Atypicals
SGA D2 and 5HT2 antagonism causes?
______ competes with medication so not all D2 receptors are attached to medication
reduce risk of EPS because blocking 5HT2A causes DA release
DA
(prevents EPS because there isn't chronic and complete D2 blocking
If a pt is prediabetic, overwt, and hyperlipemia what meds would you avoid?
I. Quetiapine
2, Seroquel
3. Zyprexia
What should the PMNP monitor when pt are on antipsychotics and how often?
FBS
HgBA1C
Lipids
Waist Circumference
Every 3-6 months
Catalepsy is.....
passive hold of posture against gravity
(position pt like a candle-lift arm and they will hold it there)
Mannerism is.....
circumstantial caricature of normal actions
Blocking 5HT2A in the Mesocortical pathway causes
Blocking 5HT2A in the Tuberoinfundibular pathway causes
IN creased DA levels which improves DA deficiency
Cognitive
Affective
Negative Sxm
Regulation of prolactin release
Lower risk for metaboli side effects
asenapine/Sapris 9Gastric bypass pts
Ziprasidone/Geodon take with 500 cals food
Ioperidone/Fanapt (alpha blocker)
Lurasidone/Latuda take with 500 cals food
Catatonia is......
a change in reactivity to the environment
requires a physical exam
hypoactive, hyperactive, or malignant (autonomic instability.
Tx with benzos
seen in 7-17% of MEDICALLY hospitalized pts
can occur in other psychiatric disorders
Waxy Flexibility is ......
slight, even resistance to positioning
Stereotypy is....
non goal directed movements taht are repeated with frequency
Effects of Atypicals
Some are partial D2 agonist
stimulates release of DA only partially
leads to Moderated DA outpt
can be D2/D3 partial agonist
ARIPIPPRAZOLE is a DA partial agonist
Atypical partial agonist @ D2
Aripipprazole/Abilify
Brexpiprazole/Rexulti
Cariprazine/Vyylar
Sx of hypoactive Catatonia
Negativism-resistance to instructions
Rigid often uncomfortable postures (laying in bed hold there head parrell to pillow)
Mutism-refuse to speak/respond
Stupor
Grimacing-fixed
Mutism is.....
Little to no words
Tx of Catatonia
Benzos
lorazepam trail helpful in dx
frequent administration (Q 4 hrs)
high doses IV (preferred) or PO
ECT
gradually decrease benzos while receiving ECT r/t benzos are antileptics
other side effects of Atypicals
5HT2C and H1
Mucarinic M3 Antagonist
D2 Mucarinic M1, H1, and 1 Alpha Adrenergic recpetor antagonist
Unknown Pathway
wt gain
Insulin Resistance
sedation and Dizziness
increased Triglycerides
Stronf D2 receptor agonist?
Risperidone/Risperdal
Paliperidone/Invega
Sx of hyperactive Catatonia
difficult to dx
Purposeless excessive movement
Echolalia-echo (mimic) speech
Echopraxia-echo movement
Negativism is......
opposition or no response to instruction
These sxms describe what disease process?
excessive water ingestion not caused by antidiuretic hormone
drinks greater than 5L/day
can cause severe hyponatremia and can lead to water intoxication and death
common with pts dx with Schizophrenia
assoc, with LT hospitalization
can also occur in individuals with intellectual and developmental disabilities
Psychogenic Polydipsia
Choosing the right Pharm tx
What else to consider?
familarize yourself with the receptors and fxn
determine which sx you want to address
find a match between what you are looking to target and the medication's properties
******* Evidence shows EARLY CONSUSTANT TX is assoc. with prognosis.
Compliance, cost, and access
Metabolic side effects (worse) H1, M1
Clozapine/Clozaril
Quetiapine/Seroquel
Olanzapine/Zyprexia
Stupor is
no psychomotor activity, not responding ro the environment
Posturing is.......
active posturing against gravity
Tx for polydipsia is.....
Limited
Behavioral Modification
Psychosocial Rehabilitation
Fluid Restriction
may consider naltrexone