Schizophrenia drugs and treatments
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| another word for antipsychotics | neuroleptics
major tranquilizers
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| how neuroleptics work | 1) block dopamine receptors
2) block dopamine and serotonin receptors
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| time frame for neuroleptic results | full effect in 3-6 weeks
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| problem with neuroleptics | 10% of pts don't respond
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| paradigm of thirds | 1) 1/3 achieve significant and lasting improvement
2) 1/3 achieve some improvement with intermittent relapses and residual disability
3) 1/3 experiences severe and permanent incapacity and do not respond to meds
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| sex that responds better to antipsychotics | women
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| overall effects of neuroleptics | 1) decrease hallucinations
2) decrease delusions
3) improve cognitive state
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| imperative education for pts and their families when neuroleptics are started | they need to know that results are not immediate and improvement may not happen until over a month after the drug therapy is started
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| classes of neuroleptics | 1) typical
2) atypical
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| typical neuroleptics | 1) older class
2) work on positive signs and symptoms
3) more side effects
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| atypical neuroleptics | 1) newer generation
2) work on positive and negative symptoms
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| Forms of neuroleptics | 1) oral (tabs, liquids)
2) parenteral
3) long-acting
4) decanoate forms
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| contraindications: typical neuroleptics | 1) known hypersensitivity
2) comatose state
3) CNS depression evident
4) parkinson's or narrow angle glaucoma
5) liver, renal or cardiac insufficiency
6) controlled seizure disorders
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| typical neuroleptics that are not compatible and why | prolong the QT interval
1) thioridazine
2) pimozide
3) haloperidol
4) molindone
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| contraindications: atypical neuroleptics | 1) hypersensitivity
2) comatose
3) severe depression
4) dementia-related psychosis
5) lactation
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| atypical neuroleptics that are not compatible and why | prolong QT interval
1) ziprasidone
2) risperidone
3) paliperidone
4) iloperidone
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| interactions: typical | 1) additive hypotensive effects (anti-HTN)
2) additive CNS effects (CNS depressants)
3) additive anticholingeric effects (anticholinergics)
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| side effects: DA blockage | 1) extrapyramidal symptoms (EPS)
2) prolactin elevation
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| side effects: cholinergic blockage | 1) dry mouth
2) blurred vision
3) constipation
4) urinary retention
5) tachycardia
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| side effects: alpha1 adrenergic blockage | 1) dizziness
2) orthostatic hypotension
3) tremors
4) reflex tachycardia
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| side effects: histamine blockage | 1) weight gain
2) sedation
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| other side effects | 1) photosensitivity
2) seizures
3) agranulocytosis
4) diabetes
5) skin rash
6) ECG changes
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| treatment: dry mouth | 1) give sugarless candy, gum, ice, frequent sips of water
2) strict oral hygiene
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| treatment: blurred vision | 1) explain that it will subside after a few weeks
2) don't drive car until vision clears
3) clear small items from pathways to prevent falls
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| hormonal side effects in men | 1) decreased libido
2) retrograde ejaculation
3) gynecomastia
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| hormonal side effects in women | reversible amenhorrhea. continue on contraceptives.
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| agranulocytosis: what, which drug, when | 1) low WBC
2) typical, clozapine
3) usually occurs during first 3m of treatment
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| agranulocytosis: symptoms, reaction | 1) sore throat, fever, malaise
2) get a count
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| special precautions for clozaril | 1) baseline WBC and absolute neutrophil count before
2) weekly counts for the first 6m of treatment
3) only 1w supply dispensed at a time
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| hypersalivation: what drug, treatment | 1) clozaril
2) sugar free gum to increase swallowing rate
3) anticholingeric meds like scopolamine patch or clonidine
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| EPS: states, causes | 1) 75% of ppl get them
2) caused by low DA
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| EPS | 1) pseudoparkinsonism
2) akinesia
3) akathisia
4) acute dystonia
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| pseudoparkinsonism | 1) tremor
2) shuffling gait
3) drooling
4) rigidity
5) lack of arm swing
6) masked fascies
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| pseudoparkinsonism: when, who | 1) 1-5d after initiation of meds
2) women, elderly, dehydrated pts
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| masked fascies | face not animated bc muscles aren't moving
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| treatment of pseudoparkinsonism | 1) anticholinergics
2) reduce dose
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| pseudoparkinsonism: drugs | 1) artane
2) cogentin
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| akinesia | 1) muscle weakness
2) fatigue
3) slow movement
4) painful muscles
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| akinesia: treatment | anticholinergics (same as pseudoparkinsonism)
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| akinesia: drugs | same as pseudoparkinsonism
1) artane
2) cogentin
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| akathisia | 1) continuous restlessness and fidgeting
2) restless legs/can't sit still
3) anxiety
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| akathisia: stats, dangers, who, when | 1) 20-50% pts affected
2) most linked w non-compliance and suicide
3) can be misinterpreted as exacerbation of symptoms
4) women
5) 50-60d after start of therapy
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| akathisia: treatment | 1) change antipsychotic
2) anti-anxiety drugs
3) anticholinergics
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| akathisia: anti-anxiety drugs | 1) inderal
2) ativan
3) valium
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| akathisia: anticholinergics | 1) artane
2) cogentin
3) benadryl
4) symmetrel
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| acute dystonia | 1) involuntary spasms
2) abnormal postures
3) rigidity in face, arms, legs, neck
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| types of dystonia | 1) oculogyric crisis
2) torticollis
3) laryngeal/pharyngeal constriction
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| oculogyric crisis | contracted positioning of the eyes. Eyes pulled in one direction or rolled back
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| torticollis | contracted positioning of neck muscles. Pull neck to one side
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| laryngeal/pharyndeal constriction | 1) gagging
2) cyanosis
3) respiratory distress
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| acute dystonia: treatment | 1) IV cogentin
2) IV benadryl
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| tardive dyskinesia | abnormal muscle movement, especially of face, tongue, mouth, fingers or toes
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| tardive dyskinesia: treatment | 1) no effective treatment
2) often irreversible
3) withdraw drugs at first sign
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| tardive dyskinesia: first sign | vermiform movements of the tongue
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| neuroleptic malignant syndrome (NMS) | hyperactivity of sympathetic nervous system
1) muscle rigidity
2) tachypnea
3) hyperpyrexia
4) tachycardia
5) fluctuations in BP
6) incontinence
7) confusion/delirium
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| NMS: cardinal sign | hyperpyrexia: 101-107 degree fever
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| NMS: stats, when | 1) rare. 1-2% of pts
2) 14-30% mortality rate
3) onset can happen at any point in treatment form hours to years, but progression is rapid
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| NMS: treatment | 1) d/c antipsychotics immediately
2) place on medical unit
3) drugs to counteract
4) cool pt
5) hydration
6) cardiac monitoring
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| NMS: meds and what they do | 1) parlodel: relieve muscle rigidity/DA blockage decreased
2) dantrium: relax muscles
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| NMS: caution w geodon | have baseline EKG before it bc it causes electrical abnormalities in the heart
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| education for meds | 1) review side effects
2) caution about OTC meds
3) don't d/c meds without talking to dr
4) use sunscreen and protective clothing
5) report sore throat, fever, bleeding
6) WBC every week for clozaril
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| OTC meds that may interact | 1) cold meds
2) diet pills
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| general principles when around schizophrenic patients | 1) be calm around pt
2) keep promises
3) be consistent in care
4) set limits
5) don't touch without warning in paranoid pts
6) avoid laughing/whispering
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| how to treat the schizophrenic pt | 1) don't reinforce hallucinations or delusions
2) reality orientation
3) encourage verbalization
4) if withdrawn, spend one on one time
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| effects of smoking on neuroleptics | increases metabolism
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