Question | Answer |
What is the cause of Schizophrenia | unknown, but deals with excessive dopamine and possibly serotonin in brain, it is genetic and biological |
How effective are Antipsychotics in improving symptoms of Schizophrenia? | >60% of patients improve and maybe more w/ 2nd generations drugs |
What are symptoms of an acute schizophrenic episode? | delusions (religous, grandiose, or persecutory) and hallucinations consisting of voices arguing or commenting on behavior |
After acute schizophrenic episodes, what may remain? | residual symptoms including suspiciousness, anxiety, and diminsed judgement which make it difficult to maintain close relationship and employment |
What are the most common 2nd Generation (Atypical) Antipsychotics? | Aripiprazole (abilify), Clozapine (Clozaril), Quentiapine (Seroquel), and Risperidone (risperdal) |
What is the Antipsychotic drug of choice? | 2nd Generation Antipyschotics because they have lower incidence of adverse effects, (especially EPSE) and improved efficacy |
What is the MoA of 2nd Generation Antipsychotics? | Block serotonin and dopamine receptors
block alpha 1, h2, and muscarinic |
what is the main difference between 1st and 2nd generation antipsychotics? | 2nd gen block serotonin receptors more than D2 receptors causing lower risk of extrapyramidal SE and less adverse effects while being more efficient |
What is the therapeutic use of 2nd Generation antipsychotics/ | FDA approved for schizophrenia, schizoaffective disorder, bipolar, treatment-resistant depression, agitations, rritability, and aggression in autism |
What are some adverse effects of the 2nd generation Antipsychotics | sedation, sexual dysfunction, poor blood glucose controle, risk of type 2 diabetes, antiholinergic SE, hyperprolactinemia, EPSE, weight gain, torsods, fatal dysrhythmia, ortho hypotention |
What are EPSE (extrapyramidal side effects)usually caused by? | Dopamine blockade which happens in 2nd gen. antipsychotics |
What are the EPSE in order from least effective to most | Acute dystonia, akathisia, parkinsonism-like movement disorders, tardive dyskinesia |
what is acute dystonia | EPSE develops within first days of antipsychotic therapy with symptoms of severe spasms of tongue, face, neck or back muscles |
Is acute dystonia a medical emergency? | Yes, call 9-1-1 and treat with anticholinergic drugs |
What is Akathisia? | EPSE occuring within first few months of therapy, showing symptoms of pacing, dquirming and need to be in motion. Mistaken for anxiety or exacerbation of psychoses |
What is Parkinsonism-like movement disorders? | occurs within first few months causing bradykinesia, drooling, tremor, rigidity, shuffling gait, cogwheeling, stooped posture
overall slowness of movement and looks like parkinsons disease |
How is Akathisia treated? | May respond to anticholinergic drugs |
How is Parkinsonism-like movement disorder treated? | anticholinergic drugs, amantadine, or propranolol
antiparkinson drugs (levodopa or bromocriptine) counteracts EPSE but worsens schizophrenia |
What is Tardive Dyskinesia | EPSE long-term therapy causes involuntary movement of tongue or face (rapid blinking, facial tics, lip-smacking, tongue twisting, tongue flicking out of mouth |
What effects can tardive dyskinesia have if not recognized early? | symptoms can be irriversible, can effect eating |
how is tardive dyskinesia treated? | if early: switch to 2nd gen agent or reduce doses, cannot use anticholinergic or anti-parkinsons drugs to reverse symptoms |
what are common 1st Generations (typical) Antipssychotics | Haloperidol (Haldol) |
What is the MoA of 1st generation antipsychotics? | block dopamine receptors (mainly D2) which increases orthostatic hypotension and hyper pholactinimia |
What is the therapeutic use of 1st gen antipsychotics | similar to 2nd gen. but less used for off-label uses, antiemetic |
What are the adverse effects of 1st gen antipsychotics? | same as 2nd gen with increased risk of EPSE and anticholinergic SE,
orthostatic hypo, anticholinergic SE and sedation education |