PSYCH PART 1.docx

[PSYCH PART 1] SCHIZOPHRENIA Goal: suppression of acute episodes, prevention of acute exacerbations, and maintenance of functioning 1^ST^ gen or conventional antipsychotics blockade of receptors of dopamine can cause movement disorders known as extra pyramidal symptoms - FGAs are very safe and...

[PSYCH PART 1] SCHIZOPHRENIA Goal: suppression of acute episodes, prevention of acute exacerbations, and maintenance of functioning 1^ST^ gen or conventional antipsychotics blockade of receptors of dopamine can cause movement disorders known as extra pyramidal symptoms - FGAs are very safe and overdose is rare. Overdose hypotension, CNS depression, and EPS - They are classified by potency: low, medium and high. Potency refers only to the size of dose needed to elicit a given response, not the maximal effect a drug can produce. - Tardive dyskinesia can be irreversible - Valbenzaine followed by deutetrabenazine. - Prolong QT and somnolence - AE: dystonia can cause spasm of tongue, face, neck or back, oculogyric crisis (upward deviation of the eyes), and opisthotonos (tetanic spasm of the back causing the trunk to arch forward while the head and lower limbs are thrust backward). Joint dislocation can occur. Antipsychotic parkinsonism, akathisia, neuroleptic malignant syndrome (can give dantrolene and bromocriptine). - Chlorpromazine, haloperidol, thioridazine and pimozide can cause fatal dysrhythmias - Initial tx: anticholinergics (benztopine, diphenhydramine) +-----------------------------------+-----------------------------------+ | Haloperidol | \- can be used in children | | | | | (Butyrophenone family) | \- AE: galactorrhea, | | | gynecomastia, menstrual | | | irregularities, prolong QT | +-----------------------------------+-----------------------------------+ 2^nd^ gen mod block of dopamine and stronger block of serotonin receptors risk of EPSs is less than 1^st^ gen - Weight gain, DM, and dyslipidemia +-----------------------------------+-----------------------------------+ | Clozapine | \- most effective. Improves +,-, | | | and cognitive | | | | | | \- AE: agranulocytosis enroll in | | | REMs program prior to Rx. Monitor | | | WBC and neutrophil ct weekly for | | | 6mo then q2weeks for 6mo. | | | | | | \- if ct falls below normal drug | | | must be stopped and blood ct | | | monitored for 4weeks after | | | cessation | | | | | | **- BBW: myocarditis** | | | | | | \- interactions: cancer drugs, | | | phenytoin, ketoconazole | +-----------------------------------+-----------------------------------+ Depot antipsychotics: injectable formulation for long-term therapy. Rate of relapse is lower. Better for pts with adherence difficulty. Slow steady absorption so plasma levels remain constant between doses. Dosing is every 2-4 weeks. Asenapine (SGA) available in sublingual to avoid first pass Loxapine available in 10mg inhaled powder. 1 inhalation in 24 hrs After control of an acute episode, therapy should cocntinue for at least 12 months.