Antipsychotic Agents (Neuroleptics) Flashcards
What are the 6 main treatment options classified as “Antipsychotics?”
- Typical 1st gen antipsychotics
- Atypical 2nd gen antipsychotics
- Benzisoxazoles
- Quinolones
- Lithium
- Anti-convulsants
Which antipsychotic?
- MOA: blocks CNS dopamine (D2) receptors (dopamine antagonist)
Typical 1st gen
What are the 2 types of 1st gen antipsychotics and the names of the drugs in each group?
(6 drugs total)
Butyrophenones
- Haloperidol (Haldol)
- Droperidol
Phenothiazines
- Fluphenazine (prolixin)
- Perphenazine
- Chlorpromazine
- Thioridazine
SE of 1st generation antipsychotics?
Extrapyramidal Sxs (EPS)
- Dystonic rxn (trismus, grimacing, torticollis)
- Tardive dyskinesia (lip smacking, teeth grinding)
- Parkinsonism (rigidity, tremor)
What type of SE of which drug?
- Reversible EPS hours to days after initiating typical antipsychotic d/t dysruption of Dop-Ach balance (↓ dopamine leads to excess ACH mediated activation) –> intermittent, spasms, sustained involuntary muscle contractions (trismus, protrusion of tongue, facial grimacing, torticollis, diff speaking)
Dystonic Reaction (Dyskinesia) which is an EPS symptom
Typical 1st gen Antipsychotics
How do you treat Dystonic Reaction (EPS symptom of typical 1st gen antipsychotic)?
- Symptoms usually resolve within 10 mins of IV administration of Diphenhydramine (has anticholinergic SE such as Benztropine)
- Benzodiazepines (normal dopamine-ACH balance mediated by GABA containing neurons)
Which SE of which drug?
- Repetitive involuntary movements, mostly involving extremities & face (lip smacking, teeth grinding, rolling of tongue)
- Seen with long term use of the drug
Typical 1st gen antipsychotics
- Haldol, Droperidol
- Fluphenazine, Perphenazine
- Chlorpromazine
- Thioridazine
Which two 1st gen antipsychotic drugs have less EPS sxs, and have more anticholinergic SE?
- Chlorpromazine
- Thioridazine
(Phenothiazines)
Which SE of which drug?
- Rigidity and tremor due to ↓ dopamine in nigrostriatal pathways
Parkinsonism
SE of typical 1st gen antipsychotics
- Haloperidol
- Droperidol
- Fluphenazine
- Perphenazine
- Chlorpromazine
- Thioridazine
Besides EPS, what is another SE of 1st gen antipsychotics?
Neuroleptic Malignant Syndrome (NMS)
- Life threatening disorder d/t D2 inhibition in basal ganglia which causes AMS, extreme muscle rigidity, tremor, autonomic instability (tachycardia, tachypnea, hyperthermia/fever, diaphoresis, incontinence), and leukocytosis
1st gen antipsychotics can cause Neuroleptic Malignant Syndome.
- What age group is MC?
- Occurs within how long of ingesting medicine?
- young adults
- within 90 days of initiation or dose increase
How do you treat Neuroleptic Malignant Syndrome?
- Stop offending agent (1st gen antipsych)
- Tx hyperthermia w/ cooling blankets & ice to axilla/groin and ventilatory support
- Dopamine agonists (Bromocriptine, Amantadine, Levodopa/Carbidopa)
SE of which drug?
- ↑ prolactin
- weight gain
- QT prolongation
- cardiac arrhythmias, sedation
- anticholinergic SE, dermatitis, blood dyscrasias
Neuroleptic Malignant Syndrome from 1st gen antipsychotics such as:
- Haloperidol
- Droperidol
- Fluphenazine
- Perphenazine
- Chlorpromazine
- Thioridazine
What are the 3 contraindications to use of Haldol (1st gen typical antipsychotic)
- Parkinson disease
- Anticoagulant use
- Severe cardiac disorder
MOA of which drug?
- CNS dopamine D4 receptor & serotonin (5HT2) antagonists
Atypical 2nd gen antipsychotics “Pines”
- Quetapine
- Olanzapine
- Clozapine
- Loxapine
What drug do you use to treat psychosis and the positive sxs of schizophrenia?
1st gen typical antipsychotics
- Haloperidol
- Droperidol
- Fluphenazine
- Perphenazine
- Chlorpromazine
- Thioridazine
What drug is 1st line for psychotic disorders?
Atypical 2nd gen antipsychotics “Pines”
- Quetapine
- Olanzapine
- Clozapine
- Loxapine
Which drug is useful for patients who develop resistance to other antipsychotics?
(patients experience sxs for 2-6 weeks on other meds)
Clozapine
What are the SE of 2nd gen atypical antipsychotics?
Extrapyramidal Sxs (EPS)
- Dystonic Reactions (spasms, trismus, torticollis, diff speaking)
- Tardive Dyskinesias (repetitive involuntary movements)
- Parkinsonism (rigidity/tremors)
- ↑ prolactin levels, hyperglycemia, HLD, weight gain, NMS
Agranulocytosis and myocarditis are results of which medication?
Clozapine
(Atypical 2nd generation antipyschotic)
What labs should be monitored with Atypical 2nd generation antipsychotics?
CBC, because Clozapine can cause agranulocytosis
Which drug causes weight gain and DM?
Olanzapine (Atypical 2nd gen antipsychotic)
Which drug causes QT prolongation and seizures?
Atypical 2nd gen antipsychotics
“Pines”
MOA of which drug?
- Partial dopamine (D2) receptor and serotonin 5-HT1A receptor antagonist
Benzisoxazoles
- Risperidone (Risperdal)
- Ziprasidone (Geodon)
