Antipsychotic Agents and Lithium Flashcards
Typical (Classical) Antipsychotics
D2 receptor affinity
Phenothiazines (chlorpromazine, thioridazine, fluphenazine)
Thioxanthenes (thiothixene)
Butyrophenones (haloperidol)
Atypical antipsychotics
Serotonin receptor affinity
Heterocyclics (clozapine, loxapine, olanzapine, risperidone, quetiapine, ziprasidone, aripiprazole)
Low Potency
-fewer extrapyramidal effects but more H1, Alpha1 & M blocking effects
Chlorpromazine, thioridazine, mesoridazine
High Potency
- more extrapyramidal effects but less H1, Alpha1 & M blocking effects
Haloperidol, Fluphenazine, Droperidol
Dopaminergic tracts
- Mesocortical-mesolimbic
- Nigrostriatal
- Tuberoinfundibular
- Medullary-periventricular
- Incertohypothalamic
- Mesocortical-mesolimbic
- mentation and mood
- Nigrostriatal
- Extrapyramidal function
- Tuberoinfundibular
- Prolactin release
- Medullary-periventricular
- eating behavior
- Incertohypothalamic
- anticipatory motivational phase of copulatory behavior
Class: Typical antipsychotic
Use: Schizophrenia & other psychotic disorders
SE: EPS, Tardive dyskinesia, Failure of ejaculation, Marked sedation, corneal & lens deposits
Chlorpromazine
Class: Typical antipsychotic
Use: Schizophrenia & other psychotic disorders, antiemesis
SE: EPS, tardive dyskinesia, failure of ejaculaion, retinal deposits, Cardiotoxicity
Notes: Strongest autonomic effects
Only antipsychotic w/ fatal dose
Thioridazine
Class: Typical antipsychotic
Use: Schizophrenia & other psychotic disorders, Huntington’s disease, tourette’s syndrome
SE: EPS (major), Hyperprolactinemia, Neuroleptic malignant syndrome
Note: Weakest autonomic effects
Least sedating among typical antipsychotics
Haloperidol
Class Atypical antipsychotic
Uses: Schizophrenia (refractory, suicidal)
SE: Weight gain, hyperglycemia (DM), Hyperlipidemia, Myocarditis,
Notes: ONly antipsychotic that reduces risk of suicide
Clozapine
Class: Atypical antipsychotic
Uses: Schizophrenia, other psychotic disorder, bipolar disorder (manic episodes)
SE: Somnolence, fatigue, sleep paralysis, hypnagogic hallucination, cataracts, priapism
Quetiapine
Class: Atypical antipsychotic
Uses: Schizophrenia, other psychotic disorder, bipolar disorder
SE: Insomnia, Hyperprolactinemia (marked), photosensitivity
Note: Only antipsychotic approved for schizophrenia in the youth
Risperidone
Features of Neuroleptic Malignant Syndrome
Fever, Encephalopathy, Vitals unstable, Elevated CPK, Rigidity
Class: Mood stabilizer
MOA: uncertain. Decreases cAMP. Inhibits inositol-1-phosphatase, causing depletion of inositol and inositol triphosphate
Uses: Bipolar disorder, recurrent depression, schizoaffective disorder
SE: Thyroid enlargement, Nephrogenic diabetes insipidus, edema, Bradycadia
Lithium
Mood stabilizer CI in sick sinus syndrome
Lithium
Disease caused by Lithium in fetus
Ebstein anomaly
