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antipsychotics
psychopharmacology
| Question | Answer |
|---|---|
| What do Antipsychotic Medications Do? | Reduce neurotransmission of dopamine |
| Mechanism of Action | The exact unknown. |
| According to the dopamine theory of schizophrenia, positive symptoms are the result of | an overactivity in the mesolimbic dopamine pathway. |
| Based on the observation that drugs that increase dopaminergic availability (L-DOPA, cocaine, amphetamines) can trigger | psychotomimetic effects in individuals not affected by schizophrenia. |
| first-generation antipsychotics are D2 antagonists. As a result, they | reduce dopaminergic neurotransmission in the four dopamine pathways. |
| people stop taking their meds/FGA because of | Dysfunction associated w/cognitive impairments and disturbances of emotions and affect (negative symptoms)Blockade of the mesocortical pathway by high doses of FGA can cause secondary negative symptoms and cognitive effects. |
| Blockade of D2 receptors in the mesolimbic pathway has been proposed as a possible mechanism of antipsychotic action of first-generation agents | overactivity of this pathway is thought to decrease positive symptoms of schizophrenia. |
| Nigrostriatal pathway | antagonism and drugs used in this pathway may cause Extrapyramidal Symptoms |
| Tuberoinfundibular pathway: | Hyperprolactinemia- D2 blockade increases prolactin levels by promoting its release in the pituitary gland. |
| First Generation Antipsychotics(still used in clinical practice) | Haloperidol, Chlorpromazine (Thorazine), Fluphenazine (prolixin) |
| FGA Side Effects think Parkinson’s | Dyskinesia –movement d/o (nigrostriatal DA pathway), TD – permanent, Dystonia, neck (torticollis), arms, legs –painful – benztropine, diphenhydramine tx – IM, Akisthesia , hyperprolactinemia, amenorrhea, galactorrhea (lower dose) |
| Hyperprolactinemia | D2 blockade (tubuloinfundibular dopamine pathway) |
| Second Generation Antipsychotic Medications | 5HT2A Antagonism, Increases dopamine neurotransmission in the nigrostriatal pathway, Reduces risk of extrapyramidal symptoms.Theoretically improves negative and cognitive symptoms in schizophrenia by I increasing dopamine release in the prefrontal cortex. |
| SCA Example | Iloperidone (Fanapt) has antagonist action at D2 and 5HT2A receptors |
| The Schizophrenia Patient Outcomes Research Team (PORT) recommended treating first episodes with antipsychotics other than | clozapine or olanzapinemay be used depending on need to clear psychosis)- associated with more weight gain, insulin resistance and dyslipidemia than other antipsychotics . In addition, clozapine can cause agranulocytosis. |
| Know phases of schizophrenia | Prodrome phase- late adolescence- withdrawn- poor affect, flat, not engaging, anhedonia, poor ADLs- CBT good in this stage- ANCC wants us to know the stages |
| ACUTE PHASE- The Schizophrenia PORT recommended that first-episode patients receive antipsychotic doses in | the lower half of the recommended dose range. Ie; a first-episode pt would be tx with 1-3 mg of risperidone or 10 mg of aripiprazole daily-exception; quetiapine, may require titration to 500 to 600 mg daily. |
| STABILIZATION PHASE | The stabilization phase covers the first 6 months or more after the onset of an acute phase, during which acute psychotic symptoms decrease in severity. |
| The treatment goals during the stabilization phase are to | minimize stress and provide support to prevent relapse, enhance the patient's adaptation to life in the community, facilitate continued reduction of symptoms, and consolidate remission. |
| During the stabilization phase, monitor the patient for at least | 6 months on the same medications at the same dose used in acute phase. Prematurely lowering the dose or discontinuing medication can lead to relapse. |
| According to the APA Guideline, the overall goal of the stable phase is | "to optimize functioning and minimize the risk and consequences of relapse." |
| The goal of maintenance antipsychotic treatment of schizophrenia is to | minimize symptoms and functional impairments, avoid relapses, and promote recovery that allows self-determination, full integration into society, and pursuit of personal goals. |
| Indications for Use of antipsychotics | Schizophrenia, Schizophreniform, Schizoaffective Disorder, Delusional Disorder, Medical Conditions with Psychotic Symptoms, Mood Disorders(Bipolar/Major Depressive Disorder) with Psychotic Symptoms |
| The FDA reported in a public health advisory that the use of SGAs is associated with increased mortality ***BLACK BOX WARNING*** | .(nursing homes- linked to stroke and MI) |
| For each patient, an individual assessment and documentation of risks and benefits of therapy is necessary | The use should be assessed in a case-by-case basis. |
| Long-acting Injectable SGAs | Risperdal Consta- every 2 weeks, Invega Sustenna, monthly, Abilfy Maintena monthly, Zyprexa Relprevv monthly - Post-Injection Delirium Sedation Syndrome (PDSS) risk: 3 hour watch Clozapine (Clozaril) |
| SGA used in treatment resistant patients and can be life saving for those who respond | last resort d/t agranulocytosis, Weekly CBC x 6 months, then q 2 weeks, Only registered pharmacies may dispense & must have CBC at pharmacy, (ANC) >2000uL, Therapeutic level ~ 200 – 400 ng/ml |
| FGA also block which receptors, other than D2 | histamine-1, muscarinic-1 and alpha-1 |
| prescribing guideline for FGA | haldol (2mg), prolixin (2mg) and thorazine (100mg) |
| MOA of SGA | through fx activation of 5-HT(1A) receptors by 5-HT(2A) and D(2) receptor-mediated interaction,is basis for neurocognitive effects. Abilify may not only be a simply partial D(2) agonist but also a 5-HT(1A) agonist and 5-HT(2A) antagonist. |
| some SGA do what | are 5ht1 agonists (prefrontal cortex) and block glutamate- seroquel and clozapine, |
| antipsychotics with low weight gain | Asenapine (saphris) , Amisulpride, Aripiprazole, Lurasidone (latuda) , Ziprasidone, Haloperidol |
Created by:
arsho453
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