ANTIPSYCHOTIC AGENTS AND LITHIUM Flashcards
caused by a relative excess of dopamine in the mesolimbic-mesocortical pathway
Schizophrenia
Positivr symptoms
HIDES Hallucination Illusion Delusion Excitement Suspciousness
Negative Signs
Anhedonia
Avolition
Anergia
D1 receptor family?
D2 receptor family?
D1 fam - D1, 4, 5
D2 fam - D2, 3
addresses more of the positive symptoms
TYPICAL ANTIPSYCHOTICS
addresses both positive and negative symptoms
ATYPICAL ANTIPSYCHOTICS
higher chances of causing EPS
high potency typical antipsychotics
- haloperidol, droperidol
more likely to cause sedatiom and postural hypotension due to alpha receptor blockade
Low Potency Typical Antipsychotics
- thioridazine, chlorpromazine
with higher propensity to cause metabolic derangements (weight gain, endocrine problems)
Atypical antipsychotics
Blocks more D2 receptors than 5HT2A
Typical Antipsychotics
Atypical - blocks more 5HT2A receptors
TYPICAL ANTIPSYCHOTICS
PHENOTHIAZINES
PIPERIDINES
BUTYROPHENONE
PHENOTHIAZINES
Chlorpromazine
Levomepromazine
Prochlorperazine
Promethazine
Thiothexene
Flupentixol
Thioridazine
Fluphenazine
Perphenazine
Trifluoperazine
AE: RETINAL DEPOSITS
thioridazine
Phenothiazine with the most muscarinic blockade therefore has the least EPS amongst typical antipsychotics
Thioridazine
phenothiazine with quinidine like actions (prolongation of QT interval)
Thioridazine
Phenothiazine with significant Parkinson-like effect
Fluphenazine and Trifluoroperazine
BUTYROPHENONE
Haloperidol
Droperidol
USE: BUTYROPHENONE
Schizophrenia
BPD - manic phase
Huntington’s Disease
Tourette’s Syndrome
major tranquilizer with highest potential for EPS and neuroleptic malignant syndrome
Haloperidol
least sedating among typical antipsychotics
Haloperidol
ATYPICAL ANTIPSYCHOTICS
DIBENZODIAZEPINE THIENOBENZODIAZEPINE DIBENZOTHIAZEPINE BENZISOXAZOLE DIHYDROINDOLONE DIHYDROCARBOSTYRIL
DIBENZODIAZEPINE
CLOZAPINE
THIENOBENZODIAZEPINE
OLANZAPINE
DIBENZOTHIAZEPINE
QUETIAPINE
BENZISOXAZOLE
RISPERIDONE
PALIPERIDONE
DIHYDROINDOLONE
ZIPRASIDONE
DIHYDROCARBOSTYRIL
ARIPIPRAZOLE
DOC for refractory and suicidal schizo
Clozapine
With the highest tendency to cause weight gain among atypical
Clozapine, Olanzapine
Only antipsychotic that reduces the risk of suicide
Clozapine
Most feared complications of clozapine
Agranulocytosis and seizures
Clozapine is not associated with seizure because?
it blocks the D2C receptors (mesocortical mesolimbic area) not the D2A (nigrostriatal pathway)
D4=a1>5HT2A>D2=D1
causes minimal or no increase in prolactin and has reduced risk of EPS (MINIMAL D2 antagonism)
Olanzapine, Quetiapine, Aripiprazole
atypicals least likely to cause tardive dyskinesia
Quetiapine and Clozapine
atypical that causes somnolence, sleep paralysis, hypnagogic hallucinations, cataracts, priapism and QT prolongation
Quetiapine
atypical with the highest propensity to cause hyperprolactinemia (amenorrhea, galactorrhea)
Risperidone
only antipsychotic approved for schizophrenia in the youth
Risperidone
atypical causing marked QT prolongation
Ziprasidone
atypical - partial agonist at the D2 receptor
Aripiprazole
Least sedating atypical
Aripiprazole
Safe in pregnancy - atypical
Olanzapine and quetiapine
No atropine-like effects - atypical
Aripiprazole, Ziprasidone
QT prolongation - atypical
Ziprasidone, Quetiapine
Atypical can also be used in anorexia nervosa and depression
Olanzapine
Atypical can also be used in sleep promotion and maintenance
Quetiapine
Atypical can also be used in depression, intractable hiccups, tourette syndrome
Risperidone, Paliperidone
Atypical can also be used in MDD, autism, cocaine, dependence
Aripiprazole
MOOD STABILIZER
LITHIUM
DOC FOR BIPOLAR DISORDER
LITHIUM
most common side effect of lithium
tremor
lithium is contraindicated in
sick sinus syndrome or brady tachy syndrome
AE of LITHIUM
LiTHIUM
Low Thyroid hormone
Heart - Ebstein Anomaly
Insipidus - nephrogenic
Unintentional Movement (Tremor)
Threshold for toxicity
2meq/L
Treatment for Lithium Overdose
Hemodialysis
Manifestation
brady, hypotension
agitation, tremor, twitching