Antipsychotics and Lithium: DRUGS AFFECTING THE CNS

Lesson 3 midterms part 3

SCHIZOPHRENIA

A type of chronic psychosis characterized by delusions, hallucinations (often in the form of voices), and thinking or speech disturbances. The onset of illness is often during late adolescence or early adulthood.

• Hallucinations

• Illusions

• Delusions

• Excitement

POSITIVE SYMPTOMS OF SCHIZOPHRENIA:

• __________

• __________

• __________

• __________

• Loss of function

• Anhedonia

• Decreased emotional expression

• Impaired concentration

• Diminished social engagement

NEGATIVE SYMPTOMS OF SCHIZOPHRENIA:

• __________

• __________

• __________

• __________

• __________

Typical Antipsychotic Drugs

Block dopamine receptors in the limbic system, reticular activating system, and brain. They may block all dopamine receptors, including those not associated with psychoses.

• Addresses positive symptoms of schizophrenia

Atypical Antipsychotic Drugs

Block dopamine and serotonin receptors. They specifically target receptors responsible for psychosis, making them more specific for psychotic disorders.

• Addresses BOTH positive and negative symptoms of schizophrenia

Anti-HAM (antihistamine, anti-alpha adrenergic, antimuscarinic)

NON-DOPAMINERGIC SIDE EFFECTS OF ANTIPSYCHOTICS

Antihistamine (H1)

Anti-HAM (antihistamine, anti-alpha adrenergic, antimuscarinic):

• Sedation and weight gain

Antiadrenergic (alpha1)

Anti-HAM (antihistamine, anti-alpha adrenergic, antimuscarinic):

• Hypotension, failure of ejaculation

Antimuscarinic (M1)

Anti-HAM (antihistamine, anti-alpha adrenergic, antimuscarinic):

• Anticholinergic effects

LOW POTENCY D2 ANTAGONIST

TYPICAL ANTIPSYCHOTICS:

• lower chances of causing extrapyramidal symptoms (EPS)

HIGH POTENCY D2 ANTAGONIST

TYPICAL ANTIPSYCHOTICS:

• higher chances of causing EPS

Acute dystonia

EPS (Extrapyramidal Symptoms):

• spasms of muscles of tongue, face, neck and back

Akathisia

EPS (Extrapyramidal Symptoms):

• feeling of restlessness

parkonsinism

EPS (Extrapyramidal Symptoms):

• bradykinesia, tremors, rigidity, shuffling gait

Neuroleptic Malignant Syndrome (NMS)

EPS (Extrapyramidal Symptoms):

• rigidity, fever (potentially fatal)

Tardive dyskinesia

EPS (Extrapyramidal Symptoms):

• orofacial dyskinesia

• Chlorpromazine

• thioridazine

LOW POTENCY D2 ANTAGONIST

• Uses: Schizophrenia and other psychotic disorders

• SE: high anti-HAM effects, lower risk of EPS

• Haloperidol

• Fluphenazine

• Trifluoperazine

HIGH POTENCY D2 ANTAGONIST

• Uses: Schizophrenia and other psychotic disorders

• SE: Higher rates of EPS, hyperprolactinemia, less anti-HAM

ATYPICAL ANTIPSYCHOTICS

Greater affinity to 5HT2A > D2 receptors

• Lower risk of EPS; lower risk of hyperprolactinemia

• Higher risk of metabolic side-effects

CLOZAPINE

ATYPICAL ANTIPSYCHOTICS:

• DOC for refractory and suicidal schizophrenia

• SE: agranulocytosis, hypotension and bradycardia, seizures, weight gain

OLANZAPINE

ATYPICAL ANTIPSYCHOTICS

• Uses: Anorexia nervosa, Depression

• SE: Weight gain

QUETIAPINE

ATYPICAL ANTIPSYCHOTICS

• Uses: Bipolar (Manic episode), sleep promotion and maintenance

• SE: Somnolence, fatigue, sleep paralysis, priapism

RISPERIDONE and PALIPERIDONE

ATYPICAL ANTIPSYCHOTICS

• Uses: Depression, Intractable hiccups, Tourette syndrome

• Note: Only approved antipsychotics for schizophrenia in the YOUTH

• SE: Insomnia, Marked HYPERPROLACTINEMIA

ZIPRASIDONE

ATYPICAL ANTIPSYCHOTICS

• Uses: Bipolar (acute mania)

• SE: QT prolongation, Increased mortality with patients with dementia-related psychosis

• Lowest risk of weight gain

ARIPIPRAZOLE

ATYPICAL ANTIPSYCHOTICS

• MOA: Partial agonist at D2 receptor

• Uses: MDD, Autism, Cocaine dependence

• SE: Lowers serum prolactin, low risk of metabolic AE and sedation

• Note: Least sedating atypical antipsychotic

• Do not allow patients to crush or chew the tablet as it decreases absorption of the drugs

• Monitor for orthostatic hypotension

• Consider warning the patient or the patient’s guardian about the risk of tardive dyskinesia

• Monitor CBC to check signs of bone marrow suppression

• Provide positioning of legs to decrease the discomfort of dyskinesia

• Provide sugarless candies for drying of the mouth

• Encourage the patient to void before taking the dose if urinary retention is a problem

• Provide safety measures such as side rails and assistance in ambulation if there are CNS effects

• Provide vision examination to determine ocular changes

• Conduct thorough health teaching on the effects and adverse effects of the drugs

• Offer support and encouragement to help patients cope with their drug regimen

NURSING CONSIDERATIONS

• Do not allow patients to _____ or _____ the tablet as it decreases absorption of the drugs

• Monitor for _________

• Consider warning the patient or the patient’s guardian about the risk of _________

• Monitor _____ to check signs of bone marrow suppression

• Provide _________ to decrease the discomfort of dyskinesia

• Provide _________ for drying of the mouth

• Encourage the patient to ____ before taking the dose if urinary retention is a problem

• Provide _________ such as side rails and assistance in ambulation if there are CNS effects

• Provide _________ to determine ocular changes

• Conduct thorough _________ on the effects and adverse effects of the drugs

• Offer _________ and _________ to help patients cope with their drug regimen

LITHIUM

• alters sodium transport in the nerve and muscle, inhibit the release of norepinephrine and dopamine slightly and decreases intraneuronal content of second messengers (IP3 and DAG). The last action may modulate impulses to control the hyperactive state in mania

• Used in Manic phase of Bipolar disorder

• Has a very narrow therapeutic index!!

• Tremors

• Sedation

• Edema

• Leukocytosis

• Ebstein anomaly – especially during 1st trimester of pregnancy

SE of lithium:

• _________

• _________

• _________

• _________

• _________ – especially during 1st trimester of pregnancy

• Daily monitoring of lithium serum levels

• Give the drug with food to alleviate GI irritation

• Ensure that the patient has adequate intake of salt and fluid

• Monitor closely, especially during the initial stage of therapy

• Arrange for small and frequent meals with sugarless lozenges for drying of the mouth

• Provide safety measures like side rails and assistance with ambulation if CNS effects occur, to prevent potential injury

• Offer support and encouragement to help the patient cope with the drug regimen

NURSING CONSIDERATIONS

• Daily monitoring of _________ levels

• Give the drug with _________ to alleviate GI irritation

• Ensure that the patient has adequate intake of _________ and _________

• _________, especially during the initial stage of therapy

• Arrange for small and frequent meals with _________ for drying of the mouth

• Provide _________ like side rails and assistance with ambulation if CNS effects occur to prevent potential injury

• Offer _________ and _________ to help the patient cope with the drug regimen

Generalized

SEIZURE:

• Involved both hemispheres; loss of consciousness

• Rapidly spreads

Partial 

SEIZURE:

• Involves one hemisphere 

• does not spread

Tonic Clonic

GENERALIZED SEIZURE:

• Involuntary Muscle contractions

• involve both tonic (stiffening) and clonic (twitching or jerking) phases of muscle activity

Absence

GENERALIZED SEIZURE:

• short loss of consciousness

• Short pause, absent seizures

• brief, sudden lapses of consciousness

Atonic

GENERALIZED SEIZURE:

• a brief seizure that causes a sudden loss of muscle control, leading to drooping or falling

• not that common and similar to absence

Myoclonic

GENERALIZED SEIZURE:

• characterized by a brief, shock-like jerk or twitch of a muscle or muscle group, which can affect one or both sides of the body

Status Epilepticus

GENERALIZED SEIZURE:

• a medical emergency where a seizure lasts for more than 5 minutes, or where a person has multiple seizures without regaining consciousness between them

Febrile

GENERALIZED SEIZURE:

• convulsion in a child that's caused by a fever. The fever is often from an infection.

PARTIAL SEIZURE: