lecture _3 agents used to manage schizophrenia june 2014
Post on 07-Jul-2018
218 Views
Preview:
TRANSCRIPT
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
1/36
Post Basic PsychiatricNursing Programme
Psychopharmacology
Managing
SchizophreniaPresenter:Novlette Mattis-Robinson
(R.Ph, BPharm. , MP!P!"#
1
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
2/36
$N%&PS')%&S
• Psychotropic agents used to manageschizophrenia and other psychoticand neurologic illnesses
• Previously called “Tranquilizers” –somnolence, relaxation, sedation
• Other Names -
–Neuroleptics
–Dopamine Antagonists
2
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
3/36
$N%&PS')%&S
• The !rst antipsychotic agents "ereintroduced in the early to mid #$%&'s –rau"ol!a al(aloid, reserpine and the
Phenothiazines )*hlorpromazine+• eserpine "as prolematic ut the
*hlorpromazine "as very impressive
•
.ntipsychotics have reduced thenumer o/ hospital eds occupied ypatients diagnoses "ith 0chizophrenia1
3
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
4/36
$N%&PS')%&S
• The ma2or use – treat 0chizophrenia
• .lso used to treat .gitation and
Psychosis associated "ith psychiatricand 3 or organic disorders1
• They have little or no ause potential– not classi!ed as controlledsustances1
4
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
5/36
$*S"S )+S&)PR"N&$
• The actual cause is uncertain
• 4ultiple theories that provide partial
explanations Theories include5
– 6opamine hypothesis
–
7enetics – Neurodevelopmental
– Psychosocial
5
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
6/36
$*S"S )+S&)PR"N&$
• opamine %heory
– Postulates that dopamine hyperactivity inthe rain is responsile /or psychotic
symptoms – Other neurotransmitters involved are %-
hydroxytryptamine )0erotonin 3 %-8T+ and7lutamate
• enetic %heory – 8istory in !rst –degree relative – #& 9 ris(
– 8istory in oth parents – ris( : to ;&9
6
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
7/36
$*S"S )+S&)PR"N&$
• Neuro/evelopmental
– Occurs as a result o/ utero disturancesduring pregnancy )eg1 complications,
neonatal hypoxia+1 0tudies have lin(edprenatal conditions to : ris( o/schizophrenia1
– uences )stress,
poor interpersonal s(ills, /amily con>icts+
7
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
8/36
%R"$%M"N% )+S&)PR"N&$
• No (no"n cure exist /or 0chizophrenia
•%reatment )ptions – Psychotherapy
– Pharmacotherapy
•.ntipsychotic 4edications – Typical or ?irst 7eneration
–.typical or 0econd 7eneration
8
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
9/36
$N%&PS')%&S(hemical lasses#
• Phenothiazines – e1g1 *hlorpromazine
• @utyrophenones – e1g1 8aloperidol
• Thioxanthenes - e1g1 Auclopenthixol
• 6ienzoxazepines - e1g1 Boxapine
• 6ihydrolindoles - e1g1 4olindone
9
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
10/36
$N%&PS')%&S(hemical lasses#
• 6iphenylutylpiperidines – e1g1 Pimozide
• @enzamides – e1g1 0ulpride
• Thienoenzodiazepines – e1g1Olanzapine
• 6ienzothiazepines – e1g1 Cuetiapine
10
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
11/36
"0$MP1"S )+ %'P&$1$N%&PS')%&S
• *hlorpromazine - B.7.*TDB
• ?luphenazine - 4O6
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
12/36
%'P&$1$N%&PS')%&S
• Mechanism of Action – Primarily through loc(ade o/ 6opamine
receptors
– Other receptors are involved )see diagram+• Ecacy
– Fhen in equivalent dose )equipotent+,eGcacy is similar
– Typical .ntipsychotics are usually aseHective as .typicals /or +ve symptomsut less eHective /or –ve symptoms
12
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
13/36
%'P&$1$N%&PS')%&S
• Potency – *lassi!ed y their potency /or the
dopamine receptors ($# )high,
moderate, lo"+ – 8igh potency agents have higher aGnity
/or $ and are associated "ith higher ris(/or
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
14/36
%'P&$1$N%&PS')%&S
• $/verse "2ects
–Dopamine Receptor Blockae
•
8yperprolactinemia• Par(insonism
– Alpha –arenergic !lockae
• Postural hypotension
• Orthostatic hypotension
14
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
15/36
%'P&$1$N%&PS')%&S
• Muscarinic Receptor Blockae – .nticholinergic eHects )dry mouth,
constipation, lurred vision, urine retention+
– Thioridazine is the most potentantimuscarinic phenothiazine+
• "istamine Receptor Blockae
– 0edation – Dncreased appetite )may cause "eight gain+
15
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
16/36
%'P&$1 $N%&PS)%&S
• #$"ER E%%E&$'
– @loc(ade o/ norepinephrine reupta(e
– @loc(ade o/ serotonin receptors
– Dnhiition o/ gro"th hormone release)thin( aout use in children+
– Dmpairment o/ mechanisms related to
temperature regulation
16
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
17/36
1$SS&+&$%&)N )+$3"RS" "++"%S
• Neurological
– 0edation
–
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
18/36
1$SS&+&$%&)N )+$3"RS" "++"%S
• Enocrine
– 4enstrual irregularities
– 7alactorrhoea
– 6ecreased glucose tolerance
• "aematological
– .granulocytosis
• "epatic
– *holestatic Iaundice
18
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
19/36
"0%R$P'R$M&$1S'NR)M" ("PS#
• esults /rom the loc(ade o/ postsynaptic dopamine receptors on thenigrostriatal tract o/ the rain –
imalance in cholinergic anddopaminergic systems1
• ?our );+ categories o/
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
20/36
"0%R$P'R$M&$1S'NR)M" ("PS#
$cute ystonia – .normal involuntary movements
especially around mouth, 2a", /ace, and
nec(1 – eactions characterized y pain/ul muscle
spasms, !xed up"ard gaze, nec( t"isting,arching o/ the ac( and clenched 2a"s
)trismus and laryngospasm+
– Jsually occurs "ithin the !rst KL hrs o/starting antipsychotic therapy
20
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
21/36
"0%R$P'R$M&$1S'NR)M" ("PS#
• $cute ystonia cont4/
–8igh potency antipsychotics are moreli(ely to produce these reactions
– Treatment –anticholinergics e1g1@enztropine, antihistamine e1g16iphenhydramine
–Parenteral therapy is pre/erred toinitiate therapy
21
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
22/36
"0%R$P'R$M&$1S'NR)M" ("PS#
$5athisia
• . su2ective /eeling o/ motor
restlessness "here the patientcannot sit or lie still
• The patient o/ten paces and
ecome agitated and 3 oraggressive
• . compulsion to e in motion
22
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
23/36
"0%R$P'R$M&$1S'NR)M" ("PS#
$5athisia cont4/
• 4ay occur days to "ee(s a/ter
therapy• Treatment – decrease dose o/
antipsychotic agent, s"itch to
lo" potency agent, usePropranolol L& – M& mg daily
23
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
24/36
"0%R$P'R$M&$1S'NR)M" ("PS#
Par5insonism
•*haracterised y tremor, rigidity anda(inesia or rady(inesia
•Occurs "ee(s to months a/ter therapyand more common in elderly /emales
•
Treatment – anticholinergic agents eg1@enztropine L mg and Trihexiphendyl Lmg
24
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
25/36
"0%R$P'R$M&$1S'NR)M" ("PS#
%ar/ive ys5inesia
• *haracterized y a rhythmic involuntarymovement o/ the tongue, lips, 2a", /ace,
extremities and sometimes the trun(• Occurs months to years a/ter therapy
egan and may e irreversile
• Protrusion o/ tongue, puc(ering o/mouth, che"ing motions, lip smac(ing,puGng o/ chee(s
25
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
26/36
"0%R$P'R$M&$1S'NR)M" ("PS#
%ar/ive ys5inesia
• 4ore common in "omen and personsolder than %& yrs
• Persons "ith rain damage and mooddisordes are at higher ris(s
• Treatment – prevention, early diagnosis
and mgt1 @enzodiazepines e1g1 6iazepam,lithium and *aramazepine may help
26
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
27/36
N"*R)1"P%& M$1&N$N%S'NR)M" (NMS#
• Bi/e threatening
• 0ymptoms – hyperpyrexia )#&K ?+,agitation, stupor, s"eating, respiration
– these usually develop rapidly over aL; – KL hr period
• Ba results – increased F@*, *P, liver
enzymes and renal shutdo"n• *an miss 6x in early stages )high
potency agents mostly+
27
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
28/36
"0%R$P'R$M&$1S'NR)M" ("PS#
• Management – discontinue thedrugs immediately and startsupportive care 3 measures
• Supportive measures – monitorvitals, renal output, (eep patient cool
• There is no (no"n treatment
28
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
29/36
"0$MP1"S )+ $%'P&$1$N%&PS')%&S
• .ripiprazole - .@DBD?
• *lozapine - *BOA.DB
•Olanzapine - AP
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
30/36
*&"1&N"S
• .merican Psychiatric .ssociation ).P.+recommends using an .typical !rst)
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
31/36
)&" )+$N%&PS')%&
• 6epends on patient's previousexperiences
• .dverse eHects
• 4edical condition )concomitant+
• 4edication interactions
• Patients pre/erence
• *ost
• 6osage /orm availale
31
M$N$"M"N% )+
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
32/36
M$N$"M"N% )+S&)PR"N&$ 6&%
$N%&PS')%&S• .ssists "ith many aspects o/ thin(ing
and emotions
• @y themselves do not allo" mostpatients to /unction /ully in society
– Dntensive training in social s(ills
• 6opamine hypothesis does not account/or all the pathology o/ 0chizophrenia)"ee(s required to attain Tx ene!ts+
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
33/36
%'P&$1$N%&PS')%&S
enerally
– 8ighly lipid solule
– 8ighly protein ound )$L - $$9+
– Barge volume o/ distriution
– =ariale @ioavailaility
– elatively short plasma hal/ li/e )#&-L& hrs+
– 4etaolites may e /ound in urine "ee(sa/ter last dose o/ drugs )drugs hidden intissues+
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
34/36
M$7)R S&" "++"%S )+%'P&$1 $N%&PS')%&S
+our (8# classical si/e e2ects y "hich the agents are compared
–0edation )lo" potency agents+
–8ypotension
–
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
35/36
$%'&P&$1$N%&PS')%&S
• These agents have a greater aGnity/or the %8TL receptors
• *lassi!cation as .typical is ased on
three clinical oservations –
-
8/18/2019 Lecture _3 Agents Used to Manage Schizophrenia June 2014
36/36
R"+"R"N"S
• 0huster, Ioel5 Psychopharmacologicagents, emington, The 0cience andPractice o/ Pharmacy, L#st
top related