Antipsychotic Drugs

Question 1

Indications for antipsychotics

Answer 1

Tx of serious mental illness: schizophrenia
Bipolar and affective disorder
Depressive and drug-induced psychosis
Autism

Movement disorders

Question 2

First generation (typical) antipsychotic drugs

Answer 2

-All are dopamine receptor antagonists
-Block receptors in CNS
-Many adverse effects: motor disturbances

-Extrapyramidal motor disturbances: early onset effects of drugs. Tardive dyskinesia: oral and facial muscles. Tongue protrusion, lip smacking. After months-yrs of drug tx. Irreversible.
-EPS can be managed with anticholinergic drugs: Benztropine

-Neuroleptic Malignant Syndrome (4-14 days after start drug): “lead pipe” rigidity, high fever, CV problems (BP, dysrhythmias). Tx: bromocriptine

DRUG: Chlorpromazine

Question 3

Second generation (atypical) antipsychotic drugs

Answer 3

-Block 5-HT receptors
-Less effect on DA receptors than typical antipsychotics, hence fewer motor disturbances

DRUG: Clozapine
-Very little EPD
-Take regular blood counts (agranulocytosis-WBC)

Question 4

ALL antipsychotics can cause

Answer 4

EPD (but WAY less common in atypical 2nd gen)

Weight gain due to disturbances in blood glucose (but more common in atypical drugs)