Long Acting Injectables Intramuscular (IM) Injections
[Pages:46]Long Acting Injectables &
Intramuscular (IM) Injections
Darren Chapman RPN Clinical Nurse Educator McKesson Canada (Otsuka-Lundbeck Alliance)
What You Need To Know
Learning Objectives
Review current hypothesis for medication treatment of schizophrenia and psychotic disorders
Review current Long-Acting Injectable Antipsychotic Clinical Recommendations for Clinicians . Review current available Long Acting Injectables in Canada
Review land marking techniques for the five injection sites used for all IM Injections and which sites are best for LAI's
Discuss and review Administration Information and Techniques.
What ifs?
Now the fun begins Practice Time for Injections
Overview Schizophrenia Disease State
Chronic, severe brain disorder that is considered one of the most disabling of the serious mental illnesses. Associated with both positive and negative symptoms
? Positive symptoms: delusions, hallucinations, disorganized thinking, disorganized behavior and catatonic movements
? Negative symptoms: alogia, avolition, affective flattening, anhedonia, dysphoric mood, difficulty concentrating
2 2 3
The Dopamine Hypothesis of Schizophrenia
? The dopamine (DA) hypothesis is the oldest and most established of the schizophrenia hypotheses. It has evolved from clinical observations, and received empirical validation from antipsychotic treatment and more direct testing from imaging studies. Although clearly not sufficient to explain the complexity of this disorder, it offers a direct relationship to symptoms and to their treatment
? Anissa Abi-Dargham; Schizophrenia Research Forum 2012
Major Brain Dopamine Pathways and Schizophrenia
Mesocortical pathway1,2
? Associated with cognition and motivation Negative symptoms ? Alogia ? Affective flattening ? Avolition Tuberoinfundibular pathway1,2 ? Controls prolactin secretion
1. Kandel ER et al. Principles of Neural Science. 3rd ed. St. Louis, MO: Elsevier; 1991. 2. Stahl SM. Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 2nd ed.
New York, NY: Cambridge University Press; 2000.
Nigrostriatal pathway1,2
? Controls motor movement
Mesolimbic pathway1,2 ? Associated with memory and emotional behaviors1
Positive symptoms ? Delusions ? Hallucinations ? Disorganized speech/
thinking ? Disorganized or
catatonic behavior
Dopamine Hypothesis of Schizophrenia
Schizophrenia is associated with impaired dopaminergic neurotransmission in the brain
Hypoactivity in mesocortical pathway - Negative symptoms - Impaired learning and memory
Hyperactivity in the mesolimbic pathway -Positive symptoms
Normal dopamine activity in tuberoinfundibular pathway (involved in prolactin regulation
Stahl SM. Essential Psychopharmacology of antipsychotics and mood stabilizers. 1st ed. Cambridge: Cambridge University Press; 2002.
Normal dopamine activity in nigrostriatal pathway (involved in movement regulation)
Dopamine Antagonism in the Mesolimbic Pathway
Improves Positive Symptoms
Presynaptic neuron
Mesolimbic Hyperdopaminergic Pathway
Dopamine
D2 antagonists
D2 receptor Postsynaptic neuron
Stahl SM. Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 2nd ed. New York, NY; 2000.
Improvement of positive symptoms
Dopamine Antagonism in the Mesocortical Pathway May Worsen Negative Symptoms
Presynaptic neuron
Mesocortical Hypodopaminergic Pathway
Dopamine
D2 antagonist
D2 receptor
Postsynaptic neuron
Possible exacerbation of negative symptoms
Stahl SM. Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 2nd ed. New York, NY; 2000.
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