Antipsychotics Flashcards
Brand names are capitalized
Chlorpromazine
thorazine (typical or traditional)
Prolixin
fluphenazine (typical or traditional)
Haldol
haloperidol (typical or traditional)
Stelazine
trifluoperazine (typical or traditional)
Navane
thiothixene (typical or traditional)
Mellaril
thioridazine (typical or traditional)
Orap
pimozide (typical or traditional)
Loxitane
loxapine (typical or traditional)
Moban
molindone (typical or traditional)
Serentil
mesoridazine (typical or traditional)
Trilafon
perphanazine (typical or traditional)
Clozaril
clozapine (atypical or novel)
Risperdal
risperidone (atypical or novel)
Zyprexa
olanzapine (atypical or novel)
Seroquel
quetiapine (atypical or novel)
Geodon
ziprasidone (atypical or novel)
Abilify
ariprazole (atypical or novel)
(older or newer) - basically equally effective in controlling psychosis, treating positive symptoms more effectively than negative symptoms
older; traditional; typical
positive symptoms treated by antipsychotics
hallucinations, delusions, disorganized thinking
traditional or typical antipsychotics generally are better at targeting positive symptoms
negative symptoms treated by antipsychotics
affective flattening, lack of motivation, poverty of speech
high potency antipsychotics are:
less sedating and have fewer initial side effects. these are generally tried first.
these require a lower dosage (e.g., 2 mg of Haldol is equal to 100 mg of Chlorpromazine)
More potent antipsychotics
Haldol
Prolixin
Navane
Stelazine
Novel antipsychotics….
generally effective for both positive and negative symptoms.
Exert stronger effects as antiserotonergic, antiadrenergic, anticholinergic, and antihistaminergic than as a dopamine antagonist.
Do not cause EPS (Extrapyramidal symptoms)
Depot neuroleptics (decanoate)
antipsychotics administered intramuscularly (by injection).
doses last for 2 to 4 weeks.
useful when patients have poor or inconsistent compliance.
Depot Neuroleptics, aka…..
Decanoate is added to the name of these types of antipsychotics
Example: Prolixin and Haldol decanoate
Mechanism of Action
Dopamine Antagonists via blocking dopamine receptors.
Dopamine hypothesis
This hypothesis states schizophrenia results from an excess of dopamine. This is not fully confirmed.
Side effects of antipsychotics differ between drug profiles. In general, most significant of LOWER potency medications include:
Sedation
Anticholinergic effects
Orthostatic hypotension
Lowering of the seizure threshold
Side effects of antipsychotics differ between drug profiles. In general, most significant of HIGHER potency medications include:
Extrapyramidal symptoms (movement disorders such as acute dystonic reactions, pseudoparkinsonism, akathisia)
Akathisia
syndrome characterized by unpleasant sensations of inner restlessness that manifests itself with an inability to sit still or remain motionless.
Sometimes caused by antipsychotics, as well as any physically-addictive drug during drug withdrawal.
Extrapyramidal Symptoms (EPS)
movement-related symptoms, some of which are the most potentially damaging side effects of antipsychotics. EPS symptoms can be treated through the use of anticholinergic agents (ACAs)
Cogentin (benztropine)
Anticholinergic Agent, used to treat EPS symptoms that result from antipsychotics
Artane (trihexylphenidyl)
Anticholinergic Agent, used to treat EPS symptoms that result from antipsychotics
Dystonia
Acute and painful muscle spasms of the neck, back, tongue, eyes, and/or larynx. Dis = problem; tonia = tone. Also considered an EPS.
Parkinsonism (pseudoparkinsonism)
involves a mask-like face, shuffling gait, drooling, resting tremor, rigidity, and akinesia. These symptoms persist throughout treatment and afflict 12-45% of all patients. This condition is treated by lowering dose, switching drugs, or using an anticholinergic agent.
Neuroleptic Malignant Syndrome
(NMS) - affects 1% of all patients treated with antipsychotics and potentially lethal. It involves severe muscle rigidity, altered consciousness, autonomic instability (e.g., heart rate and blood pressure changes), and high fever. NMS requires emergency medical attention and is often treated by stopping all neuroleptics using an IV for hydration, administering anti-fever medications, and treating any lung complications.
Tardive Dyskinesia
involves abnormal movements of the lips, tongue, jaw, limbs, and trunk. TD generally arises after at least six months of treatment and typically plateaus after 3-6 years without worsening any further. Occasionally, the symptoms only emerge after the antipsychotic as been terminated or dosage is lowered. This condition is not believed to be progressive and may be reversible. 50% of patients who develop this condition after antipsychotics have been stopped experience a full remission of symptoms.
Agranulocytosis
potentially lethal side effect most associated with Clozaril (clozapine), and is usually the reason why this drug is tried only after others have failed.
this condition is a sudden drop in the granulocyte count, usually occurring within hours to 12 weeks of initial administration, and manifesting as a sore throat and high fever.
Dependence/withdrawal/overdose
antipsychotics do not cause addiction, dependence, or tolerance. Withdrawal is only caused when a high dose is suddenly stopped. Symptoms include:
gastrointestinal distress, headaches, insomnia, and nightmares.
Overdoses are generally not highly lethal except if >30 supply is taken at one time. More lethal when combined with another drug such as a Tricyclic antidepressant.
