistant depression

-Agitation, irrability, and aggression in Autism

Off-label:

-Behavior disorders in dementia and delusion disorders

-Mgmt. of personality disorders

-Suppress severe Tourette's symptoms

Term
List the 2nd generation with the highest rate of extrapyramidal side effects (EPSEs) as compared to the other 2nd generation drugs.
Definition
Risperdal
Term
Utilizing clinical case scenarios, symptom descriptions, and expected symptom timeline in relationship to length of therapy, identify the various types of EPSEs caused by antipsychotics and identify appropriate actions (e.g. call 911 vs. refer to prescriber).
Definition

1) Acute dystonia-

-may develop w/in the 1st days of therapy

-severe spasms of muscles of tongue, face, neck, back, and throat

Medical emergency

-Treat w/ IV anticholoinergic drugs (i.e. diphenhydramine IV)

 

2) Akathisia-

-Usually occurs w/in the 1st few months of therapy

-Pacing, squirming, need to constantly be in motion

Mistaken for anxiety

-May also respond to anticholinergic drugs

 

3) Parkinsonism-like movement disorder (Psuedoparkinsonism)-

occurs w/in the first few months of therapy

-Bradykinesia, drooling, tremor, rigidity, shuffling gait, cogwheeling, stooped posture

-Best treated w/ anticholinergic drugs, amantadine or propranolol

 

4) Tardive Dyskinesia-

-Develops w/ long term therapy

-Involuntary movement of tongue or face, lip smacking, tongue twisting, tongue flicking out of mouth

Can interfere w/chewing, swallowing, or speech

May progress to limbs

-Treat by switching to an antipsychotic w/low EPSE

-Anticholinergic and anti-parkinson drugs are not effective to reverse symptoms

Term
Discuss the role of the physical therapist in early identification of EPSE.
Definition

1) Identify and refer ASAP

2) Monitor EPSE using appropriate rating scale:

Abnormal Involutary Movement Scale (AIMS)

Anually- 2nd gen.

Every visit- 1st gen.

Term
Understand that tardive dyskinesia may not be reversible in some patients, even if the antipsychotic is discontinued.
Definition
If it develops there may be nothing at all we can do about it.  Does not respond well to anticholinergic and anti-parkinson drugs, stopping the antipsychotic often the symptoms may not even go away.  Something different has happened inside the brain.
Term
List the name of the test commonly used to monitor tardive dyskinesia.
Definition

(AIMS)

Abnormal Involuntary Movement Scale

Term

2nd generation antipsychotics

-Mech. of Action

-Adverse effects

Definition

Mech of Action:

Block serotonin and dopamine receptors (D1, D2, D4)

Adverse Effects:

-Sedation, sexual dysfunction

-Weight gain (monitor BMI)

-Glucose dysregulation (increased risk of developing T2DM)

-Anticholinergic SE (much milder)

-Hpyerprolactinemia (block dopamine, therfore increase milk production, much milder)

-Orthostatic Hypotension (fall risk issue)

-QT prolongation (prolong too much called Torsades de pointes)

-EPSE

-Black box warning (Elderly patients w/dementia-related psychosis have increased risk of death)

Term

1st Generation Antipsychotics

(a.k.a "typical)

Definition
haloperidol
Term

2nd generation Antipsychotics

(a.k.a. "atypical)

Definition

-Abilify

-olanzepine

-Seroquel

-Risperdal (highest rate of EPSE, still less than 1st gen)

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