Term
Schizophrenia
clinical presentation |
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Definition
| (chronic) characterizes by disordered thinking, decrease ability to comprehend reality |
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Term
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Definition
| late adolescence-early adulthood |
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Term
Schizophrenia
types of symptoms |
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Definition
positive
negative
cognitive |
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Term
Schizophrenia
Positive symptoms |
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Definition
Exaggerated/distorteion of normal function.
-Hallucinations, delusions, disordered thinking, disordered speech, combative, agitation, paranoia, tension |
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Term
Schizophrenia
Negative symptoms |
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Definition
Loss or diminution of normal function.
-Social withdrawl, emotional withdrawl, loack of motivation, poverty of speech, blunted affect, poor insight, poor judgement, poor self-care |
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Term
Schizophrenia
Cognitive symptoms |
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Definition
Subtle changes that occur yrs before florid.
-Disordered thinking, decrease ability to focus attention, prominent learning & memory difficulties> leading to thinking & speech that is incomprehensible |
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Term
Schizophrenia
Acute apisodes |
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Definition
-Delusions(religious, grandiose, persecutory)
-Hallucinations (audio &/or visual)
-Feel controlled by external influences
-Disordered thinking & loose associations>irrational conversations
-Blunted affect/labile
-Misperception of reality>uncooperative & hostile
-Impaired self-care (dishelved & dirty)
-Disrupted sleep & eating patterns |
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Term
Schizophrenia
residual symptoms |
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Definition
After florid symptoms(hallucinations/ delusions) remit
-Supicious, poor anxiety mngmt, Diminished judgment, insight motivation & self care, Difficult to establish relationships, keep jobs, & function independtly, social withdrawl, Do not recognize need for medications |
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Term
Schizophrenia
long term course |
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Definition
| Episodic acute exacerbations. Some have progressuve decline in mental & social function, some stabilize, some improve |
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Term
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Definition
| (theories) genetic, perinatal, neurodevelopmental, neuroanotomic, possible dopamine activation & insufficient activation on glutamate, psychosocial stressors in susseptible pts. |
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Term
Schizophrenia
drug therapy objectives |
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Definition
| supress acute episodes, prevent acute exacerbations, maintenance highest level function |
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Term
Schizophrenia
drug therapy selection |
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Definition
effectiveness, tolerability, cost.
Antipsychotics mainstay.
Adjunct-Benzos, antidepressants |
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Term
Schizophrenia
Adherence to drug therapy |
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Definition
Barriers:tx is prolonged, pt fail to see need, pt unwilling or unable, side effects.
Enhance: ensure not cheecking, encourge family to oversee admin, give verbal & written instructions of dose size & time, inform need to take scheduled not PRN, inform of side effects & minimizing, assure know not addictive, establish therapeutic relationships, IM depots for long-term |
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Term
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Definition
| Care, support, protection (self & others), counseling (pt & family), behavioral therapy, vocational training |
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Term
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Definition
| schizophrenia, delusional disorders, bipolar, depressive psychoses, drug induced psychoses, supress emesis, Tourette's, Huntington's chorea |
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Term
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Definition
First generation/conventional
Second generation/atypical |
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Term
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Definition
Equipotent of + symptoms, SGA better w/- symptoms
FGA's-strong dopamine blockade, Higher risk EPS
SGA's-moderate Dopamine blockade & serotonin blockade, lower risk EPS, Higher cost,Significant risk Metabolic Effects (wt gain, DM, dyslipidemia, resulting in CV events & death). |
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Term
FGA
Group properties/classifications |
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Definition
Potency classification (low, med, high-differ in side effects NOT max efficacy)
Chemical classifications- 5 |
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Term
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Definition
| Block receptors in & out of CNS DA, ACh, histamine, NE |
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Term
FGA effects
in Schizophrenia |
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Definition
| Benefits suppress + symptoms by blocking DA receptors in mesolimbic area of brain. Take 1-2 days for intial effect, 2-4wks for substantial effects, months full effect |
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Term
FGA
effects by specfic receptor blockade |
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Definition
DA-EPS, prolactin release
H1-sedation
Muscarinic-dry mouth, blurred vision, urinary retention, constipation, tachy cardia
Alpha1-orthostatic hypotension, reflex tachycardia
5-HT2-wt gain |
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Term
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Definition
| EPS(all 4 types), NMS, anticholinergic, orthostatic hypotension, sedation, neuroendocrine effect, seizures, sexual dysfunction, agranulocytosis, dysrhythmias, dementia, neonatal withdrawl, photosensitivty, pigment deposits in skin cornea and lens of eye, dependence |
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Term
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Definition
| movement disorders resulting from antipsychotic drugs on extrapyramidal motor system |
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Term
| Type of FGA increases TD risk |
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Definition
Late side effect with no satisfactory tx.
Equal risk in all potency |
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Term
| Type of FGA & risk for dystonia, parkinsoniam, akathisia |
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Definition
All are early side effects and manageable w/drugs.
Lowest risk in low potency drugs |
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Term
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Definition
Severe spasms of muscle of tongue, face neck, back, oculgyric crisis (eyes roll back), opisthotonus (meningitis like spasm), severe cramping w/joint dislocation, laryngeal dystonia
-May look like psychotic hysteria
-Disturbing & dangerous (swallow/resp)
-Starts within hours of first dose
-tx w/anticholinergic IV/IM |
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Term
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Definition
Antipsychotic induced characterized by bradykinesia, mas-like face, drooling, tremor, rigidity, shuffling gait, cogwheeling, stooped posture.
-Start in first month of tx
-tx w/anticholinergics, amantadine (avoid levadopa & DA)
-resolves spontaneously within months of onset (w/d anti PD then)
-If severe switch to a SGA |
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Term
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Definition
Pacing/squirming brought on by an uncontrollable need to be in motion. Profound sense of restlessness.
-Develops in first 2 mths of tx (most frequent in high potent FGAs)
-tx BB, benzo, anticholinergic or change to low potent FGA
-differentiate from psychosis exacerbation |
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Term
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Definition
Most troubling EPS: most irreversible, risk increases w/duration & dose
Characterized by involuntary twisting, writhing, wormlike movements of tongue and face. lip-smacking, fly-catching.
Early-tongue/face movements
Late-involuntary move of limbs, digits, trunk
tx-w/d anticholinergics, gradual benzos, decrease dose FGA or change to SGA
prevent-using lowest effective dose for shortest time, assess need @12mths, neuro check q3mths for TD |
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Term
| Neuroleptic Malignant Syndrome |
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Definition
Lead pipe rigidity, sudden high fever, sweating, autonomic instability (dysrhythmias, fluctuating BP) LOC rise & fall, confused, mute, seizure, coma. Death from RF, CV collapse, dysrhythmias
tx-supportive, d/c antipsychotic, cooling blanket, IVF, benzos, dantrolene & bromocriptine. Wait 2 wks before restart FGA-lowest dose lowest potency or change to SGA |
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Term
More likely side effects
Low potency FGA |
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Definition
| Anticholinergic, orthostatic hypotension (tolerance develops in 2-3 mths), sedation (give doses at HS, subsides in a week or so), sexual dysfunction (decrease libido, difficult orgasm, erectile & ejaculatory dysfunction-switch to high potent FGA) |
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Term
More likely side effects
High potency FGA |
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Definition
| Fewest side effects, but increased EPS. |
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Term
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Definition
| All FGAs and SGAs increase mortality in elderly with dementia (HF, sudden death, infections) |
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Term
| FGAs that cause agranulocytosis |
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Definition
| Chlorpromazine and some other phenothiazines(WBC @ 1st sign of infection) |
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Term
| FGAs responsible for dsyrhythmias |
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Definition
| chlorpromazine, haldol, thioridazine, pimozide(EKGs and serum K+ periodic) |
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Term
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Definition
| 3rd trimester of pregnancy exposure>neonate experience EPS and withdrawl. tremor, agitation, sleepiness, difficulty feeding, severe breathing difficulty, altered muscle tone |
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Term
| FGA class with dermatologic effects |
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Definition
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Term
Physical and psychological dependence
FGA |
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Definition
| Rare-abrupt withdrawl can cause abstinence syndrome. Restless, insomnia, HA, gastric distress, sweating |
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Term
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Definition
| Anticholinergics, CNS depressants, levadopa & DA |
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Term
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Definition
Rare-hypotension, CNS depression, EPS
tx-antiPD drugs, IVF, alpha agonist (phenylephrine), gastric lavage. (can't use emetics-effects would be blocked by neuroleptic) |
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Term
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Definition
| Haldol, fluphenazine, trifluperazine, thiothixene, pimozide |
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Term
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Definition
| Early frequent EPS. Less sedation, hypotension, & anticholinergic. QT prolonger.Occasional neuroendocrine effects. Rare-NMS, photosensitive, seizure, impotence |
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Term
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Definition
available in IM depot, PO/IM
Extensive hepatic metabolism
preferred for Tourettes |
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Term
Fluphenazine
prescriber info |
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Definition
-high potent FGA-same side effects as others
-available in IM depot |
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Term
Pimozide
indication & prescriber info |
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Definition
-Only approved for Tourettes
-QT prolonger
-same side effect profile as other FGA
-contraindicated in concurrent use of Zoloft, Clexa, Lexapro |
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Term
Medium potent FGA
drug list |
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Definition
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Term
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Definition
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Term
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Definition
IV/PO/IM.
extensive first pass metabolism
IV/IM 10x oral level |
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Term
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Definition
| sedation, orthostatic hypotension, anticholinergic. QT prolonger Occasional neuroendocrine, photosensitive, and seizure. Low risk EPS, TD. Rare NMS & agranulocytosis |
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Term
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Definition
| CNS depressants and anticholinergics |
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Term
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Definition
| Qt prolonger. Common sedation, orthostatic hypotension, anticholinergic, weight gain, and inhibition of ejaculation. Occasional EPS, neuroendocrine and photosensitivity. Rare NMS, convulsions, agranulocytosis, and pigmentary retinopathy |
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Term
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Definition
| Clozaril, Risperdal, paliperidone, Zyprexa, Geodon, Seroquel, Abilify, Saphris, Fanapt, Latuda |
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Term
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Definition
Block dopamine and serotonin (less DA) NE, histamine, and ACh.
May be most effective drug for schizophrenia, but serious risk for agranulocytosis |
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Term
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Definition
| Rapid absorp, high protein bound, extensive metabolism P450 system, 12h 1/2 life |
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Term
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Definition
| Schizophrenia (esp. suicidal, - symptoms, and high EPS in FGAs), levadopa psychosis (preferred over FGA b/c little block DA in striatum) |
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Term
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Definition
| FATAL AGRANULOCYTOSIS, sedation, WT GAIN, orthostatic hypotension, anticholinergic, myocarditis, tachycardia, neuroendocrine(min), sexual dysfunction(min), seizure, low risk EPS/TD, new onset DM, dyslipidemia |
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Term
Clozaril
lab monitoring for agranulocytosis |
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Definition
WBC & ANC: before tx (must be normal), weekly x6mths, q2wks x6mth, monthly.
If ever WBC <3000 or ANC <1500 DC then
daily monitor WBC & ANC. If <2000,<1000 perm dc. WBC & ANC x4wks after dc |
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Term
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Definition
-Fasting blood sugar at baseline and at 12weeks then annual.
-Weight at baseline, 4,8,12 wks then q3mths
-Waist circumference baseline and annual
-Fasting lipid pannel baseline, 12wks, q5yrs |
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Term
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Definition
-report s/s infection immediatly
-regular exercise, monitor weight, calorie control(may start metformin)
-DM s/s
-myocarditis s/s
-slow positional changes (esp @ first & with dose increases)
-Rx will not be filled w/o WBC counts, only one week supply at a time |
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Term
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Definition
| Powerful serotonin blocker, less to DA. Block histamine and alpha receptors |
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Term
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Definition
| rapid acting, metabolized to active metabolites, 1/2 life 24hr (dose adjust renal/liver dysfunction) |
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Term
Risperdal
therapeutic effect |
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Definition
| relieves positive and negative symptoms of schizophrenia, improves cognitive symptoms. Significant improve in one week. TD pts, antidyskinetic effect |
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Term
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Definition
Infrequent/rare. Dose related.
EPS at high doses and w/IM, increase prolactin,wt gain, DM, dyslipidemia, agitation, dizzy, somnolence, fatigue. Excessive dose cause sedation, difficulty concentration, and sleep disruption. |
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Term
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Definition
Active metabolite of risperidone.
only difference: not extensively metabolized,no drug interactions, QT prolonger, shell passes in stool |
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Term
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Definition
| Block serotonin, DA, histamine, ACh, & NE |
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Term
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Definition
| 1/2 life 30hrs, extensive hepatic metabolism |
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Term
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Definition
Min EPS, HIGH risk metabolic effects (wt gain, DM, dyslipidemia),leukopenia/neutropenia, somnloence, constipation, anticholinergic, orthostatic hypotension, sleepwalking, writer's cramp.
OD-slurred speech & drowsy |
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Term
Zyprexa & Geodon
lab monitoring |
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Definition
| High risk pts, pre-existing low WBC or hx of drug induced leukopenia/neutropenia= CBC often during first few mths. If absolute neutrophil <1000 DC zyprexa and monitor until return to normal |
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Term
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Definition
OD possible causing CNS depression and/or delirium, EPS, joint pain, ataxia, aggression, dizzy, weak, HTN, convulsions.
-S/S develop 1-3 hours after inject and should be monitored by health care for 3 days, and no dangerous activity (driving) for remainder of day |
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Term
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Definition
| Block DA, serotonin, histamine, and alpha receptors. Block serotonin and NE reuptake. |
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Term
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Definition
| High protein bound, CYP3A4 metabolism, ^absorp w/food, 1/2 life 7hr |
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Term
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Definition
| Significant QT prolonger, somnolence, orthostatic hypotension, rash. Low risk EPS, wt. gain, DM, dyslipidemia, leukopenia/neutropenia |
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Term
Geodon & Seroquel
Drug interaction |
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Definition
| other QT prolongers, CYP3A4 drugs |
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Term
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Definition
| Improves positive and negative (less neg) and cognitive symptoms of schizophrenia. Strong serotonin, weak DA blockade. Block histamine and ACh. |
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Term
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Definition
| extensive hepatic metabolism, CYP3A4, 1/2 life 6h |
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Term
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Definition
| sedation, orthostatic hypotension, wt gain, dyslipidemia,cataracts, QT prolonger. Low risk EPS. |
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Term
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Definition
| Eye exam at baseline and q6mths, for possible cataracts |
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Term
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Definition
| Dopamine system stabilizer. Blocks histamine & alpha receptors. Partial antagonist serotonin and DA. |
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Term
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Definition
| high protein binding, CYP3A4 & CYP2D6 metabolism, prolonged 1/2 life of metabolites, 14 days to reach plateau |
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Term
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Definition
| HA, agitation, nervous, anxiety, insomnia, N/V, dizzy, somnolence. Very low EPS, NMS, lowest metabolic effect risk, orthostatic hypotension |
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Term
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Definition
| Block DA, histamine, and alpha receptors |
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Term
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Definition
| extensive 1st pass-given sublingual, CYP1A2 metabolism, 1/2 24h. Local anesthetic properties. NO food/drink for 10min after. |
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Term
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Definition
| Drowsy, hypotension, EPS w/higher doses, QT prolonger, numb mouth. Decrease risk anticholinergic, prolactin elevation, and metabolic effect |
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Term
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Definition
| Chemical r/t risperidone. Block D2 and 5-HT2 |
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Term
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Definition
| Dry mouth, somnolence, fatigue, nasal congestion, orthostatic hypotension, and wt gain. QT prolonger. Low risk EPS, DM, and dyslipidemia. |
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Term
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Definition
| CYP3A4 & CYP 2D6 metabolism. 1/2 life 18-37h. Titrate dose, BID dosing |
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Term
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Definition
| CYP3A4 metabolizer, 1/2 life 18h, food increases absorp. |
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Term
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Definition
| Somnolence, akathisia,parkinsonism, nausea, agitation, anxiety |
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Term
| Antipsychotics available in IM drug depot |
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Definition
(Reduces drug burden and reduces TD risk) Haldol, fluphenazine, risperidone, paliperidone, Zyprexa
dose q2-4wks |
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Term
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Definition
Individualized. Size and timing likely to change over time.
Initial-divided daily doses, when dose determined, HS daily dose.
Initial doses are usually high to gain control of behavior. |
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Term
| Special handling of liquid antipsychotics |
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Definition
| Dilute in milk, juice, carbonated drinks. Some light sensitive. Phenothiazines can cause contact dermatitis. |
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Term
| Initial therapy with antipsychotics |
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Definition
First week-agitation, hostility, anxiety, tension, eatign and sleeping patterns begin to normalize.
Next 6-8 weeks-Improve in socialization, self-care, mood, formal thought processes. Up to 12 wks for response |
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Term
| Maintenance therapy with antipsychotics |
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Definition
| Continue for at least 12mths after acute episode. At 12mths attempt DC is no symptoms tapering gradually |
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Term
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Definition
| Comatose, severly depressed, PD, prolactin-dependant carcinoma of breast, bone marrow depression, and severe hypotension or hypertension |
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Term
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Definition
| Glausoma, adynamic ileus, BPH, CV disease, hepatic or renal dysfunction, seizure disorder. |
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Term
| Antipsychotics to avoid in pts w/hypokalemia, hypomagnesia, bradycardia, congenital QT prolongation, dysrhthmias, MI, HF, or concurrent use of other QT prolonger |
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Definition
| Chlorpromazine, thioridazine, haldol, pimozide, ziprasidone, asenopine, iloperidone, seroquel, paliperidone |
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