NSG 552 Exam 1 Review (Psychopharmacology)
Review the 4 Dopamine pathways – Symptoms of breast tenderness,
spontaneous lactation, and menstrual irregularities occur when dopamine is
decreased in the Tuberoinfundibular pathway – Hyperprolactinemia
Mesolimbic: DA hyperactivity = Positive sx
Neurotransmitters increase DA in the mesolimbic area
• Hallucinations, delusions, etc
• Excess DA in this pathway will produce positive psychotic sx
Mesocortical: DA deficit = Negative sx.
Neurotransmitters decrease DA activity in the mesocortical area
• i.e. cognition, affect, apathy, behavior, etc
believed negative sx are r/t a deficit of DA in this particular pathway
Nigrostriatal: blockade of DA in this pathway produces increased motor
movements
• Dopamine blockade in this pathway = decrease DA = increase ACh
• Deficient DA in this pathway causes movement disorders
• e.g. EPS (Pseudo parkinsonism, Akathisia, dystonia & TD
• Tardive: D2 blockade in this pathway. Late occurring, mostly irreversible
Tuberoinfundibular: D2 blockade = Hyperprolactin. Common w/Risperdal
• Dopamine inhibits prolactin
• Blockade of DA = decrease DA = increase Prolactin
• Sx of elevated prolactin levels: galactorrhea, amenorrhea, possible sexual
dysfunction
**Importan Note : Dopamine inhibits prolactin
Therefore: Blockade of dopamine = decrease DA = increase Prolactin
,WEEK 2
Management of Acute Psychosis
IM haloperidol should be administered with benztropine (Cogentin) or
diphenhydramine to reduce the risk oof severe EPS or dystonia
Severely agitated patients: use a benzodiazepine combination w/the
antipsychotic (e.g. Haldol + Lorazepam + Cogentin)
**Important Note
Antipsychotic polypharmacy can increase the risk for re-hospitalization, diabetes,
EPS, sedation, seizures, metabolic effects, mortality, and sudden cardiac death.
Know the meds that are First generation (e.g. Haldol, Chlorpromazine) vs. Second
generation (e.g. Risperidone, Olanzapine, Quetiapine)
FGA/Typical/1st generation SGA/Atypical/2nd generation
-block D2 receptors -serotonin-dopamine antagonist
Haloperidol (Haldol) Risperidone (Risperdal)
Can be given PO/IM/IV; Decanoate Greatest prolactin elevation
(LAI) S/E: NMS
Given in acute agitation or psychosis
S/E: Neuroleptic Malignant Syndrome
(NMS)
Chlorpromazine (Thorazine) Olanzapine (Zyprexa)
Can cause blue-gray skin discoloration Acute agitation IM acts w/in 15 min
and corneal/lens deposits Monitor for dose-related
Causes Orthostatic hypotension hyperprolactinemia
Also used for N/V & intractable hiccups Relprevv (injection)= monitor 3 hrs d/t
PO & IM formulation (effective for risk delirium & sedation S/E: NMS
agitation in emergencies)
Fluphenazine (Prolixin) Quetiapine (Seroquel)
PO/IM. Decanoate (LAI) available Strongest H1 antagonism
, S/E: Neuroleptic Malignant Syndrome
(NMS)
Perphenazine (Trilafon) Clozapine (Clozaril)
S/E: NMS, hypersalivation (sialorrhea)
Lowest risk of TD
Only antipsychotic shown to
decrease SI risk Agranulocytosis
Loxapine (Loxitane) Ziprasidone (Geodon)
Higher risk of seizures Weight neutral
Thioridazine (Mellaril) Aripiprazole (Abilify)
Associated w/retinitis pigmentosa Weight neutral
watch for
orthostatic
hypotension
adjunctive tx of
depression, bipolar
Trifluoperazine (Stelazine) Pimavanserin (Nuplazid)
Approved for nonpsychotic anxiety Used in Parkinson’s related psychosis
(newer med)
** Haldol and Prolixin: watch for Lurasidone (Latuda)
allergic reactions in patients sensitive Low risk for metabolic syndrome
to sesame Use w/caution in pts w/hepatic
impairment
Manage positive sx of schizophrenia First line tx
Can worsen negative sx secondary to Accounts for 80% of total
decrease DA in the antipsychotics prescribed
Mesocortical pathway Effective for both positive and negative
S/E: QTC prolongation -obtain baseline symptoms
EKG MOA: blocks both D2 and 5HT2A
Orthostasis -blockade of a1 receptors Can cause EPS but at a lower risk
Elevated liver enzymes: EPS, Akathisia, Lower incidence oof TD
dystonia, Parkinsonism
Hyperprolactinemia
Higher risk of causing TD
Review the 4 Dopamine pathways – Symptoms of breast tenderness,
spontaneous lactation, and menstrual irregularities occur when dopamine is
decreased in the Tuberoinfundibular pathway – Hyperprolactinemia
Mesolimbic: DA hyperactivity = Positive sx
Neurotransmitters increase DA in the mesolimbic area
• Hallucinations, delusions, etc
• Excess DA in this pathway will produce positive psychotic sx
Mesocortical: DA deficit = Negative sx.
Neurotransmitters decrease DA activity in the mesocortical area
• i.e. cognition, affect, apathy, behavior, etc
believed negative sx are r/t a deficit of DA in this particular pathway
Nigrostriatal: blockade of DA in this pathway produces increased motor
movements
• Dopamine blockade in this pathway = decrease DA = increase ACh
• Deficient DA in this pathway causes movement disorders
• e.g. EPS (Pseudo parkinsonism, Akathisia, dystonia & TD
• Tardive: D2 blockade in this pathway. Late occurring, mostly irreversible
Tuberoinfundibular: D2 blockade = Hyperprolactin. Common w/Risperdal
• Dopamine inhibits prolactin
• Blockade of DA = decrease DA = increase Prolactin
• Sx of elevated prolactin levels: galactorrhea, amenorrhea, possible sexual
dysfunction
**Importan Note : Dopamine inhibits prolactin
Therefore: Blockade of dopamine = decrease DA = increase Prolactin
,WEEK 2
Management of Acute Psychosis
IM haloperidol should be administered with benztropine (Cogentin) or
diphenhydramine to reduce the risk oof severe EPS or dystonia
Severely agitated patients: use a benzodiazepine combination w/the
antipsychotic (e.g. Haldol + Lorazepam + Cogentin)
**Important Note
Antipsychotic polypharmacy can increase the risk for re-hospitalization, diabetes,
EPS, sedation, seizures, metabolic effects, mortality, and sudden cardiac death.
Know the meds that are First generation (e.g. Haldol, Chlorpromazine) vs. Second
generation (e.g. Risperidone, Olanzapine, Quetiapine)
FGA/Typical/1st generation SGA/Atypical/2nd generation
-block D2 receptors -serotonin-dopamine antagonist
Haloperidol (Haldol) Risperidone (Risperdal)
Can be given PO/IM/IV; Decanoate Greatest prolactin elevation
(LAI) S/E: NMS
Given in acute agitation or psychosis
S/E: Neuroleptic Malignant Syndrome
(NMS)
Chlorpromazine (Thorazine) Olanzapine (Zyprexa)
Can cause blue-gray skin discoloration Acute agitation IM acts w/in 15 min
and corneal/lens deposits Monitor for dose-related
Causes Orthostatic hypotension hyperprolactinemia
Also used for N/V & intractable hiccups Relprevv (injection)= monitor 3 hrs d/t
PO & IM formulation (effective for risk delirium & sedation S/E: NMS
agitation in emergencies)
Fluphenazine (Prolixin) Quetiapine (Seroquel)
PO/IM. Decanoate (LAI) available Strongest H1 antagonism
, S/E: Neuroleptic Malignant Syndrome
(NMS)
Perphenazine (Trilafon) Clozapine (Clozaril)
S/E: NMS, hypersalivation (sialorrhea)
Lowest risk of TD
Only antipsychotic shown to
decrease SI risk Agranulocytosis
Loxapine (Loxitane) Ziprasidone (Geodon)
Higher risk of seizures Weight neutral
Thioridazine (Mellaril) Aripiprazole (Abilify)
Associated w/retinitis pigmentosa Weight neutral
watch for
orthostatic
hypotension
adjunctive tx of
depression, bipolar
Trifluoperazine (Stelazine) Pimavanserin (Nuplazid)
Approved for nonpsychotic anxiety Used in Parkinson’s related psychosis
(newer med)
** Haldol and Prolixin: watch for Lurasidone (Latuda)
allergic reactions in patients sensitive Low risk for metabolic syndrome
to sesame Use w/caution in pts w/hepatic
impairment
Manage positive sx of schizophrenia First line tx
Can worsen negative sx secondary to Accounts for 80% of total
decrease DA in the antipsychotics prescribed
Mesocortical pathway Effective for both positive and negative
S/E: QTC prolongation -obtain baseline symptoms
EKG MOA: blocks both D2 and 5HT2A
Orthostasis -blockade of a1 receptors Can cause EPS but at a lower risk
Elevated liver enzymes: EPS, Akathisia, Lower incidence oof TD
dystonia, Parkinsonism
Hyperprolactinemia
Higher risk of causing TD
