Antipsychotics Flashcards
chlorpromazine
1st generation/typical anti-psychotic
PRL, OHTN, urticaria, dermatitis, photosensitivities
low potency, PRL, OHTN, skin issues
fluphenazine
1st generation/typical anti-psychotic
high EPS, PRL. potent
perphenazine
1st generation/typical anti-psychotic
higher EPS/PRL. potent
haloperidol
1st generation/typical anti-psychotic
potent, lowers seizure threshold
high EPS, PRL
trifluperazine
1st generation/typical anti-psychotic
clozapine
2nd generation/atypical anti-psychotic
little PRL increase, weight gain, metabolic syndrome
risperidone
2nd generation/atypical anti-psychotic
5-HT/D2 antagonist
limited EPS at low doses. PRL increase.
Metabolized to paliperidone (active metabolyte.
olanzapine
2nd generation/atypical anti-psychotic
little PRL increase
low potency, similar to clozapine, weight gain, metabolic syndrome
Quetiapine
2nd generation/atypical anti-psychotic
NO PRL increase
low potency, similar to clozapine
Ziprasidone
2nd generation/atypical anti-psychotic
limited EPS
Aripiprazole
2nd generation/atypical anti-psychotic
partial D2/5HT1A agonist
lower AE
NO PRL increase
Lurasidone
2nd generation/atypical anti-psychotic
EPS risk
5-HT partial agonist
low vs high potency
typical vs atypical
Low = low EPS
high = high EPS
Typical = D2 blockers, EPS, PRL elevation, vary in potency. For positive symptoms only.
Atypical = D2 & 5HT antagonism. 5HT reduces EPS, improved efficacy for negative symptoms.
effect of antipsychotics on cortex
lower seizure threshold
site of antipsychotic fx
Limbic system. Co-administered anticholinergics do not block this, but do block EPS.
action of antipsychotics on hypothalamus
increase PRL, avoid in BrCA
N/V with antipsychotics
reduced b/c of DA antagonism
relation between EPS and antimuscarinic potency
inverse
acute dystonia
1st 5 days
spasms, grimace, torticolis, oculogyric crisis
tx: anticholinergic, antiparkinsons D2 blocker
Akathesia
5-60 days
feelings of distress or discomfort. ants in the pants
tx: D2 blocker, anxiolytic/propranolol
parkinsonian syndrome
D2 blockers & amantadine
neuroleptic malignant syndrome
rare. Fever, parkinsonism & catatonia. coarse tremor, autonomic instability, elevated CrK, myoglobinemia, 10% mortality.
cessation, supportive care, dantroline or bromocriptine
perioral tremor
rabbit syndrome
anticholinergics, cessation
tardive dyskinesia
Mos-yrs, chronic D2 excess. Receptor upregulation.
no adequate tx. medically induced huntington’s
atypical antipsychotics with high and low metabolic sydrome rates
clozapine, olanzapine (high)
zisprazidone, aripiprazole (low)
