Ch 55 Drug Therapy For Psychotic Disorder

Front 1

Akathisia

Back 1

motor restlessness and inability to be still, usually occurs in the first few months of treatment with antipsychotic agents

Front 2

Anhedonia

Back 2

lack of pleasure

Front 3

Delusions

Back 3

false beliefs that persist in the absence of reason or evidence

Front 4

Drug-induced parkinsonism

Back 4

loss of muscle movement, muscular rigidity and tremors, shuffling gait, masked facies, and drooling

Front 5

Dystonia

Back 5

uncoordinated, twisting, and repetitive movements

Front 6

Extrapyramidal effects

Back 6

movement disorders such as tardive dyskinesia, akathisia, dystonia, and drug-induced parkinsonism that may occur with usage of antipsychotic drugs

Front 7

Hallucinations

Back 7

sensory perceptions of people or objects that are not present in the external environment

Front 8

Neuroleptics

Back 8

antipsychotic drugs used to treat disorders that involve thought processes

Front 9

Neuroleptic malignant syndrom

Back 9

a rare but potentially fatal adverse effect; characterized by rigidity, severe hyperthermia, respiratory failure, and acute renal failure

Front 10

Paranoia

Back 10

belief that other people control their thoughts, feelings, and behaviors or seek to harm them

Front 11

Psychosis:

Back 11

severe mental disorder characterized by disorganized thought processes, hallucinations, and delusions

Front 12

Schizophrenia

Back 12

variety of related psychotic disorders; symptoms include agitation, behavioral disturbances, delusions, disorganized speech, hallucinations, insomnia, and paranoia

Front 13

Tardive dyskinesia

Back 13

irreversible late extrapyramidal effect of some antipsychotic drugs

Front 14

Schizophrenia positive symptoms (excess)

Back 14

hallucinations

delusion

agitation

behavioral disturbances

insomnia

paranoia

Front 15

schizophrenia negative symptoms (deficit)

Back 15

anhedonia

lack of motivation

blunted affect

poor grooming

poor social skills

poverty of speech

social withdrawal

Front 16

Chlorpromazine (Thorazine)

Back 16

(Typical) phenothiazines prototype

Front 17

Haloperidol (Haldol)

Back 17

Typical antipsychotics prototype

Front 18

(Typical) phenothiazines other drugs in class

Back 18

Fluphenazine (Prolixin)

Perphenazine (Trilafon)

Prochlorperazine (Compazine)

Thioridazine (Mellaril)

Trifluoperazine (Stelazine)

Front 19

Clozapine (Clozaril)

Back 19

Atypical antipsychotics prototype

Front 20

Atypical antipsychotics other drugs in class

Back 20

Aripiprazole (Abilify)

Asenapine (Saphris)

Iloperidone (Fanapt)

Lurasidone (Latuda)

Olanzapine (Zyprexa)

Paliperidone (Invega)

Quetiapine (Seroquel)

Risperidone (Risperdal, Risperdal Consta)

Ziprasidone (Geodon)

Front 21

Chlorpromazine

Back 21

____________ is well absorbed and distributed to most body tissues, and it reaches high concentrations in the brain. After oral administration, the onset of action is 30 to 60 minutes, with a peak of 2 to 4 hours and a duration of 4 to 6 hours. After intramuscular (IM) administration, the onset of action is 10 to 15 minutes, with a peak at 15 to 20 minutes and a duration of 4 to 6 hours. The half-life is 2 to 30 hours. The drug is metabolized in the liver and excreted in urine.

Front 22

chlorpromazine

Back 22

The mechanism of action of____________ is not fully understood. When the drug produces antipsychotic effects, it blocks the postsynaptic dopamine receptors in the brain.

Front 23

chlorpromazine

Back 23

The major clinical indication for____________ and other phenothiazine antipsychotics is schizophrenia. Other uses include treatment of psychotic symptoms associated with brain impairment induced by head injury, tumor, stroke, alcohol withdrawal, overdoses of CNS stimulants, and other disorders.

Front 24

Chlorpromazine

Back 24

CNS effects: excessive sedation, with drowsiness, lethargy, fatigue, slurred speech, impaired mobility, and impaired mental processes. * Hematologic effects: agranulocytosis and pancytopenia
* Other effects: antiadrenergic effects, such as hypotension, dizziness, fatigue, and faintness, as well as respiratory depression; endocrine effects; photosensitivity; and difficulty with temperature regulation
* Cardiovascular effects: prolonged QT and PR interval, T-wave blunting, and depression of the ST interval

Front 25

Patient Teaching Guidelines for Chlorpromazine

Back 25

Take the medication as prescribed.

Do not combine the medication with over-the-counter medications or alcohol.

Be sure to drink enough fluids, especially during hot weather.

If you go outdoors, wear protective clothing and use sunscreen.

Use caution when changing positions. It may be necessary to lie down for approximately an hour after taking your medication, because faintness and dizziness may occur.

Do not overexercise and reduce body fluids.

Do not drive a car or operate dangerous machinery. Dizziness or decreased mental alertness may occur.

Report dark urine, pale stools, and yellowing of the eyes or skin to a health care provider.

If you are a woman of childbearing age and intend to become pregnant, discuss chlorpromazine use with a health care provider.

Front 26

Haloperidol

Back 26

____________ is well absorbed after oral or IM administration. For the oral drug, the onset of action is 2 hours, with a peak of 2 to 6 hours and a duration of 8 to 12 hours. For the IM drug, the onset of action is 20 to 30 minutes, with a peak of 30 to 45 minutes and a duration of 4 to 8 hours. The half-life of the drug is 21 to 24 hours. It is metabolized in the liver and is excreted in urine and bile.

Front 27

haloperidol

Back 27

Prescribers order ____________ to control the symptoms of schizophrenia and psychotic disorders.

Front 28

haloperidol

Back 28

The FDA has issued a BLACK BOX WARNING ♦ regarding extrapyramidal and withdrawal symptoms in newborns who have been exposed to____________ . Withdrawal symptoms occur in newborns born to women who take ____________ during the third trimester of pregnancy.

Front 29

haloperidol

Back 29

It is important to note that the FDA has not approved ____________ for treatment of dementia-related psychosis. A BLACK BOX WARNING ♦ alerts health care practitioners that older patients who suffer from dementia and dementia-related psychosis and receive ____________ have an increased risk of death compared with those patients who receive a placebo.

Front 30

Haloperidol has several adverse effects, including

Back 30

* Cardiovascular effects: abnormal T waves, prolonged ventricular depolarization, QT prolongation, torsade de pointes, tachycardia, and sudden death
* CNS effects: akathisia, hyperthermia, dystonia, extrapyramidal symptoms, neuroleptic malignant syndrome, parkinsonism, seizures, and vertigo
* Dermatologic effects: photosensitivity, hyperpigmentation, contact dermatitis, and alopecia
* Genitourinary effects: anticholinergic adverse effects such as urinary retention, sexual dysfunction, amenorrhea, breast engorgement and galactorrhea (women), and priapism and gynecomastia (men)
* Metabolic effects: hyperglycemia, hypoglycemia, and hyponatremia
* Respiratory effects: bronchospasm or laryngospasm

Front 31

haloperidol

Back 31

Contraindications to____________ include Parkinson’s disease, seizure disorders, and severe mental depression.

Front 32

Herbs and Foods That Increase the Effects of Haloperidol

Back 32

Kava

Gotu kola

St. John’s wort

Valerian

Front 33

Patient Teaching Guidelines for Haloperidol

Back 33

Take the medication as prescribed.

Report sore throat or fever to the prescriber.

Notify the prescriber of any adverse effects such as tardive dyskinesia, dystonia, or akathisia.

Do not drive a car or operate dangerous machinery. Dizziness or decreased mental alertness may occur.

If you go outdoors, wear protective closing and use sun screen.

Maintain adequate hydration.

Use lozenges to counteract anticholinergic effects.

Realize that dark-colored urine (pink or red-brown) is normal.

If you are a woman of childbearing age and intend to become pregnant, discuss haloperidol use with a health care provider.

Front 34

Clozapine

Back 34

____________ is an oral drug. Its onset of action is unknown, with a peak of 1 to 6 hours and a duration of weeks. The half-life is 12 hours. ____________ crosses the placenta and enters the breast milk. The drug is metabolized in the liver, and it is excreted in the urine and in the feces.

Front 35

clozapine

Back 35

Apparently, the drug blocks the dopamine receptors in the brain, depressing the reticular activating system. It also blocks the serotonin and glutamate receptors. In addition,____________ has anticholinergic, antihistamine, and alpha-adrenergic blocking activity.

Front 36

clozapine

Back 36

Clinicians consider ____________ and other “atypical” antipsychotics to be first-line therapy for schizophrenia. Prescribers use the drug to manage patients with severe schizophrenia who have not responded to standard antipsychotic medications. Other uses in psychosis include reducing the risk of recurrent suicidal behavior in patients with schizophrenia or with schizoaffective disorder.

Front 37

clozapine

Back 37

The FDA has issued a BLACK BOX WARNING ♦ related to the administration of ____________ to elderly patients with dementia. The risk of death is increased in these patients. The FDA has not approved the drug for use in dementia.

Front 38

Clozapine has several adverse effects, including

Back 38

* Cardiovascular effects: orthostatic hypotension, tachycardia, ECG changes, and increased risk of myocarditis (greatest during the first month of treatment). The patient is also at risk for myocardial infarction, pericarditis, cardiomyopathy, mitral insufficiency, heart failure, and pericardial effusion.
* CNS effects: increased risk of seizures in patients with a known seizure disorder. An FDA-issued BLACK BOX WARNING ♦ alerts users of clozapine that the drug increases the risk of seizure activity as the dose increases.
* Hematologic effects: agranulocytosis. The FDA has issued a BLACK BOX WARNING ♦ regarding the potential risk of fatal agranulocytosis in patients who take clozapine.
* Metabolic effects: hyperglycemia and weight gain. The FDA has issued aBLACK BOX WARNING ♦ regarding the risk of hyperglycemia in patients who take clozapine. (In some extreme cases, there have been reports of ketoacidosis, hyperosmolar coma, and death.)

Front 39

Herbs and Foods That Increase the Effects of Clozapine

Back 39

Gotu kola

Kava

St. John’s wort

Valerian

Front 40

clozapine

Back 40

If____________ is to be discontinued, gradual tapering over a 2-week period is essential. If the drug is discontinued abruptly, the nurse monitors for symptoms of acute psychosis.

Front 41

clozapine

Back 41

When ____________ is given for acute psychotic episodes, the nurse observes for sedation, decreased agitation, combativeness, and psychomotor activity. When the drug is given for acute or chronic psychosis, the nurse observes for decreased psychotic behaviors, such as decreased hallucinations and delusions.

Front 42

Patient Teaching Guidelines for Clozapine

Back 42

Obtain weekly blood tests to determine the safe and effective dosage.

Keep appointments for white blood cell count monitoring.

Keep counseling appointments.

Be aware that only 1 week of medication will be dispensed at a time.

Do not drive a car or operate dangerous machinery. Dizziness or decreased mental alertness may occur.

Do not stop the medication abruptly.

You may experience drowsiness, dizziness, and decreased alertness.

If you are a woman of childbearing age and intend to become pregnant or are pregnant, discuss clozapine use with a health care provider.

Notify the prescriber of increased heart rate.

Report lethargy, weakness, or flu-like symptoms to the prescriber.

Front 43

Aripiprazole (Abilify)

Back 43

____________ is approved for the treatment of schizophrenia and acute mania associated with bipolar disorder. The drug is well absorbed orally, with or without food. It is 99% protein bound. ____________ is metabolized in the liver and has an active metabolite. Generally, no dosage adjustment for the drug is necessary on the basis of hepatic or renal impairment. It may cause neuroleptic malignant syndrome, tardive dyskinesia, weight gain, hyperglycemia, and diabetes mellitus.

Front 44

Olanzapine (Zyprexa)

Back 44

____________ is indicated for treatment of schizophrenia and the acute phase of bipolar disorder. The drug is well absorbed after oral administration; its absorption is not affected by food. After approximately 1 week of once-daily administration, a steady-state concentration is reached.

Front 45

olanzapine

Back 45

Compared with the typical antipsychotics,____________ reportedly causes less sedation, extrapyramidal symptoms, anticholinergic effects, and orthostatic hypotension. However, the drug has been associated with weight gain, hyperglycemia, and initiation or aggravation of diabetes mellitus.

Front 46

Quetiapine (Seroquel)

Back 46

____________ relieves both positive and negative symptoms of psychosis and is also indicated for the acute manic phase of bipolar disorder. After oral administration, ____________ is well absorbed and may be taken without regard to meals. It is extensively metabolized in the liver and excreted in the feces and urine. Common adverse effects include drowsiness, headache, orthostatic hypotension, and weight gain.

Front 47

Risperidone (Risperdal)

Back 47

____________ a first-choice drug that is usually well tolerated, also relieves both positive and negative symptoms of psychosis as well as the acute manic phase of bipolar disorder. It is frequently prescribed. ____________ is well absorbed with oral administration. Peak blood levels occur in 1 to 2 hours, but therapeutic effects are delayed for 1 to 2 weeks. ____________ is metabolized mainly in the liver and produces an active metabolite. Effects are attributed approximately equally to the drug and the metabolite. It is excreted in urine and in feces.

Front 48

risperidone

Back 48

Adverse effects of____________ include agitation, anxiety, headache, insomnia, dizziness, and hypotension. The drug may also cause parkinsonism and other movement disorders, especially at higher doses, but is less likely to do so than the typical antipsychotic drugs.

Front 49

Paliperidone (Invega)

Back 49

____________ is the major active metabolite of risperidone. Administration is oral, and the drug reaches peak blood levels 24 hours after administration. The drug is eliminated by the renal system. Adverse effects include akathisia, extrapyramidal effects, QT prolongation, orthostatic hypotension, syncope, hyperprolactinemia, and hyperglycemia.

Front 50

Ziprasidone (Geodon)

Back 50

____________ another atypical agent used to treat schizophrenia and the acute manic phase of bipolar disorder. This drug is effective in suppressing many negative symptoms such as blunted affect, lack of motivation, and social withdrawal. It is metabolized in the liver and excreted in the urine. Adverse effects include cardiac dysrhythmias, drowsiness, headache, and nausea. Because____________ may prolong the QT interval and cause torsade de pointes, a potentially fatal type of ventricular tachycardia, it is probably not a drug of first choice. However, it leads to a decrease in weight and improvement in cholesterol and triglyceride levels.

Front 51

clozapine

Back 51

The FDA has issued a BLACK BOX WARNING ♦ regarding the risk of fatal agranulocytosis with____________ .The FDA has issued a BLACK BOX WARNING ♦ for ____________ regarding the risk of hyperglycemia.