Antipsychotics

Question 1

Antipsychotics (general)

Answer 1

Uses: Treat schizophrenia, acute psychoses, delusions, Mania, delusional depression, durg induced psychosis, tourette’s syndrome. Huntington’s disease

Mechanism: Antagonists at several neurotransmitter receptors, largely DA receptors

Suppress psychotic symptoms

**Positive symptoms respond well, negative symptoms do not respond well

**Full effect takes multiple weeks

Antimetic effect, seizures (threshold reduced), Cognitive behavior effect

Question 2

Compare:  
Chlorpromazine
Haloperidol
Clozapine
Aripiprazole

Answer 2

See lecture, but slide indicates that Aripiprazole has zero anti-muscarinic effects and low amounts of hypotension, sedation, and eps (so i think this is best drug…and then Haloperidol is next best because it has three + for EPS and only one + for the other three)

Question 3

Amitriptyline (TCA)

Answer 3

Uses: Treat depression
Mechanism: Tricyclic antidepressants, inhibition of biogenic amine reuptake, Inhibit NE (norepinephrine) AND SERT (seratonin)

Antagonists at muscarinic receptors
Act like local anesthetic type anti-arrhythmias
Alpha-1 receptor antagonists
Antagonists at H1

Question 4

Nortriptyline (TCA)

Answer 4

Uses: Treat depression

Mechanism: Tricyclic antidepressants, inhibitor of biogenic amine reuptake, inhibit NE and SERT

Antagonists at Muscarinic receptors
Act like local anesthetic type antiarrhythmics
Alpha-1 receptor antagonists
Antagonists at H1

Question 5

SSRI Antidepressants

Answer 5

SSRI: Selective Seratonin Reuptake Inhibitors

Drugs: Citalopram, Fluoxetine, Paroxetine, Sertaline

-Little or no interactions w/ receptors, no myocardial effect
-Safer Overdose
-First drug tried for new patients
Side effects: Nausea, GI upset, lowered libido, headache, insomnia

• **“Seratonin Syndrome”: Dangerous (when used with MAO inhibitor)
• **Discontinuation Syndrome: Dizziness, paresthesia (tingling feeling in hands/feet body, so harmless but can feel crawly/itching/etc)

***Fluexetine has active metabolite so wait a long time before taking MAO-I

Fluoxetine and Paroxetine strong CPV2D4 Inhibitors (see lecture to double check? only article claims boht are cyp2D6 inhibitors?)

Question 6

SNRI Antidepressants

Answer 6

Drugs: Duloxetine, Venlafaxine

Mechanism: inhibit SERT and NE, no effect on other neurotransmitters

No cardiac toxicity, safer OD than TCA

Adverse Effects similar to SSRI

Question 7

Buproprion

Answer 7

Use: Antidepressant
Mechanism: Inhibits Dopamine (and NE a little) reuptake, and releases presynaptic DA and NE

Can cause insomnia, agitation, anorexia

Lowers seizure threshold

Question 8

MAO Inhibitors

Answer 8

Monoamine oxidase inhibitors

Drugs: Selegiline, Tranylcypromine

Mechanism: Long-acting irreversible inhibitors of enzymes that metabolize NE and 5-HT (seratonin).

• Used for patients that don’t respond to others
• Serious interactions with drugs and food but….
• Selegiline relatively selective for MAO-B; drug and food interaction is less of a problem.

Question 9

Lithium Carbonate

Answer 9

Use: Treatment of bipolar disorder

Mechanism: Affects NE and 5-HT transmission

• Simple cation, Li+
• Mood stabilizer
• Narrow/therapeutic range
• Short duration of action, renal secretion
• Many adverse effects at therapeutic levels