Antipsychotics Flashcards by Katie Bendersky

Schizophrenia

Disabling thought disorder and is comprised of both positive and negative symptoms

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Is schizophrenia hereditary?

Yes

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Positive Symptoms

Delusions (false beliefs)
Hallucinations
Agitation
Insomnia

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Negative Symptoms

Flat affect (do not show emotional expressions)
Anhedonia (lack of pleasure)
Apathy (indifference)
Social isolation

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Dopamine (DA) Hypothesis of Schizophrenia
- Theory

Symptoms of psychosis arise from a functional excess of DA in the CNS

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Dopamine (DA) Hypothesis of Schizophrenia
- Antipsychotics

Produce effects by antagonizing DA receptors (D2 and/or D2c sites) and 5-HT2 recetpors

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Typical Antipsychotics (first generation)

Block D2 sites in the nigrostriatum
Include extrapyramidal side effects (EPS)

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Mainly treats positive symptoms

Typical Antipsychotics (first generation)

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Atypical Antipsychotics (second generation)

More selective at blocking D2c and 5-HT2 receptors in the mesocortical and mesolimbic pathyways
Less of EPS

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Blocks with positive and negative symptoms

Atypical Antipsychotics (second generation)

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Mesolimbic pathway

Travels from the midbrain tegmental area to the nucleus accumbens

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Mesolimbic pathway
- Over-activity in this pathway can cause

Delusions
Hallucinations
Other “positive symptoms” of schizophrenia

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Mesocortical pathway
- Hypo-function of this pathway can cause

Apathy
Withdrawal
Lack of motivation
Pleasure (anhedonia)
“Negative symptoms” of schizophrenia

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Nigrostriatal pathway

Involves the coordination of body movements

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Nigrostriatal pathway
- Inhibition of this pathway

Extrapyramidal side effects of antipsychotic drugs

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Classic (typical) Antipsychotics

Block D2 receptors in the nigrostriatal
Treat + Symptoms

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Classic (typical) Antipsychotics
- Types

Phenothiazines
Thioxanthenes
Butyrophenones

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Phenothiazines
- Types

Chlorpromazine
Fluphenazine
Thioridazine

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Chlorpromazine

Anticholinergic effect (dry mouth, blurred vision, vomiting)

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Fluphenazine

Increased potency confers increased EPS (Depot injection available)
Antichlorgenic effect

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Butyrophenones
- Types

Haloperidol

Butyrophenones

Increased potency confers increased EPS

Haloperidol

Depot injection available

Atypical Antipsychotic Agents

Block D2c and 5-HT2 receptors in the mesolimbic and mesocortical pathways

Atypical Antipsychotic Agents - Types

Quetiapine Aripiprazole Clozapine Risperidone Olanzapine

Questiapine

Treats schizophrenia and acute manic episodes in bipolar disorders

Closapine

Agranulocytosis and leukopenia (blood work required) Seziures

Risperidone

Causes gynecomastia/galactorrhea (swollen breast tissue and breast milk)

Olanzapine

Boxed waning for sedation (coma) and delirium with IV **can lead to death**

Exhibit fewer EPS and fewer anticholinergic side effects

Atypicals

Patients demonstrate better compliance with typical or atypical?

Atypical

Antipsychotics Warning and SE - Boxed Warning

All antipsychotics have an increased risk of mortality in elderly patients with dementia-related psychosis

Antipsychotics Warning and SE - Other warnings

All antipsychotics carry a warning for falls

Antipsychotics Warning and SE - Extrapyramidal Side Effects (EPS)

Constitute one of the major disadvantages of all the classic, or 'typical' antipsychotic agents

Are EPS reversible or irreversible?

Reversible

EPS occurs when?

Early in course of treatment (acute)

EPS side effects

Akathisia (motor restlessness) Acute dystonias (involuntary muscle movements) Parkinson-like syndrome (pseudoparkinsonism)

EPS side effects - Acute dystonias

Spasm Protruding tongue Torticollis

EPS side effects - Parkinson-like syndrome

Rigidity Bradykinesia (slow movement) Tremor

EPS - Tardive (late developing) Dyskinesia (TD)

super-sensitivity of D2 receptors Develops after months or years in 20-40% of patients treated with the classic 'typical' antipsychotics

How can tardive (TD) be treated?

Switching to an atypical antipsychotic

Tardive (late-developing) Dyskinesia (TD) - Characterization

Repetitive Involuntary Purposeless movements

TD features

Grimacing Tongue protrusion Lip smacking Puckering and pursing of the lips Rapid eye blinking

TD features - rapid movements

Arms, legs and trunk may also occur Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or pianon

Difference between TD and patients with Parkinson's

Pt with Parkinson's have difficulty moving Pt with TD have difficulty not moving

Neuroleptic malignant syndrome (NMS)

Muscle rigidity, fever, and mental confusion

What do you use to treat NMS muscle rigidity?

Dantrolene (muscle relaxant that decreases Ca++ release from the sarcoplasmic reticulum

What do you use to treat NMS fever?

Supportive therapy Check vitals Cool blankets

What do you use to treat NMS?

Bromocriptine

Gynecomastia and galactorrhea

Increase prolactin (galactorrhea, amenorrhea gynecomastia) especially with Risperidone

Antipsychotic Side Effects Con't

Increase eating behaviors (weight gain)