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60 Cards in this Set

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A group of mental disorders characterized by a marked thought disturbance and an impaired perception of reality
Psychoses
severe paranoid disorders and this type of depression are examples of what group of mental disorders?
Psychotic disorders
What is the name of drugs used to treat very severe psychiatric illnesses?
Antipsychotic or neuroleptic drugs
what do Antipsychotic or neuroleptic drugs help do?
Beneficial effects on mood and thought
What drugs were used previously to help people with psychoses?
Strong sedative-like drugs were used to pacify patients which had side effects of impaired motor skills
Schizophrenia is characterized by...
delusions, hallucination (often hearing voices), thinking and speech disturbances
Schizophrenia is a form of _______. It initially affects people during _______.
psychosis


adolescence
This form of psychosis is a _____and disabling disorder affecting ~ _________% of the population.
chronic

1%
Schizophrenia is genetically inherited and may involve biochemical changes such as...
overactivity of the mesolimbic dopaminergic neurons
Etiology of Schizophrenia:

It could be caused by...

*Hint: 5 possibilities
1. overactive dopaminergic pathway in certain parts of the brain such as the limbic system

2. Excessive dopamine synthesis

3. Decreased dopamine breakdown

4. Increased post-synaptic dopamine receptors

5. Combination of these and other factors
Is the Etiology of Schizophrenia fact or theory?
THEORY...because most antipsychotics block dopamine receptors.

MORE RESEARCH NEEDED
Antipsychotics

Mechanism of Action:
Blockade of DOPAMINE RECEPTORS in the brain and periphery. Clinical efficacy of drugs related to their ability to antagonize D2 receptors i nthe mesolimbic pathway.
Antipsychotics

Mechanism of Action for NEWER DRUGS:
Newer atypical drugs such as clozapine and risperidol act by blocking SEROTONIN RECEPTORS in addition to effects on dopamine receptors
Other receptors that may be affected by the Antipsychotic drugs are...
Cholinergic receptors

Alpha-adrenergic receptors

Histamine receptors
Antipsychotic Pharmocological Actions:
1. Antipsychotic actions

2. Extrapyramidal Syndrome (EPS)

3. Antiemetic Effects

4. Antimuscarinic Effects
Name the Pharmacological Actions for: Antipsychotic Actions
1. reduction of hallucinations and agitations associated with schizophrenia

2. Produces a calming effect and reduces spontaneous physical movement

3. Usually takes several weeks to occur (approx. 6 weeks)
What is important to know about taking someone off of Antipsychotics?
Must withdraw the medicine SLOWLY
Name the Pharmacological Actions for:

Extrapyramidal Syndrome (EPS)
1. Parkinsonian symptoms, akathisia=motor restlessness, tardive dyskinesia=inappropriate postures of the neck,trunk and limbs occur with chronic treatment

2. Probably due to blockade of dopamine receptors in nigro-striatal pathway
Which drugs have a low incidence of EPS?
Clozapine and Risperidone
Name the Pharmacological Actions for:

Antiemetic Effects (prevent nausea and vomiting)
1. Most neuroleptics have antiemetic actions

2. Probably due to blockade of dopamine D2 receptors of the chemoreceptor trigger zone in the medulla
Name the Pharmacological Actions for:

Antimuscarinic effects
Most neuroleptics cause anticholinergic effects (e.g. blurred vision, dry mouth, sedation, confusion, constipation and urinary retention)
Other effects of Antipsychotics

HINT: 3 of them
1. Orthostatic hypotension and lightheadedness (blockade of alpha-adrenoceptors

2. Poikilothermia = body temperature varies with the environment

3. Increase in prolactin release (blocking D2 receptors in the pituitary)
Define Poikilothermia
body temperature varies with the environment
Pharmacokinetics of Antipsychotics:

Administration (two points)

Where is it metabolized
1. Orally or parenterally

2. Fluphenazine & Haloperidol can be injected (i.m.) as a slow release preparation every three weeks

*Useful for treating outpatients who are non-compliant with oral formulas

3. liver
Extrapyramidal motor symptoms-induced by excessive cholinergic influence. Triggered by blocking the inhibitory effect of dopamine on cholinergic neurons.

EPS includes
-tardive dyskinesia
-pseudoparkinsonian effects
-dyskinesia and dystonia
-Neuroleptic malignant syndrome (NMS)
Side effects of Antipsychotics
Side Effects of Antipsychotics
Extrapyramidal motor symptoms-induced by excessive cholinergic influence. Triggered by blocking the inhibitory effect of dopamine on cholinergic neurons.

EPS includes
-tardive dyskinesia
-pseudoparkinsonian effects
-dyskinesia and dystonia
-Neuroleptic malignant syndrome (NMS)
What are the characteristics of Tardive Dyskinesia?
Involuntary, fragmented mvmts. Rhythmic mvmts of mouth,tongue and jaw; pts often produce involuntary sucking and smacking noises; muscle rigidity and slurred speech may occur
TRUE OR FALSE

The side effect, Tardive Dyskinesia is reversable?
TRUE
In some patients, prolonged holiday from neuroleptic drugs may cause symptoms to _______ or ________ within 3 months
diminish or disappear
What population is more susceptible to Pseudoparkinsonism?
Elder pts are more susceptible because of lower brain dopamine level
Symptoms of ______ usually disappear when the dosage is adjusted or the drug is withdrawn.
pseudoparkinsonism
What are the symptoms of pseudoparkinsonism?
resting tremor, bradykinesia and rigidity
Pseudoparkinsonism results from...
decrease in dopamine activity and increase in cholinergic activity=parkinson-like effects
Pts with Akathisia may experience:
Sensations of motor restlessness and may complain of an inability to sit or lie still

Pt may appear agitated and have problems with insomnia (may pace for floor)
Akathisia is usually dealt with by:
alerting dose and/or type of medication
Pts may exhibit a broad range of bizzarre movements of the arms,legs,neck and face
symptoms of Dyskinesia and Dystonia
The movements of dyskinesia and dystonias are ________ and _________.
Involuntary and uncoordinated
What drugs can be used to treat abberant motor symptoms?
Antiparkinson drugs and benzodiazepines
The movements associated with dyskinesia and dystonias begin fairly soon after initiating therapy *even after a _______ dose
single
(NMS) Neuroleptic Malignant Syndrome can result in _____ if untreated
Death
The exact causes of _____ are UNCLEAR
NMS
catatonia (involving stupor, rigidity, excitement and tremors) and fever
symptoms of NMS
Treatment for NMS typically consists of ...
withdrawing the medication and providing supportive care
Having NMS is considered an...
EMERGENCY SITUATION!!!

TAKE OFF OF MEDS IMMEDIATELY
Nonmotor Side Effects of Antipsychotics:
1. sedation
2. anticholinergic effects (dry mouth, blurred vision and constipation)
Miscellaneous Side Effects of Antipsychotics:
1. Orthostatic Hypotension
2. Photosensitivity *advise pt. to avoid UV radiation
Therapeutic Uses for Antipsychotics:
1. Tx of Schizophrenia

2. Prevention of severe nausea and vomiting (especially helpful with tx drug-induced nausea, like with chemotherapy)

3. Other Uses:
a. Chlorpromazine used to tx intractable hiccups
b. Promethazine used to tx pruritis
Therapeutic Uses for Antipsychotics:
1. Tx of Schizophrenia

2. Prevention of severe nausea and vomiting (especially helpful with tx drug-induced nausea, like with chemotherapy)

3. Other Uses:
a. Chlorpromazine used to tx intractable hiccups
b. Promethazine used to tx pruritis
Therapeutic uses of Antipsychotics:

[Under tx of Schizophrenia]

What tends to be observed with drug use?
Observe:
-withdrawn pts tend to become active/amiable

-agitated pts tend to become calmer/relaxed
Therapeutic uses of Antipsychotics:

[Under tx of Schizophrenia]

How long before a response to meds is seen?
Initial response: within 2-7 days

In 2-6 weeks =improved socialization and can obey orders

*Non drug therapy can be initiated
Other Neuroleptic Drugs are
Clozapine and Risperidone
Useful in treating refractory schizophrenia.

A neuroleptic agent with a LOW potential for causing EPS and lower rist of tardive dyskinesia than other neuroleptics.

What is the drug?
Clozapine
Side effects of Clozapine include:
Sedation, dizziness, anticholinergic effects, orthostatic hypotension, seizure and fever
Can be used among the FIRST-LINE drugs.
Has a low potential for causing EPS and lower risk for tardive dyskinesia than other neuroleptics.

What is the drug?
Risperidone
Side effects of Risperidone:
Anxiety, sedation, EPS, GI disturbances, increased dream activity, wt. gain, decreased sexual function (libido, erectile, ejaculatory, orgastic dysfunction) and othrostatic hypotension
Special Considerations for Antipsychotics:

These drugs are of great benefit because...
1. improve behavior and reality perception

2. enhances pt cooperation during rehab
Special Considerations for Antipsychotics:

EPS is a major problem with these drugs but, OTS are in a position to...
1. notice change in posture, balance and involuntary mvmts

2. even slight changes in motor function should be reported to healthcare team immediately

**EARLY INTERVENTION may diminish permanent motor dysfunction
Special Considerations for Antipsychotics:

Less serious side effects including...
sedation, dry mouth (drink more water), blurred vision and constipation (increase fiber intake) may interfere with OT tx
Special Considerations for Antipsychotics:

During first few days of therapy, guard against _________ _________
orthostatic hypotension
As a therapist remember:
1. Inform doctor of missed doses

2. It may take up to 6 weeks to see a difference in behavior (so best work in therapy may not be seen until then)