Anti-Psychotics-Pechnick Flashcards
What are some of the positive symptoms of Schizophrenia?
Hallucinations, delusions, thought and movement disorders
What does the revised dopamine theory of Schizophrenia say?
- Positive symptoms are due to hyperactivity in the mesolimbic dopamine system
- Negative symptoms & cognitive deficits are due to hypoactivity in the mesocortical dopamine system
Which drugs are First-Generation Antipsychotics?
Phenothiazine-type drugs: 1. Chlorpromazine 2. Perphenazine 3. Trifluoperazine 4. Thioridazine 5. Fluphenazine Non-phenothiazine-type drugs: 1. Thiothixene 2. Haloperidol
Which pharmacologic activity produces the therapeutic effects of antipsychotics?
Block dopamine receptors
What are some pharmacologic effects of antipsychotics?
CNS: affect hypothalamus, seizures
Autonomics: cause symp effects
CV: block a1 receptors (can cause orthostatic hypotension)
Do antipsychotics cure Schizophrenia?
No, just reduce some symptoms
What is the black box warning of first gen antipsychotics?
Elderly pts w/dementia-related psychosis using these drugs are at an increased risk of death
What are some non-psychiatric uses of antipsychotics?
- Neuroleptic anesthesia
- Intractable hiccup
- Nausea and vomiting
How do antipsychotics inhibit nausea and vomiting?
B/c visceral stimuli and the chemoreceptor trigger zone cause dopamine and serotonin to be released and antipsychotics block their uptake!
What is the early onset neurological SE of antipsychotics?
- Extrapyramidal syndrome (EPS) - Too much ACh, not enough DA
- Sx: Parkinsonian syndrome, akathisia, acute dystonic reactions
- Tx: stop or reduce antipsychotics, antimuscarinic drugs
-CONTRAINDICATED: L-DOPA and directly-acting DA agonists because they can cause psychosis
Acute EPS is a result of blocking of which pathway?
Nigrostriatal (extrapyramidal) pathway
Which anti-psychotics are more likely to produce EPS?
Haloperidol very likely, chlorpromazine & thioridazine are much less likely
What is the late onset neurological SE of antipsychotics?
- Tardive Dyskinesia
- Too much DA, not enough ACh
- Tx: Muscarinic agonists, slowly decrease the dose of the drug and change them to an atypical antipsychotic
What is the endocrine SE of antipsychotics?
Hyperprolactinemia:
- Gynecomastia in men, galactorrhea in women
- Amenorrhea
- A tuberoinfundubular problem
What is Neuroleptic Malignant Syndrome (NMS)?
- Rare idiosyncratic response mostly seen in males and can be fatal
- Presentation similar to malignant hyperthermia
- Tx: dopamine agonists (bromocriptine or amantadine) and dantrolene
Which SE of first gen antipsychotics is disabling and frequently permanent?
Tardive dyskinesia
Which drugs are 2nd gen or atypical antipsychotics? (6)
(ZOO CAR)
- Ziprasidone
- Olanzapine
- Ouetiapine
- Clozapine
- Aripiprazole
- Risperidone
What is the pharmacologic activity of the 2nd gen antipsychotics?
- Dopamine receptor antagonist as well as serotonin receptor antagonist
- Extremely nonselective
What are some SE of 2nd gen antipsychotics?
- Less likely to produce EPS and tardive dyskinesia
- Type II diabetes and dyslipidemia
- Weight gain
Why was the widespread use of Clozapine limited?
Causes agranulocytosis in 1% of pts
What is the MOA of atypical antipsychotics?
Non-selective direct inhibitory action on dopamine and serotonin pathways
