NOT DONE Week 7: Psychosis medications

Antipsychotics uses

• Schizophrenia/schizoaffective disorder

• Bipolar

• Acute psychosis d/t medication-induced psychosis — symptoms of psychosis

• Autism

General characteristics of antipsychotics

•orally administered (i.m. administration an option with certain drugs)

•95-98% bound to plasma proteins

•subject to extensive “first-pass” hepatic metabolism

•drugs with long “half-lives” (e.g., chlorpromazine (Thorazine) - t½=30 hours)

•70% of patients respond to conventional drugs

Why does it matter that antipsychotics are highly bound to plasma proteins?

Subject to extensive “first pass” hepatic metabolism is problematic if…

someone has liver disease

Why is having a long half life of antipsychotics potentially problematic? 

because if they are given too much, it takes a long time for it to get out of the patient’s system

First generation

Second generation

MOA of first generation

primary side effects of first generation 

efficacy of first generation

examples of first generation

MOA of second generation

Primary side effects of second generation

Efficacy of secondary generation

Examples of secondary generation

First vs second generation antipsychotics

Atypical appear to be equally effective, with ____ side effects compared to first generation 

Antipsychotics are usually metabolized by…

What NT is primarily involve antipsychotics?

dopamine

What may cause altered absorption of antipsychotics?

Antipsychotic side effects — NOT DONE

• Cardiovascular

• Anticholinergic

• Weight gain 

• Diabetes 

• Sexual side effects

• Blood disorders

• Hyperprolactinemia

• Sedation

• Photosensitivity

• Low seizure threshold

• Med-related movement disorders

Cardiovascular side effects of antipsychotics

Anticholinergic side effects of antipsychotics 

What drugs are highly correlated with weight gain?

Blood disorders  d/t antipsychotics 

Hyperprolactinemia

Anticholinergic crisis

Signs and symptoms of anticholinergic crisis

Neuroleptic Malignant Syndrome

Symptoms of Neuroleptic Malignant Syndrome

•severe muscular rigidity

•impaired breathing or ventilation

•autonomic hyperactivity (hypertension, tachycardia, irregular heartbeat, tachypnea, diaphoresis)

•extremely high temperatures

•mental status changes (confusion, agitation, coma)

•incontinence

•mutism

•leukocytosis

•laboratory evidence of muscle injury (e.g. elevated CK)

Causes of NMS

•Lithium use, especially in high doses or in combination with other antipsychotic medications

•History of previous NMS episodes

•Rapid increase in lithium dosage

•Underlying medical conditions, such as dehydration or kidney disease

Treatment of Neuroleptic Malignant Syndrome

• Physical control of fever

• Muscle relaxants (dantrolene or benzos) 

• Dopamine receptor agonist to compensate for the dopamine blocking 

Prevention of NMS

• Avoid rapid increases in lithium dosage.

• Monitor lithium levels closely.

• Inform healthcare providers about any history of NMS or other risk factors.

• Consider alternative medications if lithium is not well-tolerated.

• It is important to note that lithium-induced NMS is a rare but serious condition. If you or someone you know experiences any symptoms of NMS, seek medical attention immediately

Serotonin syndrome 

Serotonin side effects NOT DONE

• Hallucinations 

• GI disturbances 

• ?

Med-related movement disorders

Acute extrapyramidal symptoms

pseudoparkinsonism

Acute dystonia

Akathisia

Tardive dyskinesia (TD)

AIMS (abnormal involuntary movement scale) scale and purpose

Black box warnings for antipsychotics

• Increased mortality in elderly patients with dementia-related psychosis ---> Atypical antipsychotics are not FDA approved for use in patients with dementia related psychosis

• aripiprazole (Abilify): compulsive or uncontrollable urges to gamble, binge eat, shop, and have sex have been reported with the use of aripiprazole

Black box warning for abilify

Clozapine (Cloxaril)

Why does Clozapine require additional monitoring?

When is Clozapine perscribed?

How long does it take for Clozapine to work?

How long does it take for Clozapine to work?

Symptoms of agranulocytosis d/t Clozapine

What do you need to monitor when taking Clozapine?

Nursing interventions for agranulocytosis d/t Clozapine

Drug interactions

Contraindications for first-generation (“typical”) antipsychotic therapy

Long acting injectables 

Complications of long acting injectables

Post-injection delirium/sedation syndrome (PDSS)

Olanzapine

Symptoms of PDSS 

How long does it take for PDSS to occur? How long does it take for PDSS to resolve?

PDSS education