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30 Cards in this Set
- Front
- Back
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What are neurotransmitters
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Acetycholine-related to side effects of anticholinergic drugs(dry mouth, blurred vision, urinary retention, and constipation)
Dopamine-Related to control of movement, pleasure sensations, hallucinations from psychosis, cognitive sife effects, release of prolactin. Serotonin/5-HT-mediates emotions and cognitive effects(panic, memory, panic anxiety, violence, sexual functions, sleep/wake cycle. Glutamate-major excitatory neurotransmitter, implicated in neurologic and psychologic disorders |
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What is the goal od pharmacotherapy?
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Aimed at stabilization of illness with goal of achieving remission, maintence phase entered hopefully to optimize protection against recurrence of illness that maximizes function and minimizes symptoms of adverse effects of treatment.
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Drug related variables
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1. Mode mechanism of action
2. Available dosage form, oral, parenteral 3. Bioavailability of various formulations 4. Onset, peak and suration of action 5. Serum half life 6. Method of examination from the body 7. Side effects/toxicities 8. Cost |
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Client related variables
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1. Diagnosis
2. Other disease state 3. Age 4. weight 5. anticholinergic susceptibility 6. History of side effect 7. Previous response 8. Family history of response 9. Willingness to comply/insight into illness 10. Financial or health insurance 11. Support system |
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Antipsychotic medications-once known as major tranquilizers and neuroleptics have been treatment of choice for schiz since intorduction of Thorazine(chlorpromazine) since 1952.
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Divided into 2 categories
1. Concentional (Typical) 2. Unconventional(atypical) Typical==similar in mode in efficacy but differ in side effect and potency Atypical-differ in mode of action related to side effect, potency compared to typical, lower potential for EPS, greater efficacy in negative sx, cognitive symptoms and refractory illness. |
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What is psychosis
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Inability to regognize reality, bizarre behaviour or inability to deal with lifes demands which may include negative and positive symptoms.
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What are postive symptoms
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Delusion, hallucination, diorganized speech, disorganized behaviours, catatonia and agitation.
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What are negative symptoms
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Decreased mental activities, blunted affect, passiveness, social apathy and withdrawl alogia(inablity to speak due tomental deficiency) anhedonia, lack of attention.
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What are secondary treatments for antipsychotic medications?
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Electrolyte imbalances, mania, drug abuse depression with psychotic features and brain tumors.
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What are the goals of therapy?
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Typical psychotics are effective in reducing positive symptoms
Atypical- are better in alleviating negative symptoms |
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Absorption, Distribution, metabolism, and Excretion
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Absorption may ne influenced by presence od food, antacids, anicholinergics and smoking(cigarette smoking causes drugs to matabolize faster requiring higher doses od medication.
Distribution depends on route of admin. with IM having greaer bioavailability than oral Excretion and Metabolism-all drugs are metabolized in liver and excreted thru kidneys. |
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Serum Monitoring-Monitoring drug levels can be useful when client is older or very young and client using multiple meds with known potential drug interactions, cleint fails to respoind with usual doses, non compliance is suspected
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Half life if most drugs between 20-40 hours in adults
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Clinical use and efficacy of antipsychotics.
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Target symptoms varies with time, psostive symptoms most responsive, combativeness, hostility, psychomotor agitation and irritability often relived in hours
Affective Symptoms-anxiety, tension, depression, inappropiate affect, reduced attention span social withdrwul amy take 2-4 weeks Cognitve/perceptive sx-hallucinations,delusion thought broadcasting may take 2-8 weeks. Negative symptoms-poor social skills, unrealistic planning, poor judgment and insight respond slowest and the least. Medicaitn may be started tid/qid useful in determing ability to tolerate meds to minimize initial impact of side effects, once client able to tolerate meds generally reduced to qd. |
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Adverse effects.
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Typical antipsychotics induce EPS, drowsiness common however usuallyu disappear in 1-3 weeks, cleint should avoid antihistamines
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What is Dystonia?
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they include spasm of eye(oculogyric) crisis neck(torticollis) Back(retrocollis) tongue(glossospasms) or other muscles, can be reversed with IM benadryl or Cogentin followed by oral med, generally occurs during early stages of tx, seldom after 3 months, risk factors include high potency meds, large doses and parenteral injections.
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What is psuedoparkinsonism?
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symptoms include decreased movement(bradykinesia(decrease in spontaneity) akinesia(absense) muscle rigidity, resting hand tremors, drooling, mask like face and shuffling gait, EPS often misdiagnosed, untreated or unrecognized, treatment include reducing or changinf med and giving oral anti-parkinson med.
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What is Akathisia
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Restlessness, pacing, rocking or inability to sit still and anxiousness, symptoms often dose related, can be confused with anxiety and agitation, close observation is necessary. Improves with decreasing dose, Inderal effective, monitor BP.
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What is tardive Dyskinesia
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Abnormal movements of voluntary groups and prolonged period of meds, may affect any muscle group but commonly affects face, mouth, tongue and digits, includes grimacing, lip smaking tongue poking and writing movements of finger/toes.
Can be severly diabling, risk factors include longer lenghts of time on antipsychotic use, high doses. high ptency. no effective treatment, vitamin E provide some benefot, Atypical lesser risk, conversion to warranted. |
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What is Neuroleptic malignant Syndrome (NMS)
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Medical emergency, characterized by decreased level of consciousness, increased muscle tone, hyperpyrexia, labile hypertension, tachycardia, tacypnea, diaphoresis and drooling. Muscle necrosis severe to cause myoglobinuric renal failure withlarge amounts of myoglobin released from large muscle and excreted in urine. Poteinally fatal, mortality rate about 10%.
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What are the risk factors of NMS(neuroleptic Malignant Syndrome)
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history of NMS, ajunctive and polypsychotrophic meds, rapid dose titration, use of high potency antipsychotics at doses or use of parenteral antipsych or may occur after years of tx. Lab findings may show greatly elevated creatinine phosphokinase levels and myoglobinuria
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What is treatment for NMS?
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discontinue medication, hydration of clients iv fluids, antipyrecic like tylenol along with cooling blankets, iv of muscle relaxant(dantrium
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Treatment of NMS.
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Most clients recover from NMS, advisable to wait 1-3 weeks B4 restarting med with care eval. alternative medicaton such as carbamazepine(tetrol) Lithiu, should be considered. haloperidol(halidol) and fluphenazine(Proxilin) should not be used, (long half life)
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What medications should not be used that are associated with NMS?
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resperidone(Resperdal) and fluphenazine(Proxilin. if used clients hsould be monitored closely for psychomotor excitement, refusal of food and anuria nd weight loss.
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Photosensitivity
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toxic response to sunlight, can occur immediately after exposure, usually after hours, signs are dermatitis, pruritis, paillovesicular eruptiomn, eczematous dermatitis, treatment is topical burn cream, and antihistamines.
instruct client to wear protective clothing and sunscree, gray blue skin associated with antipsych use |
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What 2 drug low potency typicals are associated with skin pigmentation.
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Thorazine and Mellaril
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What are the 2 depot antipsychotic marked in the US
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haloperidol deconate(Halidol) and fluphenazine decanoate(Proxilin). Decanoates usually given when clients found noncompliance with oral meds.
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haloperidol deccanoate(Haldol)
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halodol given only deep IM, not to exceed 100mg usually given q4weeks.
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fluphenzine decanoate(Proxilin)
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if determined client can tolerate may be given 12.5 to 25 mg, given Im of sq, effects seen with 48-96 hours, maintence therapy q4 weeks.
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Atypical antipsychotics.
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clozapine(Clorazil) tx for negative sx and found to be effective, first in US, reserved for refractory illness, optimal dose 300-500 mg qd, can cause sedation, larger dose given in evening, must be titrated, typical trial period is 6 months
Risks-Agranulocytosi, clients required to register with Clozaril national registry, doctor must fill out Clozaril assurance form at initiation therapy, Md must also agree to notify registery of all clients who have d/c therapy and submit results of the four required weekly blood tests after d/c therapy. |
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Weekly WBC drawn with use of Clozaril.
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WBC drawn first 6 months and every other week therafter.
Inf WBC between 3000-3500/mm may need to be obtained more frequently(2x week). If WBC b/w 2000-3000 with neutrophils b/w 1000-1500 carefully monitor client and WBC with diff should be obtaine3d daily. DISCONTINUE PERMANELTY IF WBC FALL BELOW 2000 with neutrophil below 1000 and should not be reatrted on med. Update allergy history to clozaril to prevent readministration Immunocomprised clients are poor candidates. |
