Antipsychotic drugs Flashcards
What is the mechanism of action of first-gen antipsychotics?
They are D2-antagonists and also block other receptors (H1, M, a1 receptors)
What is the mechanism of action of second-gen antipsychotics?
They are D2-antagonists and 5-HT2A antagonists
What is an example of first-generation antipsychotics?
Haloperidol (or anything ending in -azine)
What are acute (short-term) adverse effects of first-gen antipsychotics?
- Extrapyramidal symptoms: dystonia (sudden and sustained involuntary muscle contractions), akathisia (ants in pants), parkinsonian syndrome (bradykinesia, rigidity, resting tremor)
What are long term adverse effects of first-gen antipsychotics?
- Extrapyramidal symptoms: tardive dyskinesia (involuntary repetitive movements in facial region)
- Irreversible and limited effective treatment
What are rare adverse effects of first-gen antipsychotics?
- Extrapyramidal symptoms: neuroleptic malignant syndrome (muscle rigidity, fever, sweating, delirium, autonomic instability)
- Very dangerous
What are additional adverse effects seen with first-gen antipsychotics?
Orthostatic hypotension, anticholinergic effects, sedation, weight gain (d/t increased appetite)
What contraindication is there with first-gen antipsychotics?
BBW in elderly patients with dementia –> increases mortality in these patients
What are examples of second-gen antipsychotic?
Quetiapine and aripiprazole (either end in -pine, -prazole, or -idone)
Clozapine (the best & the worst bc??)
- Second-gen antipsychotic
- Best: No EPS and effective against negative sxs
- Worst: can cause agranulocytosis (increased infections) and seizures so reserved for refractory cases (also causes salivation or wet pillow syndrome)
Olanzapine
- Second-gen antipsychotic
- Most problematic for weight gain and metabolic changes
Ziprasidone
- Second-gen antipsychotic
- Causes QT prolongation
Risperidone
- Second-gen antipsychotic
- Worse in terms of increasing prolactin secretion and causing EPS
Quetiapine
- Second-gen antipsychotic
- Less adverse effects
Aripiprazole
- Second-gen antipsychotic
- Partial D2 agonist and 5-HT antagonist
- Less adverse effects
What is lithiums mechanism of action?
Inhibits multiple enzymes involved in generation of second messengers (poorly understood)
What is lithium used to treat in this case?
Bipolar disorder
What are the side effects seen in lithium?
Movement problems (tremor), Nephrogenic diabetes insipidus (interferes w ADH), hypothyroidism, pregnancy
- Also can cause N/V and kidney dysfunction (long term use)
What is lithium contraindicated in?
-Pregnancy, renal disease, and thyroid dysfunction (check renal and thyroid function regularly, as well as lithium)
- BBW for serum lithium concentration monitoring
What are other treatment options for bipolar disorder?
Antiseizure medications: valproic acid, carbamazepine, lamotrigine
Second generation antipsychotics: ziprasidone, olanzapine, risperidone, aripiprazole, quetiapine
T/F: Lithium is not good for maintenance therapy for bipolar disorder
False, lithium is the best maintenance agent in this disease
