Antipsychotic medication Flashcards
What symptoms do antipsychotics relieve in schizophrenia
Positive symptoms (hallucinations, delusions, disordered thinking)
Classes of antipsychotics
Typical antipsychotics (D2 receptor antagonists)
Atypical antipsychotics (serotonin/dopamine antagonists)
Lithium
What drug might improve negative symptoms in schizophrenia
Clozapine (atypical antipsychotic)
Primary indications for antipsychotics
Schizophrenia
Mania
Psychosis due to another medical condition
Substance-induced psychotic disorder
Secondary/other indications for antipsychotics
Behavioral disorders (adjunctive therapy) Acute sedation Intractable hiccups Tourette's syndrome Delerium
Potential cause of extrapyramidal side effects
Blockade of dopamine receptors in the corpus striatum
What antipsychotics have greatest potential for EPSEs
Piperizine-type phenothiazines (fluphenazine)
Butyrophenones (haloperidol)
What are the four early appearing movement disorders seen in EPSEs
Acute dystonic reactions - esp young males (lower dose and give anticholinergic)
Parkinsonian signs - bradykinesia, rigidity and tremor (lower dose or switch to atypical)
Akathisia - subjective and observed motor restlessness
Neuroleptic malignant syndrome - tetrad of fever, muscle rigidity, altered mental status, autonomic dysfunction (increased CK used to diagnose
What is the late appearing movement disorder seen in EPSEs
Tardive dyskinesia - choreoathetoid and/or persistent involuntary movements (commonly face, lips and tongue)
Apart from EPSEs what other side effects can typical antipsychotics have
Disturbance of temp regulation
Anticholinergic symptoms - confusion, dry mouth, blurred vision, constipation, tachycardia, urinary retention, closed-angle glaucoma
Cardiovascular - postural hypotension, prolonged QT
Hypersensitivity - skin, cholestatic jaundice
Blood dyscrasias - decrease leukoplesis, agranulocytosis
Endocrine - increased prolactin, menstrual change, weight gain
Common typical antipsychotics
Butyrophenones - haloperidol
Phenothiazine, aliphatic side chain - chlorpromazine
Piperazine-type phenothiazines - fluphenazine, trifluoperazine
Diphenylbutylpiperidine derivatives - thioridazine, pimozide
Thioxanthines - flupentixol, zuclopenthixol
Benzamides - supiride, amisulpride
Common name for sodium valproate
Epilim
Indications for sodium valproate
All forms of epilepsy
Tonic-clonic seizures
Prophylaxis of migraine
Acute manic phase of bipolar
Can sodium valproate be used in pregnancy
No (category D). Facial deformities, neural tube defects - risk in first trimester
What is the difference between sodium valproate and valproic acid
Sodium valproate is converted to valproic acid (the active agent). Therefore, lower doses of valproic acid are equivalent to higher doses of sodium valproate
What is chlorpromazine
Typical antipsychotic. Phenothiazine with an aliphatic side chain
Indications for chlorpromazine
One of most sedative antipsychotics. Useful for violent/agitated patients. (Intractable hiccups)
Which group of patients are particularly prone to EPSEs
Hyperthyroidism
What is haloperidol
Typical antipsychotic. Butyrophenone.
What is fluphenazine
Typical antipsychotic. Piperazine-type phenothiazine. Good for chronic schizophrenia.
Available in depot prep = fluphenazine decanoate
What is trifluoperazine
Typical antipsychotic. Piperazine-type phenothiazine. Used in psychosis and as a forth line Rx in anxiety states
What is pimozide
Typical antipsychotic. Piperadine phenothiazine. Selective dopamine antagonist (less sedative, less EPSE)
Indications for pimozide
Psychosis
Tic disorders
What is flupentixol
Typical antipsychotic. Thioxanthene.
