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96 Cards in this Set
- Front
- Back
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First Generation antipsychotics MOA
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D2 receptor blockers
Tx of positive sx EPSE (nigrostriatal) hypothalamic/Pituatry |
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Second Generation Atpyicals
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5HT2 Blockers -- tx positive sx and tx negative sx
Less D2 blockage -- Minimal EPSE |
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Schizophrenia Def by G&G
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Idiopathic psychoses characterized by chronically disordered thinking and emotional withdrawal
often associated with delusion and auditory halliucinations |
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What are the two types of delusions
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Delusional disorders
Paranoia |
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Positive sx
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Psychotic dimensions -- inferential thinking (delusions)
perception (hallucinations) disorganization dimension -- language and communications (disorganized speech) -- behavoiral monitoring (grossly disorganized or catonic behavior) |
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Negative sx
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Decreased range and intensity of emotional expression (affective flattening) Decreased fluency and productivity of thought and speech (alogia) reduced initiation of goal-directed behavior
-impaired ability to make decisions, social withdrawal, lack of motivation |
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decreased fluency and productivity of thought and speech
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alogia
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Reduced initiation of goal directed behavior
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avolition
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impaired ability to make decisions, social withdrawal, lack of motivation
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abulia
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chlorpromazine
what is generic |
Thorazine
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Mellaril
what is generic |
thioridazine
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trilafon
what is generic |
perphenazine
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stelazine what is generic
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Trifluoperazine
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Haloperidol
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Haldol
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Prolixin what is generic
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Fluphenzine
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Navan what is generic
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Thiothixine
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Moban what is generic
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Molindone
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Loxitane what is generic
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Loxapine
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what are the 4 pathways
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Nigrostriatal pathway
Tuberoinfundibular pathway Medulla limbic and coritcal pathway |
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Nigrostrital D2 blockage
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EPS side effects:
acute dystonic reactions akathesias pseudoparkinsonism neuroleptic malignant syndrome Perioral tremor tardive dyskinesias |
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D2 blockage in the limbic and cortical areas
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Antipsychotic effects
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D2 blockage in the tuberoinfundibular pathway
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Decrease release of growth hormone
decrease release of prolacting release inhibiting hormone so there is increases in prolactin release menstrual changes breast engorgement galactorrhea |
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DA blockage in the Chemoreceptor trigger zone
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antiemetic effect
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what other Neurotransmitters do typical antipsychotics act on
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a1 -- sedation, othrostatsis
anticholingeric (anti -SLUD) |
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Atypical antipsychotic
list the pathways of D2 blockage and what it does |
limbic -- antipsychotic
nigrostriatal -- Neuroloigcal/EPSE tuberoinfundibular -- hypothalamus pituitary medulla -- antiemetic |
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what else do atypical antipsychotics Neurotransmitters work on
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Blocks: 5HT2A -- antipsychotic
Blocks: 5HT2C increases appetite Blocks: M1 (mACH blockage) offset EPS, GI alterations, consitpation, urinary retention, cognitive blunting, dry mouth A1 blockage: sedation, orthostatsis, miosis/mydriasis H1 Blockage: sedation & weight gain |
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Clozapine
receptors |
Strong 5HT2 blockage
weak D2 blockage similar to first generation anticholingeric, a & b adrenergic block, H1 block |
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Clozapine indications
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"gold standard" for severe refactory schizophrenics
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ADR Clozapine
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Fatal Agranlocytosis
dose dependent seizure NMS Tardive dyskinesias Paradoxical hypersalviation weight gain |
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Risperdone receptors
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Strong 5HT2 blockage
at high concentrations has strong D2 blockage alpha blocker H1 blocker No antimuscarinic or beta adrenergic blockage |
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Risperdal ADR
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sedation
dose <6 low EPS dose >6 higher EPS weight gain Elevated prolactin, glactorrhea, amenorrhea NMS hyperprexia muslce rigidity TD potential pro-arrhythmic NO aticholineric |
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Risperdal precautions
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Orthostiac hypotension
priapism seizures hyperprolactinemia poetnatial cognitive and motor impairment disruption body temp regulations |
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Olanzapine receptor
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strong 5HT2 block
less D2 blockage antimuscarinic a block weak action GABAa |
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schizoaffective disorder
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have sx of both schizophrenia and mood disorder (depressive or bipolar type)
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diagnosis of schizophrenia
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lasts for at least 6 months and includes at least 1 month of >2 active phase signs and sx
Delusions, Hallucinations, disorganized speech, grossly disoganized or catatonic behavior |
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positive sx
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hallucinations, delusions, disorganized behavoir, disorganized thinking catatonia
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negative sx
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affective flattening (lack of expression) alogia, asociality (lack of social interaction) avolition (dec in goal-directed behavior)
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in diagnosis a schizophrenic what do you need to R/O
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schizoaffective disorder
drug-induced psychosis (amphetamine, cocaine, MJ, pehncyclidine LSD, EtOH, excessive anticholingerics (have VH) R/O personality disorders like schizoid or paranoid personality disorder |
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Chlorpromazine
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Thorazine
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Thorazine dose
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300-1500mg/d
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what SE do high potency antipsychotics have
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EPS, hyperprolatic
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what SE do low potency have
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sedation, anticholingeic, orthostatic hypotension
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Thioridazine
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Mellaril
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Mellaril dose
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300-800mg/d
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Loxapine
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Loxitane
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Loxitane dose
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50-225mg
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perphenazine
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trilafon
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trilafone dose
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32-96mg/d
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Olanzapine what chemicals does it work on
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strong 5HT2 block
less D2 and other DA receptor blockade antimuscarniaic alpha adrenergic block H1 block |
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ADR with olanzapine
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weight gain
anticholingeric can be a problem increase blood glucose |
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quetiapine chemicals
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less D2 blockage
minimal anticholingeric |
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ziprasidone chemicals
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5HT2 blocker
5HT1 blocker -- anxioltyic effects D2 blocker blocks 5HT and NE reuptake |
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quetiapine ADR
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orthostatic hypotension
weight gain |
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ziprasidone ADR
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prolong QTc interval if longer than >500msc D/C drug
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Aripiprazole chemicals
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partial D2 agonist
partial 5HT 1 antag potent 5HT2 |
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Aripiprazole ADR
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HA anxiety insomnia lightheadesdness akathesiai
N/V constipation |
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the person believes that he is being tormented, tricked, followed, watched, subjected to ridicule, most common
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paranoia
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the person belives that certain incidents and external events area specifically directed to him or have special meaning
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referential
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person belives that something has occurred within one;s body or has a physical disorder
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somatic
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person has exaggereated sences of one's importance or believes to have a special relationship with another famous person or deity
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grandiose
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person believes that one;s thoughts are being sent to the outside -- can cause fear and increase paranoia
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thought broadcasting
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person belives that thoughts are being placed into one's mind by outside forces (pt will wear walkmans, caps, and tinfoil to protect themeslves from these thoughts
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Thought insertion
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connected stream of thoughts, however, answers to questions may be oliquely related to completely unrelated person gets "off the subject"
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trangential
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connected stream of thoughts however answers to questions involves excessive use of details -- like going around in a big circle
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circumstantial
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interrupted stream of thoughts and requires the interview to repeat the questions -- may be atributed to a recent hallucination
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blocking
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unrelated stream of thoughs; person may slip of track from one topic to another
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loose associations/deraliment
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words are not linked together byt meaning, speech is severley disorganized and nearly incomprehesible
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word salad
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seneless sentences dictated by similary of sounds rhyming
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clanging
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Low potency antipsychotics
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Thorazine, Mellaril, Serentil
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Mid potency antipsychotics
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loxapine, molindone, perphenazine
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mid/high
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stelezine, navane,
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high
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prolixin, haldol
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Typical antipsychotic for rapid tranquilization
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BZD are used with AP
Haloperidol + benztropine + lorazepam administer IM q1-4hrs until pt is clamed |
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Prolixin deconate dosing
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PO dose/25 = #ml given q2-3d
PO overlap beyond the second injection not needed elimination half life ~1.5wks |
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Haloperidol deconate dosing
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PO dose x (10-15) = Dose mg IM deconate per month
PO overlap may be for several weeks |
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dosing clozapine
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12.5-25mg/d
titrate the dose by 25mg qd until 300-450mg/d give 2wks for response max dose 900mg/d |
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clozapine agrnulocytosis
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WBC<3500 cells or ANC<2000 CI
WBC<3000 or ANC<1500 Interrupt therapy WBC<2000 or ANC<1000 stop therapy |
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risperdal dosing
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start with 1mg bid
increase by 1-2mg q4-7d therapetuic dose 2-4 up to 6-8 |
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risperdal consta
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store in refrigerator
admin q2wks after inital IM injection there is a 3wk lag time of medication release start injection |
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Olanzapine dosing
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start 5-10mg qhs
range:5-20mg/d smoking may require higher doses |
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quetiapine dosing
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start 25mg bid increase by 25-50mg q2-3d therapeutic 300-400mg/d MAX 750-800/d
baseline and q6months eye exams |
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ziprasixone dosing
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dosing start 40mg bid may increase up to 80mg bid with food
BID dosing |
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ziprazidone IM dosing
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10mg q2hrs or 20mg q4hrs
NTE 40mg/d duration of action 4hrs |
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Abilify MOA
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dopamine-serotonic system stabilier
Partial D2 (post and pre) autoreceptor agonist 5HT2 receptor partial agonist |
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abilify dosing
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10-15mg qd up to 30mg/d
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Atypical dosage forms
oral diintegrating tabs |
olanzapine, Risperdal,
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Oral solution
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riperdal and abilify
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IM for rapid injection
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geodon, zyprexa, abilify
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IM for long-acting
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risperdal consta
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olanzapine CYP
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substrate for 1A2
inhibitors of 1A2: fluvoxamine Tacrine |
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Clozapine CYP
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substrate for 1A2
inhibitors of 1A2: fluvoxamine Tacrine |
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Risperdal CYP
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substrate 2d6
inhibitors of 2D6: paroxetine, fluxetine, haloperidol |
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Aripiprazole CYP
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substrate 2d6
inhibitors of 2D6: paroxetine, fluxetine, haloperidol |
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Quetiapine CYP
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substrate 3A4
Inhibitors: fluxetine, cimetidine protease inhibitors grapefruit juice |
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Ziprasidone CYP
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substrate 3A4
Inhibitors: fluxetine, cimetidine protease inhibitors grapefruit juice |
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ariprazole CYP
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substrate 3A4
Inhibitors: fluxetine, cimetidine protease inhibitors grapefruit juice |
