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Session 4 Pharm- 1

Pharm -1- Antipsychotics

What type of disorder are the following schizophrenia, manic phase of bipolar affective disorder, schizoaffective disorders, severe states of agitation psychotic disorders
When does schizophrenia typically start 15-45 yrs
Who tends to present with schizophrenia earlier males or females males 20s vs females 30s
What are the subtypes of schizophrenia paranoid, disorganized, catatonic, undifferentiated, residual
Does subtyping of schizophrenia help you tailor the pharmacotherapy better no
Are the following positive or negative symptoms of schizophrenia- delusions, hallucinations, disorganized speech, catatonia positive
Affective flattening, alogia, avolition and anhedonia are positive or negative signs of schizophrenia negative
Acute schizophrenia and in younger patients is marked more by positive or negative symptoms positive symptoms
Chronic Schizophrenia and older pts with schizophrenia have more positive or negative symptoms predominant negative symptoms
Which symptoms positive or negative of schizo are generally more troubling to the pt and indicated a poor prognosis negative symptoms
What is the underlying neurochemistry basis for schizophrenia excess of dopamine in the mesolimbic and mesocortical pathways
What are the three treatment phases of schizophrenia acute phase (predominant positive symptoms, Stabilization phase, stable phase
Antipsychotics are split into two large groups what are they typical and atypical
are D2 receptors typical or atypical antipsychos Typical
Which type of antipsychotic is better at treating negative symptoms typical or atypicals atypicals
Which antipsychotic has more motor side effects and hyperprolactinemia typicals
Which antipsychotic group atypical or typical targets both 5HT2a receptors and D2 receptors Atypicals
The typical antipsychos are further subdivided into what two groups phenothiazines and non phenothiazines
What type of drug is chlorpromazine (Thorazine) Typical Phenothiazine antipsychotic
What type of drug is Thioridazine (Mellaril) Typical Phenothiazine antipsychotic
What type of drug is Perphenazine (Trilafon) Typical Phenothiazine antipsychotic
What type of drug is Fluphenazine (Prolixin) Typical Phenothiazine antipsychotic
What type of drug is Thioxanthene (Navane) Non Phenothiazine Typical antipsychotic
What type of drug is Haloperidol (Haldol) Non Phenothiazine Typical antipsychotic
What type of drug is Molindone (Moban) Non Phenothiazine Typical antipsychotic
What type of drug is Pimozide (Orap) Non Phenothiazine Typical antipsychotic
What is the MOA of typical antipsychotics meds potent D2 receptor family blockers, tx positive symptoms>negative (Less effective in tx of negative symptoms)
What are the side effects of typical antipsychotics motor side effects (extrapyramidal symptoms) because of blockade of dopamine receptors in nigrostriatal pathway. Neuroendocrinology side effects from blockade of tuberoinfundibular pathway
Pt is taking an typical antipsychotic and has acute dystonia, bradykinesia, rigidity, postural imbalance and akathisia what are these side effects called acute extrapyramidal symptoms
What are the chronic extrapyramidal symptoms tardive dyskinesia, Tardive Dystonia
What tx can you give to correct for the extrapyramidal symptoms of the typical antipsychos anticholinergic drugs- Procyclidine, orphendadrine, benztropine, Benadryl
Pt is having extrapyramidal side effects from their typical antipsychotic beside anticholinergic drugs what can you do to address the s/e reduce the dose, switch to an atypical antipsychotic
Pt develops Tardive Dyskinesia you decide to stop their typical antipsychotic will this get rid of their s/e no Tardive symptoms will persist even after drugs have been stopped
What drug can be given to improve the tardive dyskinesias and Dystonia that can develop with typical antipsychos clozapine
Pt is taking a typical antipsychotic and the come in complaining of discharge from their breast what is going on Typical Antipsychos block D2 receptors in tuberoinfundibular pathway that takes out dopamine inhibition of prolactin and you get high serum levels of prolactin that can cause discharge
Typical Antipsychos can also cause Autonomic and Histaminergic s/e what are they dry mouth, difficulty urinating, constipation, blurred vision, confusion, ortho hypotension, sedation from blockade of muscarinic receptors, Alpha Adrenoreceptor and H1 histamine receptor blockade
Why is haloperidol typically the typical antipsychotic used to tx acute schizophrenia has less sedation, low anti muscarinic effects and very little ortho hypotension than other typicals and is great to control positive symptoms common in acute schizophrenia
Pt needs long term tx for schizophrenia are you more likely to use a typical or atypical antipsychotics Atypical Antipsychotic
What type of drug is clozapine (Clozaril) Atypical Antipsychotic
What type of drug is Olanzapine (Zyprexa) Atypical Antipsychotic
What type of drug is Risperidone (Risperdal) Atypical Antipsychotic
What type of drug is Quetiapine (Seroquel) Atypical Antipsychotic
What type of drug is Ziprasidone (Geodon) Atypical Antipsychotic
What type of drug is Aripiprazole (Abilify) Atypical Antipsychotic
What s/e of atypical antipsychos and typical antipsychos may be especially concerning for pts self image weight gain
Which atypical antipsychos don’t cause as much weight gain Ziprasidone (Geodon) and Aripiprazole (Abilify)
What atypical antipsychotic has limited place in therapy due to fatal neutropenia clozapine
When can you use clozapine unresponsive to two other neuroleptics or has tardive dyskinesia
What must you do prior to and while administering clozapine Carefully monitor CBCs
T/F Clozapine causes hypo salivation F it actually causes hyper salivation opposite of the other antipsychos that cause dry mouth
What is the most commonly used atypical used during an acute psychotic break Olanzapine (Zyprexa)
What s/e is the most concern with Olanzapine (Zyprexa) Causes weight Gain more than other antipsychos and can cause EPS at increased doses
You don't want to give your pt Olanzapine or Haloperidol what is the next most common choice even though it also causes EPS, Hyperprolactinemia, and weight gain (though not as much as olanzapine) Risperidone (Risperdal)
Pt has Parkinson's disease and psychosis what drug would be a popular choice to tx them Quetiapine (Seroquel) causes somnolence and postural hypotension though
What place in therapy does aripiprazole (Abilify) take can tx depression as well and has minimal weight gain compared to other atypicals and typical antipsychos
When should you not use Ziprasidone (Geodon) a newer atypical antipsychotic it can cause cardiac arrhythmias in pts with baseline risk factors (elderly, preexisting cardiac disease, pts on diuretics or medication that prolongs QT interval)
Created by: smaxsmith