Antipsychotics Flashcards
What are positive symptoms?
Delusions, paranoia, hallucinations
What are negative symptoms?
Residual symptoms, apathy, withdrawal, blunt affect
What are the 4 dopamine pathways?
1) Mesolimbic (pleasure/reward)
2) Mesocortical (worsens negative sx)
3) Nigrostriatal (balance of DA/Ach
4) Tuberoinfundibular (DA & prolactin)
What happens when you treat schizophrenia?
Decrease DA = Increase ACh
produces parkinsonism like symptoms (EPS) that can be treated with anticholinergics.
What is Tardive Dyskinesia?
Can not be fixed neuroleptic malignant syndrome
What is the father of typical antipsychotics?
Chlorpromazine, an antihistamine found to have anti psychotic properties
First generation agents have what capability?
Alpha 1 blocking and may cause orthostatic hypotension
M1 binding affinities cause what?
antisludge properties - dry mouth, constipation
How do you treat first dose phenomenon?
IV Benztopine (highly anticholinergic)
What is NMS?
hyperpyrexia, rigid, increases in CPK (leads to rhabdo)
TX: stop drug, give dantrolene / bromocriptine
All antipsychotics carry what precaution?
QT interval prolongation (TORSADES!)
Major CON of first generations?
EPS, negative symptoms not well treated, tardive dyskinesia but CHEAPER
What is Haloperidol? Risks?
High potency sedative TYPICAL antipsychotic. risk of hypotension and may lower seizure threshold
How do atypical antipsychotics work
Block DA & 5HT2A
What concerns with the atypicals?
Metabolic effects– weight gain, DM, dyslipidemia
also more expensive
Pros of atypicals?
Adherence improved, reduced EPC, better with negative symptoms
What are the atypicals?
- Risperidone
- Paliperidone
- Olanzapine
- Quetiapine
- Clozapine
- Ziprasidone
- Aripiprazole
- Asenapine
- Lurasidone
Quetiapine is approved for treatment of what?
Schizophrenia, acute bipolar mania, bipolar depressoion
Quetiapine side effects?
weight gain, DM, lipid abnormalities
Very low risk of EPS & hyperprolactinemia
What is Olanzapine?
Son of Clozapine
Equal or superior to Haldol for treating negative symptoms
Metabolic issues present but no agranulocytosis
What is Clozapine?
First Atypical
Low incidence of EPS, tardive, and good for negative symptoms
What is risk with Clozapine?
Agranulocytosis, usually older females at start of therapy
5 BBW for Clozapine?
- Agranulocytosis
- Orthostatic hypotension
- Sizures
- Myocarditis / cardiomyopathy
- Mortality increased in dementia elderly
What is Risperidone advantage & disadvantage?
- EPS (higher doses) but significant hyperprolactinemia
