Ati Psych Ch. 22: Medications For Psychosis

Front 1

Primary Reason for administration of antipsychotic meds?

Back 1

Schizophrenia

Front 2

Meds for Psychoses used to treat:

Back 2

- + symptoms related to behavior, thought, and speech (Agitation, delusions, hallucinations, tangenital speech patterns)
- Negative symptoms (social withdrawal, lack of emotion, lack of energy, flattened affects, decreased motivation)

Front 3

Goals for psychopharmacological treatment of schizophrenia: (3)

Back 3

-suppression of acute episodes
-prevention of acute reoccurence
-Maintenence of highest possible level of functioning

Front 4

Conventional Antipyschotic meds usually used for what?

Back 4

To control positive symptoms of psychosis and reserved for PTs who are:
using successfully + tolerate sideeffects
-Violent or aggressive

Front 5

Atypical Antipsychotics

Back 5

Med of choice for PT receiving initial treatment + treating breakthrough episodes in PTs on conventional meds

Front 6

Advantages of atypical antipsychotic agents

Back 6

- Relief of positive AND neg symptoms
- Decrease in affective symptoms (depression +anxiety), and suicidal behaviors
-Improvement of neurocognitive defects, such as poor memory
-Fewer/no EPS (tardive dyskinesia, due to less dopamine blockade
-Fewer anticholinergic effects - w/exception of clozapine
-Less relapse

Front 7

Conventional Antipsychotics

Back 7

Haloperidol (Haldol)
Fluphenazine (Prolixin)
Molindone (Moban)
Loxapine (Loxitane)
Thioridazine (Mellaril)
Thiothixene (Navane)

Front 8

Conventional Antipsychotics Pharm action

Back 8

Block dopamine, acetycholine, histamine, and norepi receptors in brain and periphery

Front 9

Conventional Antipsychotics Therapeutic Uses (7)

Back 9

Acute + chronic psychosis
Schizo
Bipolar - manic phase
Tourette's syndrome
Delusional and shizoaffective disorder
Dementia
Prevention n/v thru blocking of dopamine in chemoreceptor in triggerzone of medulla

Front 10

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects

Back 10

Acute dystonia, Parkinsonism, Akathasia, Late EPS, Neuroleptic malignant syndrome, anticholinergic effects, orthostatic hypotension, sedation, neuroendocrine effects, seizures, sexual dysfunction, skin effects, agranulocytosis, severe dysrhythmias

Front 11

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects --> Acute Dystonia

Back 11

Severe spasm of tongue, neck, face, and back - requires RAPID treatment
**Begin to monitor for SE btw 5 hr - 5 days after admin
*Treat w/anticholinergic agents - benzotropine (cogention) or benadryl

Front 12

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->Parinsonism

Back 12

Bradykinesia, rigidity, shuffling gait, drooling, tremors

**Observe S/S for first month after start
*Treat w/benzotropine, diphenhydramine, or amantadine (Symmetrel)

Front 13

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->Akathisia

Back 13

Inability to sit or stand still, continual pacing/agitation
*Observe for first 2 months after admin
-Manage w/ beta-blockers, benzodiazepines, or anticholinergic meds

Front 14

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->Late EPS

Back 14

Tardive Dyskinesia - involuntary movements of tongue and face, such as lip smacking. Involuntary movements of arms, legs, and trunk
*Admin lowest dose possible
*Eval PT after 12 mos and then every 3 mos. Can occur months to years after start. If signs of TD appear - dosage should be lowered, or switch to atypical agents
**Use Abnormal INvoluntary Movement Scale (AIMS) to screen for presence of EPS

Front 15

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->nEUROLEPTIC mALIGNANT SYNDROME

Back 15

Sudden high fever, BP fluctuations, dysrhythmias, muscle rigidity, change of LOC, coma

*STOP med
*Monitor vitals
*Apply cooling blankets
*Admin antipyretics
*Increase fluids
*Admin dantrolene (Dantrium)and bromocriptine (Parlodel) to induce muscle relaxation
*Wait 2 weeks before resuming therapy. Consider switching to atypical

Front 16

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->AnticholinergIC eFFECTS

Back 16

Dry mouth, blurred vision, photophobia, urinary hesitancy/retention, constipiation, tachycardia

*Chew sugarless gum, sip water, awear sunglasses outdoors, eat foods high in fiber, participate reg exercise, maintain fluid 2-3L/day, void just BEFORE taking med

Front 17

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->Orthostatic hypotension

Back 17

-Develop tolerance 2-3 months
Monitor BP + HR for orthostatic changes, hold med until MD notified of significant changes
-Instruct about signs and what to do (get up slow, etc)

Front 18

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->Sedation

Back 18

-Inform should diminish in few weeks
Instruct PT to take med at bedtime to avoid daytime sleepiness
Advise not to drive until sedation stops

Front 19

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->Neuroendocrine effects

Back 19

Gynecomastia, galactorrhea, menstrual irregularities

Tell to observe and notify MD if occur

Front 20

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->Seizures

Back 20

Greatest risk in those PTs who have existing seizure disorder

Report to MD, increase in anti-seizure med may be necessary

Front 21

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->Sexual dysfunction

Back 21

Advise of poissibility
Report to MD
May need dosage lowered/or switch to high potency agaent

Front 22

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->Skin effects

Back 22

Photosensitivity that can result in severe burn, contact dermatitis from handling med

*Advise PT to avoid excessive exposure to sunlight, use sunscreen, wear protective clothing
Advise PT to avoid direct contact with med

Front 23

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->Agranulocytosis

Back 23

Observe for signs of infection and notify MD (pt should)
If signs of infection appear - obtain PT baseline WBC. Med should be d/c if lab test indicates presence of infection

Front 24

Conventional Antipsychotics Chlorpromazine (Thorazine) Side/Adverse Effects -->sEVERE DYSRHYTHMIAS

Back 24

-Obtain baseline ECG and potassium level prior to treatment, and periodically thru out treatment period
-Avoid concurrent use w/other meds that prolong QT interval

Front 25

Conventional Antipsychotics Contraindications

Back 25

coma, have severe depression, Parkinson's disease, prlactin-dependent cancer of breast, and severe hypotension
-older PT w/dementia

Front 26

Conventional Antipsychotics Med/Food Interactions --> anticholinergic meds

Back 26

Increases effects

Advise to avoid OTC meds that contain anticholinergic agents - such as sleep aids

Front 27

Conventional Antipsychotics Med/Food Interactions -->CNS Depressants

Back 27

additive effects (alcohol, opioids, antihistamines)
Adivse to avoid alcohol, advise to avoid hazardous activities - driving

Front 28

Conventional Antipsychotics Med/Food Interactions -->Levodopa

Back 28

Activates dopamine receptors, counteracts effects
Avoid concurrent use of levodopa and other direct dopamine receptor agonists

Front 29

Early EPS treatment

Back 29

beta-blockers, benzodiazepines, anticholinergics

Front 30

Antipsychotics-Atypical Medications

Back 30

Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Clozapine (Clozaril)
Risperdone (Risperdal)

Front 31

Antipsychotics-Atypical Medications Pharm action

Back 31

Block serotinin, and to lesser degree - dopamine receptors. Aslo block nnorepi, histamine, and acetylcholine

Front 32

Antipsychotics-Atypical Medications Therapeutic Uses

Back 32

nEG AND POS symptoms of schizo
Psychosis induced by levodopa therapy
Relief of psychotic symptoms in other disorders - like bipolar

Front 33

Antipsychotics-Atypical Risperidone (Risperdal) Side Effects

Back 33

New onset of diabetes mellitus or loss of glucose controle in Pt w/diabetes, wt gain, hypercholesterolemia, orthostatic hypotension, anticholinergic effects, agitation/dizzyness/sedation/sleep disruption, mild EPS

Front 34

Antipsychotics-Atypical Risperidone (Risperdal) Side Effects-->onset of diabetes/loss of glucose control in pT w/diabetes

Back 34

-Obtain baseling fasting BG, and monitor value periodicially
-Instruct to report s/s - increased thirst, urination, appetite, - notify MD

Front 35

Antipsychotics-Atypical Risperidone (Risperdal) Side Effects-->Hypercholestremia

Back 35

Monitor cholesterol, trigycerides, andblood glucose if wt gain > 14 kg (30lb)

Front 36

Antipsychotics-Atypical Risperidone (Risperdal) Side Effects-->Orthostatic hypotension

Back 36

Monitor BP and HR
Hold med if huge changes while you notify MD

Front 37

Antipsychotics-Atypical Risperidone (Risperdal) Side Effects-->Anticholinergic effects

Back 37

-monitor and report to md if occur
-sip fluids thru out the day

Front 38

Antipsychotics-Atypical Risperidone (Risperdal) Side Effects--> agitation, dizziness, sedation, sleep disruption

Back 38

Monitor + report to MD
Admin alternative if prescribed

Front 39

Antipsychotics-Atypical Risperidone (Risperdal) Side Effects-->MILD EPSE (tremor)

Back 39

Monitor and teach PT to recognize eps
Use AIMS test to screen for EPS

Front 40

Contraindications - Risperidone

Back 40

Preg Cat C
NOT used for dementia-related psychosis
no ALCOHOL

Front 41

Antipsychotics-Atypical Med/Food Interactions - Immunosuppresives

Back 41

Like anticancer meds can further supress immune system
AVOID USE IN PTS WHO ARE TAKING CLOZAPINE (b/c this med has fork for fatal agranulocytosis)

Front 42

Clozapine - Risk for what?

Back 42

for fatal agranulocytosis!!!
Baseline and WEEKLY monitoring of WBC recommended
Notify MD of signs of infection

Front 43

Antipsychotics-Atypical Med/Food Interactions - alcohol, opioids, antihistmasines

Back 43

-Added depressant effects
-Advise to avoid alcohol + other meds that cause CNS depression
-avoid hazardous activites - like driving

Front 44

Antipsychotics-Atypical Med/Food Interactions - Levodopa

Back 44

activates dopamine receptors, counteracts effects of agent

avoid use

Front 45

Antipsychotics-Atypical Med/Food Interactions - TCAs, amiodarone (Cordarone) and clarithomycin (Biaxin)

Back 45

Prolong QT intervals, thereby increasing risk of cardiac dysrhythmias

AVOID CONCURRENT USE W/ZIPRASIDONE

Front 46

Ziprasidone (Geodon) important adverse effect (antipsychotic atypical)

Back 46

ECT changes and QT prolongation may lead to torsades de pointes

Front 47

Antipsychotics-Atypical Med/Food Interactions - Barbituates and phenytoin (Dilantin)

Back 47

Stimulate hepatic drug-metabolizing enzyme, thereby decreasing drug levels of aripiprazole, quetiaine, and ziprasidone

Monitor med effectiveness

Front 48

Antipsychotics-Atypical Med/Food Interactions - Fluconazole (Diflucan)

Back 48

Inhibits hepatic drug metablozying enzymes - increasing drug levels of aripiprazole, quetiapine , and ziprasidone

Front 49

What manifestations of schizophrenia are treated by conventional antipsychotics?

Back 49

Auditory hallucinations, delusions of grandeur, loose associations, pressured speech
(these are all positive symtpoms