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NURS 572 Ch31

Ch 31 antipsychotics- schizophrenia

positive symptoms of schizophrenia exaggerate normal fxn: delusions, hallucinations, paranoia, agitation, combative, disordered speech/thought
negative symptoms of schizophrenia decreased normal function: social/emotional withdrawal, lack of motivation, poverty of speech, poor judgement/care
general MOA conventional first generation improve positive symptoms more than negative, cognitive
1st generation receptor action block dopa D2/D2a. Variably block H-1, Alpha-1, muscarinic
2nd generation receptor action MODERATE blockage of dopa D2. Moderate blocker of SEROTONIN 5HT-2. MUCH LESS variable blockage of H-1, Alpha-1, muscarinic
1st generation ADRs - group 1 EPS, parkinsonism, akathisia, DARTA, tardive dyskinesia
1st generation ADRs - group 2 agranulocytosis, sedation, orthostatic hypoTN, dermatological (sun sensitivity, contact derm)
1st generation ADRs - group 3 neuroepileptic syndrome, seizure, sexual dysfunction
name 3 first generation drugs chloropromazine, loxapine, haloperidol
chloropromazine 1st gen, low potency (orthostatic hypoTN)
loxapine 1st gen, medium potency
haloperidol 1st gen, high potency
2nd generation ADRs - group 1 lower EPS, lower histamine/alpha-1/muscarinic
2nd generation ADRs - group 2 agranulocytosis, seizures
2nd generation ADRs - group 3 diabetes, weight gain, myocarditis, prolonged QT-c
name 6 2nd generation drugs clozapine, rispiradone, olanzapine, quetiapine, ziprasidone, aripiprazole
clozapine 2nd gen, agranulocytosis likely, CBC/diff
rispiradone 2nd gen, --> EPS > 10mg
olanzapine also for bipolar
quetiapine CYP450 metab, cataracts, dislipidemia-->CAD risk factor
ziprasidone - IM greatest PT-c prolongation potential
aripiprazole long acting. partial D2/5HT-1 agonist and pure 5HT-2 antagonist
which drug must likely SE of orthostatic hypoTN chlorpromazine (1st gen)
which are most common dose related SEs 1st gen anticholinergic, orthostatic hypoTN-alpha1 blocking, sedation-histamine blocking
which 1st generation ADR is rare but irreversible tardive dyskinesia (mouth, muscles of mastication chorea-like)
which atypical/2nd generation greatest potential for QTc prolongation ziprasidone
which 2 first generation/conventionals greatest potential for QTc prolongation chlorpromazine, haloperidol
which generation of drugs in class most likely to be associated with diabetes 2nd generation atypicals - all except ariprazole
Created by: lorrelaws