Antipsychotics Flashcards
What do you have to routinely do for any patient on clozapine?
All pts on clozapine shuold have routine WBC counts to monitor for agranulocytosis… should be performed weekly for the first 6 monhts and can decrease in frequency thereafter
What labs should you monitor with a patient on lithium?
1) Bun/Creatinine
2) thyroid
3) lithium levels (0.6-1.2 is a therapeutic level)
* if starting on lithium in a female make sure to get a pregnancy test before initiating
What is the MOA of “typical/1st gen” antipsychotics/
they block only DA (specifically D2 receptors)… also known as “neuroleptics”
Whats the deal with potency in typical antipsychotics/
they all have similar efficacy, but are categorized by how “potent” they are; either low, mid, or high.
What are the “low potency” typical antipsychotics?
1) chlorpromazine
2) thioridazine
What kind of side effects should i look for with low potency antipsychotics?
- higher incidence of anticholinergic and anti-histaminergic side effects vs high-potency…
- LOWER incidence of EPS/NMS
- MORE lethal in overdose due to QT prolongation
- slightly higher seizure risk than high-potency
What are specific SE with chlorpromazine
Ortho hypotension (anti-cholinergic)
photosensitivity and bluish skin discoloration
Corneal deposits and cataracts
What are specific SE with thioridazine
Retinitis pigmentosa
What are the 4 midpotency typical antipsychotics?
1) loxapine (higher risk of seizure)
2) thiothixene
3) trifluoperazine
4) perphenazine
What are the 2 most important high potency typical antipsychotics?
1) Haloperidol
2) fluphenazine
* both are available in long-lasting IM formats that are useful for non-compliant patients
What causes the positive symptoms of schizo?
excess dopamine in the mesolimbic pathway nuc accumbens, hippocampus, amygdala etc
what causes the negative symptoms of schizo?
too little dopamine in the mesocortical pathway
What causes extrapyramidal symptoms (EPS)?
excess dopamine in the nigrostriatal pathway… this is more frequently caused by typicals… and risperidone (an atypical)… it is least often caused by clozapine (an atypical)
Which antipsychotics are better at treating the positive symptoms of schizo?
Both are effective in treating the positive symptoms but atypicals are “preferred” because they are less likely to cause EPS (however they are more likely to cause metabolic syndrome and weight gain)
Which antipsychotics are better at treating the negative symptoms of schizo?
Atypicals are more effective than typicals for negative symptoms