Antipsychotics Flashcards
Chlorpromazine effects (4)
- Reduces the amount of anesthetic needed for surgery
- Sedation
- Calmness
- Lack of interest in and detachment from external stimuli
Chlorpromazine: brand name type, class
Thorazine; phenothiazine; 1st gen
3 positive symptoms of schizophrenia
delusions
hallucinations
thought disorders
3 negative symptoms of schizophrenia
anhedonia
withdrawal
blunting of emotional expression
3 phases of schizophrenia
- premorbid
- prodromal
- full syndrome
premorbid
subtle motor, cognitive, or social impairments
prodromal
mood symptoms, cog symptoms, social withdrawal, obsessive behaviors
full syndrome
substantial functional deterioration in self-care, work, and relationships
5 pieces of evidence for DA theory
- stimulant drug abuse
- APs are DA antagonists
- APs have affinity for D2
- affinity for D2 is best predictor of dose
- psychosis in parkinson’s patients treated with increased DA
why can’t you use a drug with the highest possible D2 affinity?
need DA in basal ganglia for normal movement
tardive dyskinesia (6)
involuntary, repetitive, purposeless body movements
- grimacing
- lip pursing
- tongue movement
- blinking
- lip-smacking
- lip-puckering
neuroleptic
APs, major tranquilizers
neuroleptic state
state of apathy, lack of initiative, and limited range of emotion
pharmacokinetics
how drugs are handled by the body
goal of pharmacokinetics
predicting time course of active drug in blood that is available at receptor sites
absorption
movement of drug from site of administration to the blood
distribution
movement of drug from blood to rest of body
metabolism
breakdown of drug
elimination
removal of drug’s metabolic waste products from the body
pharmacodynamics
the study of what drugs do to the body
Side effects of Chlorpromazine
- tachycardia
- impotence
- dizziness
- sedation
- weight gain
Second-generation antipsychotics
- More selective than the typical neuroleptics.
- They bind to dopamine D2, 5-HT2, and a2 adrenergic receptors.
- Little or no affinity for D1 receptors.
Somatic side-effects of AP´s
- Cardiac effects- orthostatic hypertension, prolongation of QTC/sudden cardiac death.
- Hematological effects
- Peripheral anticholinergic effects- blurred vision, constipation, urinary retention, dry mouth.
- Weight gain
- Metabolic side effects- high blood sugar, diabetes
- Sexual side effects- decreased libido/impotence, inhibited orgasm
- Hormonal disturbance- Prolactin increased -> breast enlargement, menstrual cycle disturbance
Neurological side-effects of AP´s
Parkinsonism- rigidity/tremor Acute dystonia Acute akathisia Tardive dyskinesia Neuroleptic malignant syndrome Sedation
Acute dystonia
abnormal positioning/spasm of muscles of the head/neck/limbs or trunk
Avolition
Difficulty, or inability to initiate and persist in goal-directed behavior. Inappropriate social skills and social isolation.
MAIN DOPAMINERGIC PATHWAYS
- Mesocortical pathway
- Nigrostriatal pathway
- Mesolimbic pathway
- Tuberoinfundibular pathway
Mesocortical pathway
Hypoactivity: negative symptoms, cognitive impairment
Nigrostriatal pathway
Part of extrapyramidal motor system
Mesolimbic pathway
Hyperactivity: positive symptoms
Tuberoinfundibular pathway
Inhibits prolactin release
MECHANISM OF ACTION – FGA (first generation)
The efficacy is thought to be due to antagonism of dopamine receptors in the mesolimbic/mesofrontal systems.
Why causes APs weight gain?
Adverse effects include and sedation and weight gain, due to histamine H1 receptor blockade
Antidepressants can be used on which diseases?
Psychotic disorders and psychotic states Bipolar disorder Treatment-resistant depression Severe agitation/violent behavior Movement disorders - Huntington disease; Tourette syndrome GAD, PTSD Insomnia; OCD Borderline personality disorder Dementia
