Antipsychotic Agents and Lithium Flashcards
Typical (Classical) Antipsychotics
Phenothiazines (Chlorpromazine, Thioridazine, Fluphenazine)
Thioxanthenes (Thiothixene)
Butyrophenones (Haloperidol)
Atypical Antipsychotics
Heterocyclics (Clozapine, Loxapine, Olanzapine, Risperidone, Quetiapine, Ziprazidone, Aripiprazole)
LAHAT NG MAY -PINE at -DONE
_____ Potency:
fewer extrapyramidal effects, more H1, Alpha1 and muscarinic blocking effects
Low
i.e. Chlorpromazine, Thioridazine, Mesoridazine
_____ Potency:
more extrapyramidal effects, less H1, Alpha1 and muscarinic blocking effects
High
i.e. Haloperidol, Fluphenazine, Droperidol
These Dopamine ___ receptors are the target of older antipsychotics
D2 receptors in the caudate putamen, nucleus accumbens, cerebral cortex and hypothalamus
Identify the Dopaminergic Tract:
Regulates mentation and mood
Mesocorticcal - Mesolimbic
Identify the Dopaminergic Tract:
Extrapyramidal function
Nigrostriatal
Identify the Dopaminergic Tract:
Control of PRL release
Tuberoinfundibular
Identify the Dopaminergic Tract:
Eating behavior
Medullary-Periventricular
Identify the Dopaminergic Tract:
Anticipatory motivational phase of copulatory behavior
Incertohypothalamic
Antipsychotic that decreases incidence of suicide
Clozapine
Antipsychotic Toxicities
Constipation, dry mouth, loss of accomodation Orthostatic hypotension, impotence Toxic-confusional state Weight gain Hyperprolactinemia
Hallucinogenic Receptors
5HT2A/2C
Antipsychotics that can improve + symptoms but not - symptoms
Typical/Classical
Antipsychotics that can improve both + and - symptoms
Atypical
PERO SOBRANG MAHAL
Tx for Acute Dystonia
Diphenhydramine
Tx for Parkinsonism
Benztropine
Tx for Rabbit Syndrome
Benztropine
Tx for Tardive Dyskinesia
None
Tx for Akathisia
Diphenhydramine
Tx for Neuroleptic Malignant Syndrome
Withdraw drug, Dantrolene
Typical Antipsychotics
Blocks D2 receptors»5HT2
Chlorpromazine
Thioridazine
Haloperidol
LAHAT NG -ZINE
Atypical Antipsychotics
Blocks 5HT2»D2
Clozapine Olanzapine Quetiapine Risperidone Ziprazidone Aripiprazole
LAHAT NG -PINE at -DONE
Sx of Neurleptic Malignant Syndrome
FEVER
Fever Encephalopathy Vitals Unstable Elevated CPK Rigidity
Prototype typical antipsychotic
SE: CORNEAL AND LENS Deposits, failure of ejaculation, marked sedation, neuroleptic malignant syndrome, contact dermatitis
Chlorpromazine
Phenothiazine
Typical antipsychotic for anti-emesis
SE: RETINAL deposits, failure of ejaculation, cardiotoxicity (arrhythmia)
Strongest AUTONOMIC EFFECTS
Thioridazine
Phenothiazine
Only antipsychotic with Fatal Overdose
Thioridazine
Phenothiazine
Typical antipsychotic Drug for Huntington, Tourette's SE: EPS (major), Neuroleptic Malignant Syndrome Weakest AUTONOMIC EFFECTS Least sedating
Haloperidol
Butyrophenone
Prototype atypical antipsychotic
Drug for refractory schizophrenia, suicidal
SE: AGRANULOCYTOSIS, weight gain, hyperglycemia, hyperlipidemia, myocarditis, seizures, ileus, hypersalivation
Clozapine
Atypical antipsychotic for Bipolar disorder, anorexia nervosa, depression
SE: weight gain, hyperglycemia, hyperlipidemia
Olanzapine
Atypical antipsychotic
SE: Somnolence, Fatigue, Sleep paralysis, Hypnagogic hallucinations, cataracts, priapism
Quetiapine
Atypical antipsychotic for intractable hiccups, Tourette’s syndrome
SE: Hyperprolactinemia, Photosensitivity
Only antipsychotic approved for schizophrenia in the youth
Risperidone
Atypical antipsychotic
SE: Postural hypotension, QT prolongation (Torsades)
Little or not tendency to cause hyperglycemia, hyperprolactinemia or weight gain
Increased mortality in elderly patients with dementia-related psychosis
Ziprasidone
PUSO
Atypical antipsychotic Least sedating atypical antipsychotic no atropine like effects Little or not tendency to cause hyperglycemia, hyperprolactinemia or weight gain Very good safety profile
Aripiprazole
Sx of Neuroleptic Malignant Syndrome
Fever Encephalopathy Vitals Unstable Elevated CPK Rigidity
Tx of Bipolar disorder
Used with antidepressants during maintenance therapy
Slow onset of action
Protective versus suicide and self-harm
Lithium
Mood stabilizer that decreases cAMP, Inhibits Inositol1phosphate
SE: Thyroid enlargement, Nephrogenic DI, Edema, Leukocytosis, Teratogen, Ebstein’s Anomaly, Bradycardia
Contraindicated in Sick Sinus Syndrome
Lithium
Tx of Lithium overdose
Hemodialysis
Threshold for Lithium Toxicity
2 mEq/L
Sx of Lithium Overdose
Neuromuscular excitability, tremors, twitching, agitation, weakness, ataxia, leukocytosis, bradycardia, hypotension