Antipsychotic drugs Flashcards
characteristics of typicals
older
more extrapyramidal side effects
treat positive symptoms
effects of typicals
induce state of apathy, lack of initiation, limited range of emotion
reduce confusion and agitation in psychotic patients
characteristics of atypicals
newer
less extrapyramidal side effects
first line for out patient
treat positive and negative symptoms
major receptor target for typicals
D2 dopamine receptor
off target receptors for typicals and their effects
alpha and muscarinic- anticholinergic side effects
H1- weight gain, sedation
serotonin 2c- weight gain
what makes one atypical
5HT2a receptor
relationship between receptor and dose
higher D2 affinity= lower dose recquried
nigrostriatal pathway
substantia nigra to basal ganglia
movement
hyperactive in schizophrenia
degeneration in parkinson’s
mesolimbic pathway
VTA to nucleus accumbent
hyperactive in schizophrenia- positive symptoms
mesocortical pathway
tegmental area to cortex
hypoactive in schizophrenia- negative symptoms
tubuloinfundibular pathwya
tegmental area to hypothalamus
controls prolactin release
typical antipsychotics
haloperidol trifluoperazine fluphenazine thioridazine chlorpromazine
high affinity for D2 typical
trifluoperazine
fluphenazine
haloperidol
low affinity for D2 typical
thioridazine
chlorpromazine
atypicals
aripiprazole clozapine olanzapine quetiapine risperadone ziprasidone
clinical indications for typicals
schizophrenia- positive symptoms acute mania- temporarily for slow onset of Li psychosis tourette's syndrome parities intractable hiccups nausea and vomiting movement disorders
treatment concerns with typicals
non adherance- cause of relapse
inadequate dosing- treatment failure
look for organic cause if no improvement
major effects of high potency typicals
can’t pee can’t see can’t spit can’t poop
EPS
EPS of high potency typicals
acute dystonia
parkinsonism
akathisia
tardive dyskinesia
acute dystonia
4 h onset
spasm of head/neck/face muscles
parkinsonism
days/weeks onset
muscle rigidity, bradykinesia, tremor, shuffling gait
akthisia
days/weeks onset
urge to move
treatment of acute dystonia, parkinsonism, akthisia
benztropine
trihexyphenidyl
diphenydramine
treatment for tardive dyskinesia
switch to lower dose or an atypical
tardive dyskinesisa
4 month onset
involuntary repetitive men tents of face/neck
worse with directed movement
irreversible
major side effect low potency typical
increased non specific effects
sedation- histamin antagonist
orthostatic hypotension, sexual dysfunction- alpha
dry mouth, constipation, vision problems- muscarinic
specific ADR with chlorpromazine
corneal deposits
specify ADR with thirodazine
retinitis pigments
retrograde ejaculation
side effects of all typicals
hyperprolactinemia
neuroleptic malignant syndrome
neuroleptic malignant syndrome
stiff hot altered consciousness elevated CK autonomic instability
treatment of neuroleptic malignant syndrome
dantrolene
bromocriptine
amatadine
benzodiazepines
