Antipsychotic Drugs Flashcards
How is Schizophrenia diagnosed?
Two or more positive symptoms and at least one negative.
Positive - delusions, hallucinations, disorganized thoughts
Negative - social withdrawal, blunted affect, lack of spontaneity
What is the underlying cause of Schizophrenia and similar disorders?
Hyperactivity of dopamine release or their receptors.
Remember each dopamine tracts do different things.
Mesolimbic Tract - arousal, stimulus processing = positive symptoms
Mesocortical tract - communication, cognition
diminished dopamine = negative symptoms
What are the types of Dopamine receptors?
D1-like = D1 and D5, increase cAMP
D2-like = D2 and D4. decrease cAMP
(Drugs typically target D2-like)
How do the drug therapies work?
They block both Dopamine and Serotonin receptors.
Typical Drugs = Mostly Dopamine, less serotonin
Atypical Drugs = Blocks Dopamine and Serotonin
What are the differences between typical and atypical drugs?
Typical Drugs treat positive symptoms, usually making negative symptoms worse.
Atypical Drugs better treat the negative symptoms
What are most concerning effects of antipsychotic drugs?
Biggest concern are Extrapyramidal Effects
Early Symptoms - Acute Dystonia (ENT spams), Parkinsonism, Akathisia (restlessness)
Late Symptoms - Tardive Dyskinesia (abnormal movements of face)
What are additional side effects of antipsychotics?
Anticholinergic Effects, Orthostatic Hypotension, Decreased seizure threshold, and Neuroendocrine (Weight Gain, more common DM events)
Neuroleptic Malignant Syndrome
What are two typical phenothiazine that are low potency and have less extrapyramidal side effects?
Chlorpromazine and Thioridazine
-more sedating and anticholinergic
What is a high potency phenothiazine?
Fluphenazine, less sedating and anticholinergic, MORE extrapyramidal effects
What is the most commonly used antipsychotic that is high potency unrelated to Phenothiazines?
Haloperidol. (Similar to Fluphenazine effects)
More Extrapyramidal effects, less sedating/anticholinergic
What are the benefits of atypical antipsychotics?
Better at treating the negative symptoms, less extrapyramidal effects, lower tardive dyskinesia, improves both positive and negative symptoms
What atypical drug would require frequent blood tests?
Clozapine.
Can cause fetal agranulocytosis, lower seizure threshold, more anticholinergic effects
What receptors does Clozapine antagonize?
D4 and 5HT2
What drug is a D1, D2, and 5HT2 antagonist and does NOT cause granulocytosis?
Olanzapine - related to Clozapine
More potent 5HT2 - less seizures and less granulocytosis
What atypical drug can cause increased complications with DM and weight gain?
Olanzapine
