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| Frage | Antworten |
| Typical Anti-Psychotics | Haloperidol (1-30mg), Chlorpromazine (75mg-1g), Sulpiride (400mg-2.4g), Perphenazine (12-24mg) |
| Atypical (second generation) Anti-Psychotics | Aripiprazole (10-30mg), Clozapine (200-900mg), Olanzapine (5-20mg), Risperidone (4-16mg) |
| Drug’s half-life | Duration action of a drug. Time period of concentration in body (plasma) to half. |
| Elimination (Half Life) | Drug removed from body or translocated to another body fluid compartment or destroyed in blood (i.e. intracellular fluid) |
| Clearance (Half Life) | Removal of drug from plasma |
| Volume of Distribution (Half Life) | Distribution of drug in body tissues |
| Steady State (Half Life) | Maintenance of drug concentration to be therapeutically effective - rapid clearance drugs given regularly to build / balance / maintain high concentration |
| Time taken to reach steady state | 5 X half life of the drug / loading dose administered so steady state reached quickly then reg dose |
| Aripiprazole Half Life | 75 hours (94 hrs active metabolite) |
| Clozapine Half Life | 12 hours (5-16 hrs) |
| Olanzapine Half Life | 35 hours (21-54 hrs) |
| Risperidone Half Life | 24 hours (active metabolite) |
| Quetiapine Half Life | 7 hrs (12 Hrs active metabolite) |
| Amisulpride Half Life | 12 hours |
| Olanzapine therapeutic dosage range Schizophrenia | 5-20mg-Adult |
| Risperidone Therapeutic Dosage Range Schizophenia | 4-16mg-Adult |
| Aripiprazole Therapeutic Dosage Range | 10-30mg Adult |
| Clozapine Therapeutic Dosage Range | 200-900mg Adult |
| reasons for blood monitoring in atypical anti-psychotics (generally) | (1) Increased risk of type 2 diabetes – even more than typical antipsychotics (2) Increased insulin resistance (3) Dyslipidemia - disorder of lipoprotein metabolism abnormal amount of lipids (cholesterol / fat) in blood. Caused by prolonged elevation of insulin levels. (4) Inc. Risk of Hyperglycemia - excessive blood glucose leading to diabetes (5) DKA (Diabetic Ketoacidosis) Reduction of insulin and corresponding high glucose produces ketones (poison) turns body acidic. |
| Clozapine and the continued blood monitoring testing necessary when on medication and the reasons for this | Agranulocytosis- acute condition involving a severe leukopenia (lowered white blood cell count). |
| Extrapyramidal Side-effects (EPS): Cause, Types, Clinical features | EPSEs are associated with blockade of D2 receptors in the Nigro-striatal dopamine pathway. (1) Type: Parkinsonism / Clinical Feature: Tremors, hypersalivation, blank expression, difficulty moving (2) Type: Dystonia / Clinical Feature: Difficulty toning muscles - Abnormal face/body movements (3) Type Tardive Dyskenesia / Clinical Feature: Involuntary movements of face (puckering) / jaw (4) Type: Akathisia / Clinical Feature: Restlessness (inner) |
| Main brain region implicated for EPS | Basal Ganglia |
| Sexual side-effects of anti-psychotics | (1) Reducing dopamine levels by blocking D2 receptors in the tubero-infundibular system with antipsychotics causes plasma prolactin concentrations to rise – Hyperprolactinemia. (2) Elevated prolactin levels lead to weight gain and sexual dysfunction (3) Prolactin is antagonized by dopamine + the body depends on the two being in balance – risk of prolactin stimulation present with all drugs that deplete dopamine |
| Signs and symptoms of Neuroleptic Malignant Syndrome (NMS) | Extreme muscular rigidity, high fevers, confusion, fluctuating consciousness, diaphoresis, autonomic instability (fluctuating BP), tachycardia, coma, death. |
| Anticholinergic (Antimuscarinic) medications used for control of EPS | Orphenadrine (150 - 400mg) Procyclidine (7.5 - 60mg) Trihexyphenidyl (5 - 20mg) |
| Side effects of Anticholinergic (Antimuscarinic) medications | Constipation, dry mouth, nausea, vomiting, tachycardia, dizziness, confusion, euphoria, hallucinations, impaired memory, anxiety, restlessness, urinary retention, blurred vision, rash. |
| Tools that monitor side-effects of antipsychotic medication | (1) Tip Sheet / Monitoring Log (2) ECG (Electrocardiogram) Measure cardiac function (3) AIMS Scale (Abnormal Involuntary Movement) (4) ANNSERS (Antipsychotic Non-Neurological Side Effects Rating Scale) (5) Simpson Angus EPS Scale (6) BARNES Akathesia rating scale (7) PANSS (Positive And Negative Syndrome Scale) |
| Advantages of Atypical anti-psychotics over Typical antipsychotics | (1) May be better tolerated than older antipsychotic drugs (2) Extrapyramidal symptoms may be less frequent (3) May not increase prolactin (Aripiprazole, Clozapine, Olanzapine, Quetiapine, Sertindole) (4) May be effective in patients with schizophrenia unresponsive to, or intolerant of, conventional antipsychotic drugs (Clozapine) |
| Concordance Definition | The extent to which the patient fulfils the intention of the prescriber in taking medication |
| Concordance Process | (1)Concordance is an alternative term (Compliance is presciptive-no choice) and suggests a joint process between service user and provider. (2) Need to engage SU in a collaborative manner to enable effective med management - Interpersonal skills / Client centred / Info / Problem solving. |
| Concordance Key Therapeutic Skills | (1) Sorting out practical issues (what meds / who supplies / how to collect+pay / other drugs-doses-homeopathic / reading labels+opening bottles / prompts / dosette box / fitting meds into routine-behavioural tailoring / payment) (2) Looking back (timelineof illness / meds / clinicians / hospitalisation / recovery) (3) Exploring ambivalence (motivational interviewing used to elicit behaviour change by exploring ambivalence) (4) Discussing beliefs and concerns about medication (evidence for / against beliefs eg poison) (5) Looking into the future (explore importance of meds / build confidence to adhere- both important to behaviour change / build self esteem-positive-empathy-goals (low SE undermines importance) |
| Adherence | The extent to which a persons behaviour e.g. taking medication or executing lifestyle changes, corresponds with agreed recommendations from a health care provider |
| Non-Adherence | Not just related to actual taking of medication but failing to attend scheduled appointments |
| Non-Adherence Factors | (1)Stopping medicines in recurrent or enduring conditions (psychotic) places SU at higher relapse risk over 1 yr - 70% over 20-30% with medication. Antidepressants - 36 months- 40/18% (2) It is normal behaviour to stop taking meds without advice - blame/judging should not be made on SU. (3) Relationship with professionals + other service related factors has a strong influence on medication-taking behaviour |
| Non-Adherence 5 main factors + summary | Five main factors (Gray et al. 2007) (1) Illness related factors (insight, symptom, severity) (2)Treatment-related factors (side-effects, treatment efficacy, methods of administration) (3)Clinician-related factors (non-collaborative working, authoritarian attitudes, access to clinicians) (4)Patient-related factors (age, sex, culture, beliefs about treatment / severity of illness) (5)Environmental factors (including peer pressure) SU satisfaction with drug treatment / treatment satisfaction – direct influence on adherence. |
| Interventions to enhance Adherence / Concordance | (1) Educational (Psycho-education) (2)Behavioural (tailor to suit routines) (3)Cognitive Behavioural Programme - engagement / psychoeducation / ID early symptoms / Develop coping strategies-behavioural strategies to reinforce adherence (4) Compliance therapy - motivational interviewing, CB techniques) |
| Concordance Tips for Practice | (1) Be clear about the message you send out (2) Convey a high level of interpersonal skill (listening, eye contact, empathy etc) (3) Convey belief in the fundamental importance and effectiveness of medication (4) Be knowledgeable about medicines (5) Translate medication information medication into English (6) Simple regime - aim for ‘once a day’ administration (7) Form good working relationship with local pharmacist (8) Collaborate with all involved in supporting client to take medication |
| NMC (2010) Standards for Medicines Management: Section 9 (Standard 24): Management of Adverse Events (1) | (1) As a registrant, if you make an error you must take any action to prevent any potential harm to the patient and (2) report as soon as possible to the prescriber, your line manager or employer (according to local policy) and (3) document your actions. (4) Midwives should also inform their named supervisor of midwives. |
| NMC (2010) Standards for Medicines Management: Section 9 (Standard 24): Management of Adverse Events (2) (Process) | (1) Open culture in reporting (2)Open multi-disciplinary approach to investigating (3) Local investigation first accounting for context and circumstances (4) Report to risk management systems in NHS – National Patient Safety Agency (NPSA) through National Report and Learning System (NRLS) (5) Distinguish between recklessness/incompetent practice/ concealment and work pressure / immediate honest disclosure in patient’s interest. |
| NMC (2010) Standards for Medicines Management: Section 9 (Standard 25) Reporting Adverse Reactions | (1)As a registrant, if a patient experiences an adverse drug reaction to a medication you must take any action to remedy harm caused by the reaction. (2)You must record this in the patient’s notes, (3) notify the prescriber (if you did not prescribe the drug) and (4) notify via the Yellow Card Scheme immediately |
| Yellow Card Scheme (Medicines and Healthcare Products Regulatory Agency-MHRA) – rationale, level of usage issues | (1)Before a medicine is granted a licence so that it can be made available in the UK it must pass strict tests to ensure it is safe and effective.(2) All effective medicines, however, can cause side effects (adverse drug reactions). (3)The expected benefits of the medicine must outweigh the possible risks of the medicine causing adverse effects in patients. (4)Even if it is only a suspicion that a medicine or combination of medicines has caused a side effect, we ask patients and health professionals to send us a Yellow Card. |
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