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Mental Health Varcarolis Ch.4: Psychopharmacology

Terms in this set (70)

- conventional antipsychotic drugs
- neuroleptics - cause significant neurological effects
- dopamine receptor agonists (DRAs)
- reduce dopamine transmission by binding to dopamine type 2 (D2) receptors
- treat Positive Symptoms of Schizophrenia

DRUGS
low-potency / more sedation and extrapyramidal symptoms (EPS):
- chlorpromazine (Thorazine),

high-potency / less less sedation and SEff:
- fluphenazine (Prolixin),
- haloperidol (Haldol)

- haloperidol used to treat specific autistic symptoms such as temper tantrums and stereotypic behavior (repeatedly bangs head on the wall or door)

new: moderate-potency conventional antipsychotic
- perphenazine (Trilafon)

SEff
- Photosensitivity

extrapyramidal syndrome:
- dystonia (muscle stiffness),
- jerky and involuntary movements of the head and arms
- akathisia (restlessness),
- tardive dyskinesia (TD),
- drug-induced parkinsonism
- S&S fast alleviated by Benztropine

acute dystonic reaction (ADR)
- more likely to occur early in treatment with a high-potency neuroleptic, especially if the patient uses cocaine.
- involuntary tension or spasm of muscles of head, neck, & tongue
- Grotesque look: head and upper head twist to side, eyes bulge slightly, deviate to right
- Tongue protrusions
- Symptoms worsen w/ stress and improve w/ voluntary muscle activity

neuroleptic malignant syndrome (NMS):
- rare but life-threatening complication with autonomic, motor, and behavioral symptoms:
- severe muscle rigidity, confusion, agitation, and increased temperature, pulse, and blood pressure.

blocking muscarinic cholinergic receptors:
- blurred vision, dry mouth, constipation,
and urinary hesitancy.

antagonism of the H1 receptors:
- sedation and weight gain.

blocking α1-receptors for norepinephrine:
- affect vasodilation => drop BP, or orthostatic hypotension.

antagonism of α1-receptors or 5-HT2 receptors:
- ejaculatory dysfunction.
- atypical antipsychotic drugs
- serotonin-dopamine antagonists (SDAs)
- higher ratio of serotonin (5-HT2) to dopamine D2-receptor blockade than FGA DRAs
- lower risk of extrapyramidal side effects (EPS)
- target negative and positive symptoms of schizophrenia
- some have significant anticholinergic and antihistaminic activity
- prolongation of the QT interval, which can be fatal with history of cardiac dysrhythmias
- baseline electrocardiogram before treatment

Risk of Metabolic Syndrome:
- Increased weight
- Increased blood glucose
- Increased triglyceride levels
- Insulin resistance

Monitor for:
- body weight,
- body mass index (BMI),
- waist circumference,
- fasting plasma glucose level,
- fasting lipid profile.

Metformin — medication used to regulate blood glucose level — reduces weight gain and waist circumference when used as an adjunct to SGAs.

DRUGS and SEff
clozapine (Clozaril)
- may suppress bone marrow, resulting in
agranulocytosis
- SSRIs elevate concentrations => seizures
- drooling (hypersalivation) - may be
relieved by sublingual drops of atropine
- weight gain up to 20 pounds within 1 year

olanzapine (Zyprexa)
- weight gain up to 20 pounds within 1 year
- administer at bedtime
- Olanzapine pamoate (Zyprexa Relprevv) - extended release injectable suspension: warning for postinjection delirium/sedation => 3 hours of continuous observation in a certified health care facility.

risperadone (Risperdal)
- EPS may occur if dosage is only slightly higher than the effective dose
- monitored for motor difficulties if dosage exceeds 4 to 6 mg/day
- orthostatic hypotension and sedation, risk for falls
- weight gain
- sexual dysfunction
+
paliperidone (Invega) - extended-release tab
- used in schiz and schizoaffective disorder and as an adjunct to mood stabilizers or antidepressants.
- morning administration is recommended
+
paliperidone palmitate (Invega Sustenna) - once-monthly deltoid or gluteal injection.

quetiapine (Seroquel)
- immediate-release (IR) - ideal hypnotic due to somnolence effect
- extended-release (XR) - milder sedation - schizophrenia and bipolar disorder
- weight gain / metabolic syndrome
- orthostatic hypotension

ziprasidone HCl (Geodon)
- dizziness and sedation
- rare: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
- always take with food which double absorption

aripiprazole (Abilify)
- reducing positive symptoms of schizophrenia
- improve depression and anxiety
- in use with venlafaxine, higher remission rates for older Pts with treatment-resistant depression, but akathisia can occur (feeling of inner restlessness and inability to stay still)
- in vial for IM - control of agitation in schizo or bipolar
+
Abilify Maintena - once-monthly IM for schizo after stabilized with oral aripiprazole

iloperidone (Fanapt)
- orthostatic hypotension

lurasidone HCl (Latuda)
- monotherapy for major depressive episodes in bipolar I disorder
- adjunctive therapy with lithium or valproate
- take with food for higher absorption (at least 350 Cal)
- avoid grapefruit juice: increases lurasidone concentrations

cariprazine (Vraylar)
- improve negative symptoms of schizo
- taken once a day for schizo and bipolar
Black Box warning: increased death in older people with dementiarelated psychosis.
+
brexpiprazole (Rexulti)
- treats schizophrenia
- used as an add-on in MDD

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