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21 Cards in this Set
- Front
- Back
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What are positive symptoms of psychotic disorders?
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Hallucinations, agitation, disordered thinking
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What are negative symptoms of psychotic disorders?
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Flat affect, avolition, social withdrawal, impoverished thought and speech
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Is NMS more likely to occur with the typical or atypical antipsychotics?
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The typical
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What are the advantages of the atypical antipsychotics relative to the typical antipsychotics?
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Atypicals treat negative symptoms, are less sedating, have less extrapyramidal symptoms
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How do antipsychotic drugs work?
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Typical and atypical block dopamine receptors
Atypical also block 5-HT serotonin receptors which helps with negative symptoms and are more selective for the mesolimbic area (as opposed to the nigrostriatal area) |
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How do antipsychotics cause movement disorders?
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By blocking dopamine at the nigrostriatal area as well as the mesolimbic area
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What are the acute EPS?
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Dystonia (motor tics, oculogyric crisis, laryngeal dystonia), akathisia (motor restlessness) and parkinsonism (bradykinesia, masked facies, shuffling gait, muscular rigidity, resting tremor, perioral tremor)
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List some side effects of antipsychotic medications.
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-Orthostatic hypotension (alpha-blockade)
-K channel blockade/Torsades (QT prolongation) -Agranulocytosis (only Clozapine) -Seizure (only Clozapine) |
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How does an acute OD of an antipsychotic present?
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A - Impaired airway reflexes
B - respiratory depression C - Orthostatic hypotension D - CNS depression, delirium (anticholinergic), EPS, miosis |
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What is tardive dyskinesia?
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A chronic movement disorder in patients that have used antipsychotics for a long time.
Involuntary movements - blinking, grimaces, tongue mvoement, chewing, trunk movements, extremity movements |
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What is respiratory dyskinesia?
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A varient of tardive that can cause repeated bouts of aspiration
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What is NMS? What are its cardinal features?
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Neuroleptic malignant syndrome results from the use of dopamine blocking agents.
Cardinal features include altered mental status, muscle rigidity, hyperthermia, autonomic instability |
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What are risk factors for NMS?
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Rapid drug loading, high dosage, high-potency antipsychotics, parental formulation, dehydration, agitation, history of NMS.
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What drugs beside atypical antipsychotics can contribute to NMS?
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Lithium, thiazines (prochlorperazine)
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What are the diagnostic criteria for NMS?
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-All 3 of: muscle rigidity, hyperthermia & use of a neuroleptic medication
-2 of: diaphoresis (95%, dysphagia, tremor, incontinence, altered mental status (97%, mutism, tachycardia (88%), labile/elevated BP, leukocytosis (98%), elevated CK (95) |
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What cardiac effects to antipsychotics have?
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They can almost all cause sinus tachycardia and prolonged QT
AV block is rarely reported |
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What antipsychotic drug causes agranulocytosis?
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Clozapine used chronically
Rarel, olanzipine |
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What antipsychotic drug causes seizures?
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Clozapine (dose related)
Others lower the seizure threshold |
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What is the treatment for an acute antipsychotic OD?
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Supportive/symptomatic
Intubation for airway protection IVF +/- pressors for hypotension Electrolyte correction/pacing/Mg/isoproterenol for arrhythmias Diphenhydramine or benztropine for dystonic reactions Propranolol or benzo's for akithisia |
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What is the treatment for NMS?
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Discontinuation of neuroleptics
Benzodiazepines to treat muscular rigidity (paralysis in extreme cases) Cooling for hyperthermia IVF for rhabdomyolysis |
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What is the role of bromocriptine, amantadine & dantrolene in NMS treatment?
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They have been tried but do not consistently show benefit.
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