Antipsychotic Medications - Lauden

Question 1

What are the options for schizophrenia treatment?

Answer 1

 Pharmacology
- Anti psychotic agents (main function on D2 receptor)
- Anxiolytic medications (Benzodiazepines)
- Mood stabilizers
- Antidepressants
 Therapy- preferably multidisciplinary
- Psychoeducation- knowledge about the disorder
- Coping with chronic disease
- Mourning
- Insight
- rehabilitation

Question 2

List the conventional and atypical antipsychotics

Answer 2

Conventional (FGAs):
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Perphenazine (Trilafon)

Atypical (SGAs):
Aripiprazole (Abilify)
Clozapine (Clozaril)-last resort-agranulocytosis
Iloperidone (Fanapt)
Olanzapine (Zyprexa)
Paliperidone (Invega)
Risperidone (Risperdal)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Amisulpiride

Question 3

What are the indications for antipsychotic medications?

Answer 3

 Schizophrenia (psychosis)
 Mania (bipolar grandiose thinking)
 Secondary psychoses (concological, Addison’s, Cushing)
 Delusional disorder (usually not compliant)
 Aggression and violence (sedative)
 Tourette’s and tic disorder
 Sedation
 Confusional state and delirium (esp Halidol acute after anesthesia or head trauma)
 Dementia behavior changes (?)- FDA (Black box for decreased lifespan but self evaluate)
 Severe anxiety
 Augmentation for Depression (not all meds)

Question 4

What are the effects of antipsychotic medications on the organs and systems?

Answer 4

 Cardiotoxic (nonspecific, ST-T changes)
 Orthostatic hypotension (from NE receptors)
 Anticholinrgic effects
 Hematology (CBC checked periodically)
 Skin (photosensitivity)
 Eyes (retinitis pigmentosum)
 Prolactin (galactorrhea from dopamine changes)
 Weight gain (commonly 2-3kg but up to 50 with glucose intolerance, more in older patients)
 Histamine effects
 Genito urinary and libido (slows speed of urination
 NMS- Neuroleptic malignant syndrome (severe contraction of muscles, hyperthermia and high fever)

Peripheral anticholinergic activity (mainly with low potency-dry mouth, constipation, blurred vision, urinary retention, nausea/vomiting)-Protect against extrapyramidal effect

Extrapyramidal syndrome (Parkinsonism, Acute Dystonia, Akathizia-need to move, Tardive Dyskinesia-usually after 10-20y)-treat with anticholinergics