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34 Cards in this Set

  • Front
  • Back
What are 5 s/s of schizophrenia?
(2> must be present for a sig. pd. of time for 1 mo.)
disorganized speech
grossly disorganized behaviour
negative symptoms
Conventional antipsychotics may potentially cause what kind of a/e and why is this so?
Extrapyramidal symptoms, movement disorders. This occurs because the rx block dopamine receptors in the CNS which causes increased Ach activity --> EPS
What is the dopamine hypothesis?
Positive symptoms thought to be due to overactive DA system. When DA receptors are blocked, symptoms improve.
When DA levels are increased, psychotic symptoms worsen.
Blockage of D2 receptors does what...
Relieves psychosis and may cause EPS
Blockage of alpha 1 receptors may cause what a/e...
orthostatic hypotension
Blockade of Muscarinic 1 receptors may cause what a/e?
anticholinergic effects
Blockade of Histamine 1 receptors causes what a/e?
Sedation and weight gain
Conventional antipsychotics are categorized according to their____ which indicates their risk and severity of _______ but not their ability to relieve symptoms of psychosis.
Potency, adverse effects
What is the MOA of conventional antipsychotics?
They block the receptors for dopamine, acetylcholine, histamine, and NE. This is also responsible for the numerous A/E.
Which class of conventional antipsychotics has the highst side effects and what are they?
Phenothiazines have many.
They are: sedation, low EPS, anticholinergic, and cardiovascular.
Why do the phenothiazines cause so many side effects?
They are not very potent so a higher dose must be given to achieve a given effect which leads to higher incidence of side effects.
What is the mechanism behind EPS side effects?
Normally dopamine (DA) suppresses Ach activity but if blocked (with rx) Ach activity increases and causes EPS.
What are the types of EPS and how do they differ?
Akathisia - feeling of restlessness
Dystonia - abrupt onset spasms of head and neck
Parkinsonian - shuffle, tremor
How are acute EPS episodes treated?
Anticholinergics, antihistamine, DA agonist (symmetrel), beta blocker (propranolol)
How does tardive dyskinesia present?
Movements appear after dose reduction, incidence increases with duration of therapy.
Mouth/tongue smacking, facial tics, nodding of head, jerking of fingers and arms, involuntary head/trunk movements.
How is TD treated?
Discontinuation of neuroleptic. Use atypical antipsychotic, vitamin E may prevent it.
If your patient taking high potency anti psychotics in high doeses comes in with muscular rigidity, hyperhtermia, tachycardia, sweating, altered LOC and elevated CK levels, what could this be?
Neuroleptic malignant syndrome
What are other possible side effects of typical antipsychotics?
Endocrine: lactation, amenorrhea, changes in libido, gynecomastia
Hematologic effects: leukopenia, agranulocytosis, thrombocytopenia
Metabolic: wt gain, hyperglycemia
Dermatologic: rash, phtosensitivity
Opthalmic: blurry vision, pigmentation retinopathies
Do typical antipsychotics alleviate negative symptoms of schizophrenia?
What is the MOA of atypical antipsychotics?
Antagonism of 5HT2 (serotonin) and weak antagonism of D2 (dopamine) receptors. (increases dopamine in frontal cortex-->improvement in neg symps. and in nigrostriatal pathway -->lower EPS risk)
What are the 6 atypical agents?
abilify, clozaril, zyprexa, seroquel, risperdal, geodon.
What is the BB warning with Atypical antipsychotics?
Increased mortality in elderly patients with dementia
Which rx may cause agranulocytosis and put pts at risk for myocarditis?
(for this reason it is not a first line agent)
Clozaril (clozapine, blood draws q week
What agent can be given IM q2weeks?
Risperdal consta
Which atypical antipsychotic should the clinitian perform an ECG prior to due to risk for arrhythmia?
Other a/e?
a/e: headache, somnolence, dizziness, GI
Why is ablify unique?
It's MOA is via D2 receptor partial agonist and 5HT2A antagonist. It is not associated with QT prolongation, hyperlipidemia or hypreglycemia.
a/e: anxiety, insomnia, nausea, headache, dizziness
Grade the atypicals by their a/e (wt gain, hypreglycemia, hyperlipidemia).
Clozaril and zyprexa>seroquel and risperdal>geodon and ablify
Which class (conventional/atypical) would you use for a child?
Atypical to decrease risk of developing tardive dyskinesia.
what is the safest agent to use in pregnancy?
What are common a/e associated with clozapine?
wt gain
hyper - lipidemia
Orthostatic HYPOtension
anticholinergic effects
What is risperdal prescribed for?
Schizophrenia or short trem treatment of acute manic eposisode.
a/e: no agranulocytosis, less sedation wt gain, elevated prolactin, orthostatic hypotension, tachycardia, akathisia
What is risperdal prescribed for?
Schizophrenia or short trem treatment of acute manic eposisode.
a/e: no agranulocytosis, less sedation wt gain, elevated prolactin, orthostatic hypotension, tachycardia, akathisia
What is zyprexa indicated for?
Schizophrenia, short term treatment of manic episodes
a/e: wt gain, orthostatic hypotension, sedation, increased liver function tests
Doses of seroquel may need to be adjusted for...
Elderly and pts with hepatic dysfunction
a/e: sedation, orthostatic hypotension, wt gain