08a_Antipsychotic Medications Flashcards
Two classes of medications most commonly provided in medical specialty offices
Antipsychotics
Antimanics
Antipsychotic Drugs:
Also known as…
Tranquilizers
Neuroleptics
Traditional Antipsychotics:
Uses
Schizophrenia Positive symptoms
Major Depressive Disorder with psychosis
Organic psychoses
Four Traditional Antipsychotics
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
Thiothixine (Narvane)
Haloperidol (Haldol)
Traditional Antipsychotics:
Mechanism of Action
Block dopamine receptors D1
Dopamine Hypothesis
Schizophrenia related to excessive dopamine or oversensitivity of dopamine receptors
Support for Dopamine Hypothesis
Amphetamines raise dopamine levels and can produce psychosis in all individuals
Low doses of exacerbate positive symptoms for those with Schizophrenia
Traditional Antipsychotics Side Effects:
Anticholinergic Effects
Dry mouth
Blurred vision
Urinary retention
Constipation
Tachycardia
Delayed ejaculation
Anticholinergic Effects Onset and Course
Symptoms appear early
Tolerance ordinarily developed in a few weeks or months
Four main Extrapyramidal side effects
Parkinsonism
Akithisia (restlessness)
Acute Dystonia (muscle spasms)
Tardive Dyskinesia
Tardive Dyskinesia:
Symptoms
Involuntary rhythmic movements of the jaw, lips, tongue, and extremities
Similar to Huntington’s Disease
Tardive Dyskinesia:
Onset and Prevalence
Late-occurring
More common in females and older patients
True or False?
Tardive Dyskinesia is Irreversible
False.
Recent studies show symptoms improve when drug is gradually withdrawn
Also alleviated by benzodiazepine / GABA agonist
Extrapyramidal side effects:
Cause and Worst offender
Effects of Traditional Antipsychotics on dopamine receptors in caudate nucleus
Haldol (Halperidol)
Neuroleptic Malignant Syndrome:
Overview
Rapid onset of motor, mental, and autonomic symptoms
Potentially fatal side effect of antipsychotic drugs
Neuroleptic Malignant Syndrome:
Symptoms
Rigidity
Tachycardia
Hyperthermia
Altered consciousness
Neuroleptic Malignant Syndrome:
Treatment
Immediately discontinue antipsychotic medication
Four Atypical Antipsychotic Drugs
Clozapine (Clozaril)
Risperidone (Risperdal)
Olanzapene (Zyprexa)
Quetiapine (Seroquel)
Atypical Antipsychotic Drugs:
Uses
Schizophrenia
Bipolar disorder non-responsive to mood stabilizers
Depression and suicidality
Alcohol and drug addiction
Hostility
Movement disorders (Parkinson’s, Huntington’s)
Atypical Antipsychotic Drugs:
Mechanism of Action
D4 dopamine receptors
Glutamate and serotonin receptors
Atypical Antipsychotic Drugs:
Pros and Cons of Treatment Effects
Pro: Alleviate both positive and negative symptoms of schizophrenia
Con: Slower onset of therapeutic effects than traditional antipsychotics
Atypical Antipsychotic Drugs:
Pros and Cons of Side Effects
EPS much less common, except for akithisia
Much less likely to cause Tardive Dyskinesia
Con: Risk of agranulocytosis; can also cause neuroleptic malignant syndrome
Atypical Antipsychotic Drugs:
Common Side Effects
Anticholinergic effects
Lowered seizure threshold
Sedation
