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Anti psychotics

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Anti psychotics

  1. 1. Anti-Psychotic Mood Stabilizing Agents Definitions Pharmacology
  2. 2. Definitions <ul><li>Anti-psychotics </li></ul><ul><li>Neuroleptics </li></ul><ul><li>Psychosis </li></ul><ul><li>Schizophrenia </li></ul>
  3. 3. Antipsychotics’ Indications <ul><li>Psychiatric </li></ul><ul><ul><li>Schizophrenia </li></ul></ul><ul><ul><li>Manic episodes </li></ul></ul><ul><ul><li>Bipolar </li></ul></ul><ul><ul><li>Tourette’s Syndrome </li></ul></ul><ul><ul><li>Senile Dementia </li></ul></ul><ul><li>Non-psychiatric </li></ul><ul><ul><li>Anti-emetic </li></ul></ul><ul><ul><li>Anesthesia </li></ul></ul>
  4. 4. Anti-Psychotics <ul><li>MOA </li></ul><ul><li>Systems Effects </li></ul><ul><ul><li>Dopaminergic </li></ul></ul><ul><ul><li>Psychologic </li></ul></ul><ul><ul><li>Neurophysiologic </li></ul></ul><ul><ul><li>Endocrine </li></ul></ul><ul><ul><li>Cardiovascular </li></ul></ul><ul><li>Minimize with </li></ul><ul><ul><li>Diphenhydramine </li></ul></ul>
  5. 5. Anti-Psychotics <ul><li>Fluphenazine </li></ul><ul><li>Haloperidol * (Haldol) </li></ul><ul><li>Olanzapine * (Zyprexa) </li></ul><ul><li>Perphenazine </li></ul><ul><li>Prochlorperazine </li></ul><ul><li>Quetiapine* (Seroquel) </li></ul><ul><li>Risperidone *(Risperdol) </li></ul><ul><li>Thioridazine </li></ul><ul><li>Thiothixene </li></ul>
  6. 6. Drug Choice Toxicity <ul><li>No basis to selection </li></ul><ul><li>Best guide patient response </li></ul><ul><li>History of past agents </li></ul><ul><li>Dosing </li></ul><ul><li>Compliance </li></ul><ul><li>Behavioral/Neurologic </li></ul><ul><li>Autonomic Nervous System </li></ul><ul><li>Endocrine </li></ul><ul><li>Allergic reactions </li></ul><ul><li>Ocular/Cardiac </li></ul><ul><li>Pregnancy </li></ul><ul><li>Neuroleptic Malignant Syndrome </li></ul>
  7. 7. Antipsychotics’ Dispensing Issues <ul><li>Minimize Side Effects with: </li></ul><ul><ul><li>Dimenhydrinate </li></ul></ul><ul><ul><li>Benztropine </li></ul></ul><ul><ul><li>Diphenhydramine </li></ul></ul><ul><ul><li>Trihexyphenidyl </li></ul></ul><ul><ul><li>Benzodiazepines </li></ul></ul><ul><li>Atypical </li></ul><ul><ul><li>Risperidol </li></ul></ul><ul><ul><li>Clozaril </li></ul></ul><ul><ul><li>Zyprexa </li></ul></ul><ul><li>Confused with </li></ul><ul><ul><li>Clinoril </li></ul></ul><ul><ul><li>Zyrtec </li></ul></ul>
  8. 8. Symptoms Related to Schizophrenia <ul><li>Hallucinations, delusions </li></ul><ul><li>Disorganized behaviors, speech, thinking </li></ul><ul><li>Catatonic behaviors </li></ul><ul><li>Apathy, lack of drive, initiative, pleasure </li></ul><ul><li>Impaired memory, attention, verbal fluency, visual processing </li></ul><ul><li>Neologisms (meaningless words) </li></ul>
  9. 11. What is Bipolar Disorder? <ul><li>A child with one bipolar parent has a 10-30% chance of becoming bipolar. </li></ul><ul><li>If both parents are, the odds reach 75%. </li></ul><ul><li>Mood Spectrum </li></ul><ul><li>Severe depression  mild/mod depression  normal  hypomania  mania or mixed mania </li></ul>
  10. 12. Mood Stabilizing Agents <ul><li>Lithium (Eskalith, Lithobid) </li></ul><ul><ul><li>MOA </li></ul></ul><ul><ul><li>Indications </li></ul></ul><ul><ul><li>Dosage </li></ul></ul><ul><ul><li>Monitoring </li></ul></ul><ul><ul><li>Drug Interaction </li></ul></ul><ul><ul><li>Toxicity </li></ul></ul><ul><ul><li>Overdose </li></ul></ul><ul><li>Other agents </li></ul><ul><ul><li>Valproic acid, carbamazepine </li></ul></ul>
  11. 13. Drug Interactions <ul><li>Lithium & diuretics – reduces lithium excretion resulting in increased lithium levels </li></ul><ul><li>Lithium & NSAID – reduces lithium excretion </li></ul><ul><li>Lithium & Fluoxetine – Lithium levels altered </li></ul><ul><li>Lithium & Molindone (Moban) – EEG changes, nephrotoxicity, confusion, convulsions </li></ul>
  12. 14. Drug Selection & Toxicity <ul><li>No basis to selection </li></ul><ul><li>Best guide patient response </li></ul><ul><li>History of past agents </li></ul><ul><li>Dosing/Compliance </li></ul><ul><li>Anticholinergic </li></ul><ul><li>Cardiovascular </li></ul><ul><li>Dermatological </li></ul><ul><li>Endocrine </li></ul><ul><li>Hematologic </li></ul><ul><li>Ophthalmologic </li></ul><ul><li>Neurological </li></ul>
  13. 15. Treatment Schedules <ul><li>Find the right drug for the right patient </li></ul><ul><li>Empirical Determination </li></ul><ul><ul><li>Patient acceptance </li></ul></ul><ul><ul><li>Adverse effects </li></ul></ul><ul><ul><li>Tolerance </li></ul></ul><ul><li>Labs do not rule over clinical judgment </li></ul><ul><li>LOOK AT PATIENT! </li></ul>
  14. 16. Case Study Psychiatry
  15. 17. <ul><li>JB is a 43-year-old male brought to the ER by SRPD for bizarre behavior. He was found wandering in the park dressed in his army fatigues trying to prevent Argentina from undermining the United States government. He states that he is employed by the CIA and is receiving secret communication from the US satellite and will not reveal the nature of his mission. The patient was noted to be smacking his lips and chewing his tongue. He is also coughing up large amounts of yellow greenish sputum. He exhibits poor eyesight, delusional thinking and is becoming progressively agitated. His backpack contains cigarettes, a flask of alcohol and medications—last doses are unknown. </li></ul><ul><li>MEDS: Fluphenazine 20 mg/day Benztropine 2 mg bid </li></ul><ul><li>Propranolol 40 mg bid Maalox Albuterol MDI 2 puffs qid & prn Azmacort MDI 4 puff BID </li></ul><ul><li>Lithium Carbonate 300mg BID </li></ul>
  16. 18. Points to Ponder <ul><li>List symptoms related to mental status. </li></ul><ul><li>Is antibiotic therapy warranted? Why or why not? </li></ul><ul><li>Discuss patient’s medication list. </li></ul><ul><li>This patient is admitted to the hospital. Develop a drug treatment plan for his conditions. </li></ul>

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