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Chapter 31: Antipsychotic agents and use in Schizophrenia
Terms in this set (21)
What is schizophrenia etiology and presentation?
-chronic psychotic disorder characterized by thinking, decreasing ability comprehend reality
-symptoms start in adolescence or early adulthood
What is the clinical presentation of schizophrenia?
-decreased ability to focus attention
-prominent learning and memory difficulties
-subtle changes may appear years before symptoms become florid when thinking and speech
-delusions(fixed false beliefs) and hallucinations
-suspiciousness; poor anxiety management; and diminished judgement, insight, motivation, and capacity for self care
What is the long term cure and cause of schizophrenia?
-acute exacerbations followed by intervals of partial remission
CAUSE: unknown but Amy be due to:
What are antipsychotic agents?
-chemical diverse ground of compounds
-used for diverse spectrum of disorders:
~~schizophrenia, delusional disorders, suppress emesis, treat Tourette's syndrome
-should NOT be allowed to treat dementia in older adults
BBW IN ALL ANTIPSYCHOTICS:
-increased mortality in elderly with dementi
-causes of death with mostly cardiovascular or infectious
What are First generation antipsychotics, AKA "conventional antipsychotics"?
MOA: blocks receptors for DA in CNS
-cause extrapyramidal symptoms
What are second generation antipsychotics, AKA "atypical antipsychotics"?
MOA: produce only moderate blockade of DA receptors; stronger blockade for serotonin
-fewer EPS but more wt gain, diabetes, dyslipidemias
What is drug therapy like?
-suppression of acute episodes
-prevent acute exacerbations
-maintenance of highest possible level of functioning
~Most FGA and SGA are equally effective, except Clozapine which is much more effective than the rest
~FGA: sig risk of EPS
~FGA: cost < than SGA
~SGA: risk of metabolic effects, less EPS
What are the main functions of first generation antipsychotics?
-suppress symptoms during psychotic episodes
-decrease risk of relapse
TIMELINE FOR RESPONSE:
-initial effect in 1-2 days
-substantial improvement in 2-4 weeks
-full effect in several months
-blocks DA2 receptors in mesolimbic area of the brain to suppress psychosis symptoms
-usually result of blocking receptors for DA, ACh, and NE
How are FGA's classified?
What is the adverse effect, Extrapyramidal symptoms(EPS) with use of FGA?
-four types of movement disorders resulting from effects of antipsychotic drugs on extrapyramidal motor system resulting from DA antagonism
1. acute dystonia:
-abnormal spasm in head, neck, limbs, or back
-increased risk for males
-oculogyric(involuntary in eye)
-MANAGE with anticholinergic drugs
-older age female at higher risk
-symptoms start 1-2 weeks
-chracterized by bradykinesia, drooling, stooped posture
-MANAGE with anticholinergics
-most common; greatest risk in young pt
-more often with high potent drugs
-characterixed by uncontrollable need to be in motion
4. tardive dyskinesia
-occurs in 3 months
characterized by: movement of tongue and face; lip smacking tongue flicking
-it is reversible in 1/3 to 1/2 of cases
-older pt at risk
-NO treatment; decrease dose or change to SGA
What is the risk factor Neuroleptic syndrome in people taking FGAs?
-rare, serious reaction--> with high potency FGAs
-"lead pipe rigidity, sudden high fever, sweating, BP fluctuations
-death occur from respiratory failure, dysrhythmias
-supportive measure by withdrawing from antipsychotic
-Dantrolene and Bromocriptine
what are additional adverse effects of FGAs?
-Anticholinergic effects (low potency)
What is Chlorpromazine?
FGA chem class: phenothiazines
-control behavioral problems in children
-sedation, ortho hypotension, anticholinergic
What is haloperidol?
FGA class: butyrophenone family
-prolong QT interval and cause dysrhythmias
What do 2nd generation antipsychotics do?
-deecreased risk of EPS than with FGA
-increased risk of wt gain, diabetes, dyslipidemia
What is Clozapine?
MOST EFFECTIVE ANTIPSYCHOTIC
-blocks D2 receptors with low affinity and 5-HT2(serotonin) receptors with strong affinity
-also blocks NS, histamine, and ACh
-GI: wt gain
What does Risperidone do?
MOA: stronger antagonist at 5-HT2 than at D2
-wt gain, diabetes, dyslipidemia
What is Olanzapine?
MOA: similar to clozapine in structure and action BUT....
-CAUSES LITTLE TO NO AGRANULOCYTOSIS*
-high risk of metabolic effects
What is Aripiprazole?
-'dopamine system stabilizer' (DSS)
-agonsit at 5-HT1 and D2
-antagonist at H1, 5-HT2, and alpah1
What are depot antipsychotic preparations?
-long acting, injectable formulations for long term maintenance of schizophrenia
How do you promote adherence to antipsychotic drugs?
o Ensure that medication is actually swallowed and not 'cheeked'.
o Encourage family members to oversee medication for outpatients.
o Provide patients with written and verbal instructions on dosage size and timing, and encourage them to take their medicine as prescribed.
o Inform patients and their families that antipsychotic drugs must be taken on a regular schedule.
o Inform patients about side effects and teach them how to minimize undesired responses.
o Assure patients that antipsychotic drugs do not cause addiction.
o Establish a good therapeutic relationship with the patient and family.
o Use a depot preparation for long-term therapy.
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