Schizophrenia Tx Meds-Test 2

Front 1

Counseling: Communication Guidelines

Back 1

refer to book, pages 212-213 and slides..too much to write.

Front 2

The brain stem
(midbrain, pons, medulla oblongata)

REVIEW don't memorize

Back 2

-midbrain; controls capillary reflex, eye movement,
-brain stem-ponds: processing station & auditory pathways.
-medulla obligate: reflex centers, balance, HR, BP, respirations, coughing, swallowing, sneezing, involving regulation area.

Front 3

cerebellum

Back 3

skeletal muscle, coordination, contraction, and maintains equilibrium

Front 4

cerebrum

(frontal, parietal, occipital, temporal lobes, the basial ganglia, amygdala and hippocampus)

Back 4

- frontal: thinking, planning, central executive functions and motor execution.
-parietal lobe: senitol sensory perception, integration of visual, and information centers.
-Temporal: language function & auditory perception, long term memory & emotion.
-occipital: visual perception & processing, vasoganglion, regulation of movement.
-amygdala and hippocampus, emotions, learning, memory, & basic drives.

Front 5

dopamine

Back 5

neurotransmitter involved in a wide variety of behaviors & emotions including pleasure.
-excessive transmission in schizophrenia.

Front 6

Gaba

Back 6

- a largely inhibitory neurotransmitter.

-Distributed widely throughout the CNS
-implicated in sleep and eating disorders
-Low levels has also been linked to extreme anxiety

Front 7

MRI & CT shows in schizophrenia

Back 7

Through MRI or CT it is possible to ID gross anatomical changes in the brain: increased posterior ventricles=loss of brain tissue
-In schizophrenia, cortical atrophy is detected, so there is an enlargement of the posterior ventricles.

Front 8

PET shows in schizophrenia

Back 8

-injected radioactive tracer travels to the brain and concentrates in area of high activity

-shows differing bain activity is and shows intensity of the activity & differing areas from the normal brain

Front 9

Standard (First-Generation) Antipsychotic Drugs
-Traditional Antipsychotics

Back 9

Act as antagonists to these receptors:

--->Acetylcholine (muscarinic receptors)

---> Norepinephrine (a1 receptors)

---> Histamine (H1 receptors)
**also a dopamine antagonists**

Front 10

-Traditional Antipsychotics

Action for schizo

Back 10

targets positive symptoms of schizophrenia b/c they dopamine antagonists-blocks dopamine (remember excess for schizo)

No effect on negative symptoms, so used less often

Front 11

-Traditional Antipsychotics

Advantage

Back 11

Less expensive

Front 12

-Traditional Antipsychotics

Disadvantage

Back 12

-Do not treat negative symptoms. (w/drawn, lack of feeling, pleasure, interest. not motivated in ADLs)
-block of dopamine receptors in motor area cause extrapyramidal side effects (EPSs) as well anticholinergic effects, retarded Indonesian,

Front 13

extrapyramidal side effects (EPSs)

Back 13

Three of the most common EPS s/e are:
-acute dystonia=acute sustained contraction of muscles usually head & neck
-akathisia=psychomotor restlessness evident as pacing or fidgeting, pronounced & distressing to pt
-pseudoparkinsonism= parkinsons symp: tremors, reduced accessory movements, shuffling gait, stiff, drooling, masked expression, "pin rolling"

Front 14

(EPS) Type of dystonia's mentioned

Back 14

-Occulogyric-eyes are locked upward, painful

-Torticollis neck muscles contracting involuntarily side to side (recording says head to side?)

Front 15

what can help lessen extrapyramidal side effects (EPSs)

Back 15

-reduce dose amount
-adding anti-Parkinson meds, esp centrally acting meds like: trihexyphenidyl (artane) & benztrophine & amantadine hydrochloride (Benadryl)
-Most pt will develop tolerance after a few months

Front 16

Serious EPS that sows up later

Back 16

Tardive dyskinesia (TD): shows up months-yrs after
-Face: protruding and rolling tounge, spastic facial distortion, smacking movements. grimincing
-Limbs: Choreic (rapid, purposeless), Athetoid (slow, complex)
-Trunk:neck & shoulder movements, dramatic hip jerks, rocking

Front 17

Tardive dyskinesia how common

treatment

Back 17

20% >2 yrs

-D/C of drug rarely relieves symptoms
-best to catch early, will worsen w/ time
-changes in appearance, provide support

Front 18

Neuroleptic malignant syndrome
(NMS)


-TX

Back 18

Severe EPS, rare, can be fatal (renal failure, cardiac)

-can occur 1st week but often occurs later, rapid progress over 2-3 days.

-early detection is the key. d/c med tx symptoms

Front 19

Neuroleptic malignant syndrome
(NMS) S/S

Back 19

-Hyperpyrexia: cardinal feature-temp over 103

- Autonomic dysfunction; htn, tachycardia, diaphoresis, incontinence, elevated vitals, UR
-delirium, stupor, coma
-Severe extrapyramidal symptoms

Front 20

Other negative side effect of block of dopamine receptors

Back 20

increase pituitary secretion of prolactin causing amenorrhea (no period), Galactorrhea (milk flow) gynecomastia in men (man boobies)

Front 21

Anticholinergic Symptom

Back 21

many tradiontional Antipsycs also block mucus secretentic receptors in internal organs, causing
-Dry Mouth
- blurred vision (usually abates in 1-2 weeks
-Urinary retention -constipation
-photo-sensitivity -sexual dysfunction

Front 22

Anticholinergic toxicity

Back 22

-non reactive puplis -dry mucus membranes
-reduced or absent peristalsis (smooth muscle move)
-unstable vitals
-seizures -urinary retention

LIFE THREATENING- EMERGANCY

Front 23

-Traditional: Other common Side Effects

Back 23

constipation, hypotension, ortho-hypon, increased appetite insomnia, sedation, UR, weight gain

Front 24

-Traditional Antipsychotics

Low Potency

examples

Back 24

-high sedation + high ACH + low EPSs
-high acetylcholine (acts as neurotransmitter) affect
-low risk for extrapyamidal symptoms

-*Chlopromazine (Thorazine), Thioridazine (Mellarill)*

Front 25

There are medium potency

Back 25

*loxapine (Loxitane), perphenazine (Trilafon)* Molindone (Trilafon)

Front 26

-Traditional Antipsychotics

High potency =

Examples

Back 26

low sedation + low ACH + high EPSs
-low acetylcholine (acts as a neurotransmitter) affect
-high risk for extrapyamidal symptoms

-*Haldol (haloperidol)*, *fluphenazine (Prolixin)*, Pimozide (Orap), triflupoperazine

Front 27

-Traditional Antipsychotics
Long acting

Back 27

Haldol Decanoate and Prolixin Decanoate: these "decanoates" are long acting

don’t have to take the medications every day, it helps with med adherence

Front 28

-A-typical, or a newer antipsychotic

Back 28

-Serotonin-dopamine antagonists
(5-HT2A)
-bind to dopamine receptors in the alembic system, therefore we do see motor side effects such as Tardive dyskinesia which is irreversible
-target negative and positive symptoms

Front 29

-A-typical, or a newer antipsychotic Advantages

Back 29

-fewer to no EPS, and other motor side effects
-target negative symptoms of psychosis as well as positive symptoms
-tx mood disorders: bipolar, depression and anxiety
-decreases suicidal behavior.

Front 30

-A-typical, or a newer antipsychotic disadvantages

Back 30

-weight gain, can happen in all, but more so.
-Metabolic abnormalities: need to monitor blood sugars & related metabolic changes
-serious side effects depending on med
-more expensive

Front 31

A-Typcials Begin to work

Back 31

1 Week but takes seceral months to reach max effect

Brief dose on benzodiazepine may be given to help pt maintain control during that time

Front 32

Common A-typical

Back 32

-Airpiprazole (Abilify) -Quetiapine (Seroquel)
-Clozapine (Clozaril) -Ziprasidone (Geodone)
-Paliperidone (invegal) -Asenapine (Saphris)
-Risperidone (Risperdal)
-Olanzapine (Zyprexa)

Front 33

-A-typical Clozaril

Back 33

-risk for agranulocytosis: monitoring the CBC closely
-other s/e= connvulsions/sezier , myocarditis
-anticonvulsive may be given as a preventative measure & cardiac status & labs monitored

Front 34

-A-typical Risperidone

Back 34

May cause EPS at higher doses
observing for a side effect known as neuromalignant syndrome
convulsions, myocarditis, other side effects. Monitoring the CBC, maybe based on the risk, anticonvulsive may be a preventative measure and also looking at the cardiac status and all the labs related to that.

Front 35

Metabolic disturbances weight gain higher w/

Back 35

Olanzapine (Zyprexa)
Clozapine (Clozaril)

Front 36

Sedation higher w/

Back 36

Quetiapine (Seroquel)
Clozapine (Clozaril)
Asenapine (Saphris)

Front 37

Differences in drug responses among ethnic groups

Back 37

-Lithium: Greater toxicity in African Amer than whites
-
Haloperidol: Same dose, but plasma concentrations 50% higher in Asians than in whites

-Clozapine: Life-threatening s/e agranulocytosis, more prevalent in Ashkenazi Jews than others