Antipsychotics 1.2 Flashcards
Agent Specific Information: Haloperidol
– treatment of Gilles de la Tourette’s
syndrome/Huntington’s Disease
Agent Specific Information: Chlorpromazine
– contraindicated in patients with seizures, lowers
threshold
– used for intractable hiccough, mechanism
unknown
– deposits in the lens and cornea common
Agent Specific Information: Thioridazine
– deposits in retina at higher doses
Agent Specific Information: emetics
All except aripiprazole and thioridazine can be used as antiemetics
– block D2 receptors in CTZ
Agent Specific Information: Prochlorperazine
– useful in treatment of “drug-induced” nausea (chemotherapy)
Agent Specific Information: Scopolamine
– drug of choice for motion sickness
Agent Specific Information: Droperidol
component of neuroleptanesthesia
Dopamine: Extrapyramidal side effects:
• Akathisia • Pseudoparkinsonism • Dystonias: o Facial grimacing, torticollis
Treatment includes withdrawal of neuroleptic and use of a centrally acting anticholinergic drug including: Trihexyphenidyl Benztropine mesylate Procyclidine HCl Biperidin
Dopamine: Extrapyramidal side effects: Drugs that cause it
All More common in more D2 specific (Haloperidol, fluphenazine, thiothixene) Drugs that exhibit strong anticholinergic effects (Thioridazine, Chlorpromazine) show fewer extrapyramidal effects than neuroleptics which preferentially block DA transmission Atypicals have a lower incidence of extrapyramidal side effects.
Dopamine: Extrapyramidal side effects: TX
Treatment includes withdrawal of neuroleptic and use of a centrally acting anticholinergic drug including: Trihexyphenidyl Benztropine mesylate Procyclidine HCl Biperidin
Dopamine: Tardive Dyskinesia
Develops after months/years of treatment • Abnormal oral/facial movements Results from “supersensitivity” to DA, which develops during long-term DA receptor blockade.
Dopamine: Tardive Dyskinesia: Drugs
All More common in typicals Incidence low with Clozapine
Dopamine: Tardive Dyskinesia: tx
No adequate therapy for advanced cases; must be recognized early Can worsen on withdrawal
Dopamine: Neuroleptic Malignant Syndrome:
POTENTIALLY FATAL • Muscle rigidity • elevated temperature • altered consciousness, • autonomic dysfunction o tachycardia, diaphoresis, tachypnea, urinary and fecal incontinence
Dopamine: Neuroleptic Malignant Syndrome: Drugs
More common in
typicals
Dopamine: Neuroleptic Malignant Syndrome: TX
Stop antipsychotic immediately! Administer Bromocriptine (dopamine D2 agonist) & Dantrolene If high temp maintained cool down patient Switch to atypical on recovery
Dopamine: Prolactin
increased serum prolactin by blockade of DA receptors in the tuberoinfundibular pathway • Menstrual irregularities • Loss of libido • Swelling of the mamillary glands (males/females) • Galactorrhea-spontaneous flow of milk from nipple • Possibly osteoporosis
Dopamine: Prolactin: Drugs
More common with Phenothiazines (Chlorpromazine, Fluphenazine, Thioridazine, Trifluoperazine, Mesoridazine, Perphenazine)
Dopamine: Prolactin: TX
Switch treatment
Cholinergic (M1):
Dry mouth, blurred vision,
urinary retention,
constipation, confusion
Cholinergic (M1): Drugs
Thioridazine, Chlorpromazine, and Olanzapine Note: Clozapine does all of these, but increases salivation
Cholinergic (M1): TX
Switch treatment to
drug with lower M1
activity
Adrenergic (α1A, α2A):
Orthostatic hypotension: may
result in syncope
Inhibit ejaculation without
interfering with erection
Adrenergic (α1A, α2A): Drugs
Chlorpromazine and
Mesoridazine most
common
Adrenergic (α1A, α2A): TX
Switch treatment to
drug with lower α
activity
Histamine (H1):
Sedation
Histamine (H1): Drugs
chlorpromazine,
olanzapine,
quetiapine, and
clozapine
Histamine (H1): Switch
Switch drug if a
problem
