Antipsychotic (Neuroleptic Drugs)
Terms
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- A group of mental disorders characterized by a marked thought disturbance and an impaired perception of reality
- Psychoses
- severe paranoid disorders and this type of depression are examples of what group of mental disorders?
- Psychotic disorders
- What is the name of drugs used to treat very severe psychiatric illnesses?
- Antipsychotic or neuroleptic drugs
- what do Antipsychotic or neuroleptic drugs help do?
- Beneficial effects on mood and thought
- What drugs were used previously to help people with psychoses?
- Strong sedative-like drugs were used to pacify patients which had side effects of impaired motor skills
- Schizophrenia is characterized by...
- delusions, hallucination (often hearing voices), thinking and speech disturbances
- Schizophrenia is a form of _______. It initially affects people during _______.
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psychosis
adolescence - This form of psychosis is a _____and disabling disorder affecting ~ _________% of the population.
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chronic
1% - Schizophrenia is genetically inherited and may involve biochemical changes such as...
- overactivity of the mesolimbic dopaminergic neurons
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Etiology of Schizophrenia:
It could be caused by...
*Hint: 5 possibilities -
1. overactive dopaminergic pathway in certain parts of the brain such as the limbic system
2. Excessive dopamine synthesis
3. Decreased dopamine breakdown
4. Increased post-synaptic dopamine receptors
5. Combination of these and other factors - Is the Etiology of Schizophrenia fact or theory?
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THEORY...because most antipsychotics block dopamine receptors.
MORE RESEARCH NEEDED -
Antipsychotics
Mechanism of Action: - Blockade of DOPAMINE RECEPTORS in the brain and periphery. Clinical efficacy of drugs related to their ability to antagonize D2 receptors i nthe mesolimbic pathway.
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Antipsychotics
Mechanism of Action for NEWER DRUGS: - Newer atypical drugs such as clozapine and risperidol act by blocking SEROTONIN RECEPTORS in addition to effects on dopamine receptors
- Other receptors that may be affected by the Antipsychotic drugs are...
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Cholinergic receptors
Alpha-adrenergic receptors
Histamine receptors - Antipsychotic Pharmocological Actions:
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1. Antipsychotic actions
2. Extrapyramidal Syndrome (EPS)
3. Antiemetic Effects
4. Antimuscarinic Effects - Name the Pharmacological Actions for: Antipsychotic Actions
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1. reduction of hallucinations and agitations associated with schizophrenia
2. Produces a calming effect and reduces spontaneous physical movement
3. Usually takes several weeks to occur (approx. 6 weeks) - What is important to know about taking someone off of Antipsychotics?
- Must withdraw the medicine SLOWLY
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Name the Pharmacological Actions for:
Extrapyramidal Syndrome (EPS) -
1. Parkinsonian symptoms, akathisia=motor restlessness, tardive dyskinesia=inappropriate postures of the neck,trunk and limbs occur with chronic treatment
2. Probably due to blockade of dopamine receptors in nigro-striatal pathway - Which drugs have a low incidence of EPS?
- Clozapine and Risperidone
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Name the Pharmacological Actions for:
Antiemetic Effects (prevent nausea and vomiting) -
1. Most neuroleptics have antiemetic actions
2. Probably due to blockade of dopamine D2 receptors of the chemoreceptor trigger zone in the medulla -
Name the Pharmacological Actions for:
Antimuscarinic effects - Most neuroleptics cause anticholinergic effects (e.g. blurred vision, dry mouth, sedation, confusion, constipation and urinary retention)
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Other effects of Antipsychotics
HINT: 3 of them -
1. Orthostatic hypotension and lightheadedness (blockade of alpha-adrenoceptors
2. Poikilothermia = body temperature varies with the environment
3. Increase in prolactin release (blocking D2 receptors in the pituitary) - Define Poikilothermia
- body temperature varies with the environment
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Pharmacokinetics of Antipsychotics:
Administration (two points)
Where is it metabolized -
1. Orally or parenterally
2. Fluphenazine & Haloperidol can be injected (i.m.) as a slow release preparation every three weeks
*Useful for treating outpatients who are non-compliant with oral formulas
3. liver -
Extrapyramidal motor symptoms-induced by excessive cholinergic influence. Triggered by blocking the inhibitory effect of dopamine on cholinergic neurons.
EPS includes
-tardive dyskinesia
-pseudoparkinsonian effects
-dyskinesia a - Side effects of Antipsychotics
- Side Effects of Antipsychotics
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Extrapyramidal motor symptoms-induced by excessive cholinergic influence. Triggered by blocking the inhibitory effect of dopamine on cholinergic neurons.
EPS includes
-tardive dyskinesia
-pseudoparkinsonian effects
-dyskinesia and dystonia
-Neuroleptic malignant syndrome (NMS) - What are the characteristics of Tardive Dyskinesia?
- Involuntary, fragmented mvmts. Rhythmic mvmts of mouth,tongue and jaw; pts often produce involuntary sucking and smacking noises; muscle rigidity and slurred speech may occur
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TRUE OR FALSE
The side effect, Tardive Dyskinesia is reversable? - TRUE
- In some patients, prolonged holiday from neuroleptic drugs may cause symptoms to _______ or ________ within 3 months
- diminish or disappear
- What population is more susceptible to Pseudoparkinsonism?
- Elder pts are more susceptible because of lower brain dopamine level
- Symptoms of ______ usually disappear when the dosage is adjusted or the drug is withdrawn.
- pseudoparkinsonism
- What are the symptoms of pseudoparkinsonism?
- resting tremor, bradykinesia and rigidity
- Pseudoparkinsonism results from...
- decrease in dopamine activity and increase in cholinergic activity=parkinson-like effects
- Pts with Akathisia may experience:
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Sensations of motor restlessness and may complain of an inability to sit or lie still
Pt may appear agitated and have problems with insomnia (may pace for floor) - Akathisia is usually dealt with by:
- alerting dose and/or type of medication
- Pts may exhibit a broad range of bizzarre movements of the arms,legs,neck and face
- symptoms of Dyskinesia and Dystonia
- The movements of dyskinesia and dystonias are ________ and _________.
- Involuntary and uncoordinated
- What drugs can be used to treat abberant motor symptoms?
- Antiparkinson drugs and benzodiazepines
- The movements associated with dyskinesia and dystonias begin fairly soon after initiating therapy *even after a _______ dose
- single
- (NMS) Neuroleptic Malignant Syndrome can result in _____ if untreated
- Death
- The exact causes of _____ are UNCLEAR
- NMS
- catatonia (involving stupor, rigidity, excitement and tremors) and fever
- symptoms of NMS
- Treatment for NMS typically consists of ...
- withdrawing the medication and providing supportive care
- Having NMS is considered an...
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EMERGENCY SITUATION!!!
TAKE OFF OF MEDS IMMEDIATELY - Nonmotor Side Effects of Antipsychotics:
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1. sedation
2. anticholinergic effects (dry mouth, blurred vision and constipation) - Miscellaneous Side Effects of Antipsychotics:
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1. Orthostatic Hypotension
2. Photosensitivity *advise pt. to avoid UV radiation - Therapeutic Uses for Antipsychotics:
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1. Tx of Schizophrenia
2. Prevention of severe nausea and vomiting (especially helpful with tx drug-induced nausea, like with chemotherapy)
3. Other Uses:
a. Chlorpromazine used to tx intractable hiccups
b. Promethazine used to tx pruritis -
Therapeutic uses of Antipsychotics:
[Under tx of Schizophrenia]
What tends to be observed with drug use? -
Observe:
-withdrawn pts tend to become active/amiable
-agitated pts tend to become calmer/relaxed -
Therapeutic uses of Antipsychotics:
[Under tx of Schizophrenia]
How long before a response to meds is seen? -
Initial response: within 2-7 days
In 2-6 weeks =improved socialization and can obey orders
*Non drug therapy can be initiated - Other Neuroleptic Drugs are
- Clozapine and Risperidone
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Useful in treating refractory schizophrenia.
A neuroleptic agent with a LOW potential for causing EPS and lower rist of tardive dyskinesia than other neuroleptics.
What is the drug? - Clozapine
- Side effects of Clozapine include:
- Sedation, dizziness, anticholinergic effects, orthostatic hypotension, seizure and fever
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Can be used among the FIRST-LINE drugs.
Has a low potential for causing EPS and lower risk for tardive dyskinesia than other neuroleptics.
What is the drug? - Risperidone
- Side effects of Risperidone:
- Anxiety, sedation, EPS, GI disturbances, increased dream activity, wt. gain, decreased sexual function (libido, erectile, ejaculatory, orgastic dysfunction) and othrostatic hypotension
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Special Considerations for Antipsychotics:
These drugs are of great benefit because... -
1. improve behavior and reality perception
2. enhances pt cooperation during rehab -
Special Considerations for Antipsychotics:
EPS is a major problem with these drugs but, OTS are in a position to... -
1. notice change in posture, balance and involuntary mvmts
2. even slight changes in motor function should be reported to healthcare team immediately
**EARLY INTERVENTION may diminish permanent motor dysfunction -
Special Considerations for Antipsychotics:
Less serious side effects including... - sedation, dry mouth (drink more water), blurred vision and constipation (increase fiber intake) may interfere with OT tx
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Special Considerations for Antipsychotics:
During first few days of therapy, guard against _________ _________ - orthostatic hypotension
- As a therapist remember:
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1. Inform doctor of missed doses
2. It may take up to 6 weeks to see a difference in behavior (so best work in therapy may not be seen until then)