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NRSG Pharm CH 17

Psychoses

QuestionAnswer
Psychoses characterized by: Delusions, hallucinations, disorganized, difficulty relating, paranoia. Acute/Chronic.
Abnormal thoughts, disordered communication, withdrawal from other people/environment. Severe depression HIGH SI rick Men 15-24 Schizophrenia
Positive sx schizophrenia ADD to normal behavior - hallucinations, delusions, paranoia irrational behavior, actions, rapid alternations between hyperactivity and stupor
Negative sx schizophrenia SUBTRACT from norm Lack of motivation, detachment, deterioration of hygiene, job, academic, withdrawal from social and interpersonal
Schizophrenia pathology overactive dopaminergic pathways - D2
Conventional/typical antipsychotics: Phenothiazines: -1st gen, + sx Chlorpromazine Nonphenothiazines: haloperidol (Haldol) (also + sx)
Atypical antipsychotics: 2nd gen, 1st line, both + and - sx, fewer side effects risperidone (Risperdal) aripiprazole (Abilify)
Chlorpromazine classes, mech T: 1st gen antipsychotic, schizophrenia drug P: phenothiazine D2 receptor antagonist, controls + sx of schizophrenia and manic of schizoaffective disorder several wk before improvement
chlorpromazine side/adverse: dizziness, drowsiness, sedation, ortho hype, sex dysfunction EPS NMS parkinsonism tardive dyskinesia
NMS s/s Neuroleptic Malignant Syndrome: elevated temp, unstable BP, profuse sweating, dyspnea, MUSCLE RIGIDITY, incontinence
EPS s/s Extrapyramidal Symptoms Acute dystonias - muscle spasms in face, tongue, neck, back akathisia - inability to relax, pacing pseudoparkinsonism - tremor, muscle rigidity, stooped posture tardive dyskinesia - wormlike movement of tongue, chewing, grimac
Phenothiazine drugs adverse Acute dystonias, akasthia, anticholinergic, disparity, hypotension, NMS, parkinsonism, sedation, sex dysfunction, tardive dyskinesia
haloperidol (Haldol) classes, mech T: conventional antipsychotic, schizophrenia P: NON-phenothiazine D2 receptor antagonist
haloperidol (Haldol) uses acute and chronic psychotic disorders, + sx only, high potency
haloperidol (Haldol) side/adverse less sedation and hypotension than chlorpromazine high incidence EPS NMS rare but can occur DO NOT D/C abruptly
risperisdone (Risperdal) classes, mech T: Atypical antipsychotic, schizophrenia drug P: D2 dopamine receptor antagonist, serotonin receptor antagonist
risperidone (Risperdal) uses: 1st line drug for tx of schizophrenia anf acute mania of bipolar + and - sx control several wk for effectiveness
risperidone (Risperdal) side/adverse Less dramatic but still sig. EPS, hyperactivity or fatigue, dizziness, visual dist, ortho hypo, wt gain hyperglycemia kava, valerian, or chamomile may inc CNS dep BLACK BOX: inc risk death older adults with dementia-related psychosis
aripiprazole (Abilify) classes, mech "3rd gen" antipsychotic, Dopamine-serotonin system stabilizer Dopamine partial agonist - acts as if weaker form dopamine is occupying receptor, more milder, stabilizing effect both + and - sx low incidence of serious side effects
aripiprazole (Abilify) side/adverse: tachy, transient fever, sedation, dizziness, headache, light-headed, somnolence, anxiety, nervousness, hostility, insomnia, N/V, dry mouth, constipation, parkinsonism, EPS, agranulocytosis, ortho hypo, NMS
Created by: kmulla
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