Antipsychotics and Antipileptics Flashcards
What is the most common type of Psychosis?
Schizophrenia
What are Neuroleptics?
Antipsychotic drugs that were designed to treat the patient rather than just sedating them. They allow for normal behavior and thinking during acute psychotic episodes and prevent recurrence of psychosis
Which dopamine receptor is most important for antipsychotic effects?
D2
How do Antipsychotics work?
Overall they work by blocking the D2 (dopamine) receptors to some extent
What are the 2 categories of Antipsychotics?
Traditional and Atypical
Why are Atypical antipsychotics considered better than the Traditional antipsychotics?
While they may be less effective than traditional drugs, they have a decreased risk of movement disorders since they dont affect dopamine receptors as strongly. They also have a lower incidence of relapse.
What is the most feared side effect of antipsychotics?
Tardive Dyskinesia
-may be irreversible!!!
-involuntary fragmented movements
-rhythmic movements of mouth, tongue, and jaw
-involuntary sucking and smacking noises
-serious swallowing disorders
-choraoathetoid movements of extremities
-dystonias of neck and trunk
What are the different types of extrapyramidal symptoms that could occur due to taking antipsychotics?
-Tardive Dyskinesia
-Pseudoparkinsonism
-Akathisia
-Dyskinesia
-Dystonia
-Neuroleptic malignant syndrome
Why do Atypical antipsychotics have a lower risk of extrapyramidal symptoms?
They block serotonin receptors more than dopamine receptors
Pseudoparkinsonism
Due to antipsychotics blocking dopamine receptors some patients may develop symptoms similar to that of parkinsons: resting tremor, bradykinesia, rigidity
-symptoms will typically disappear when dose is adjusted
Akathisia
A side effect of antipsychotics where patients feel motor restlessness (cant lie still or sit still), also agitation, pacing the floor or insomnia
-can be managed by altering dose
Dyskinesia and Dystonia
Involuntary and uncoordinated movements in arms, legs, neck and face
-side effect of antipsychotics
Neuroleptic Malignant Syndrome
Very serious side effect of taking high doses of traditional antipsychotic meds. Symptoms include catatonia, stupor, rigidity, tremors, fever, and can lead to death
**medical emergency- stop taking meds!
What are the non-motor side effects associated with antipsychotics?
-weight gain
-diabetes
-increased plasma lipids
-anticholinergic effects (cant see, cant pee, cant poo)
-sedation
-orthostatic hypotension
-cardiovascular or endocrine problems
**These are produced by atypical antipsychotics
What is Epilepsy?
A chronic neurological disorder characterized by recurrent seizures due to cerebral neurons firing rapidly
What causes cerebral neurons to fire rapidly in those with Epilepsy?
-specific incidences: stroke, tumor, encephalopathy, head trauma
-birth trauma or genetic abnormality
-unknown cause
Effectiveness of Antipileptic medications
They are effective 50% of the time eliminating seizures, effective 25% of the time reducing seizures and ineffective 25% of the time
What are the two categories of seizures?
- Generalized: whole brain is involved
-grand mal seizures
-petit mal seizures - Focal: only part of brain is involved
-simple: remains conscious
-complex: loses consciousness
What is the goal of Anti-seizure drugs?
To suppress the excitability of neurons that initiate seizures by:
1. increase the activity of CNS inhibitory neurons
2. decrease the activity of CNS excitatory neurons
3. stabilize the opening and closing of neuronal sodium or calcium channels
What are the two categories of seizure meds?
- First generation- original drugs
- Second generation
What are the 3 different ways first generation antiseizure drugs work?
- Increasing GABA to inhibit the firing of certain neurons
- Decrease the effects of excitatory amino acids (glutamate)
- Alter the movement of sodium and calcium across neuronal membrane
What are the 6 classes of First Generation Antiseizure meds?
- Barbiturates
- Benzos
- Hydantoins
- Iminostilbenes
- Succinimides
- Valproates
Barbiturates mechanism of action
Increases the inhibitory effects of GABA
Benzo mechanism of action
Increases the inhibitory effects of GABA
Which class is the primary for treating partial seizures and grand mal seizures?
Iminostilbenes: Tegretol
Why take second generation drugs over first generation?
They are no more effective than 1st generation drugs, but they have very mild side effects
Which second generation drugs are most commonly used?
- Gabapentin: reduces neuronal activity in seizure disorders
- Pregabalin
General side effects of second generation drugs
-dizziness
-sedation
-HA
-ataxia
-fatigue
-skin and vision problems
Why do women with Epilepsy have an increased risk of birth defects?
Utero exposure to the anti-seizure meds
How should someone discontinue seizures meds once they are under control?
meds should be tapered off over a 3-6 month period
Why are barbiturates not commonly used?
They have such a small TI which results in high overdose ability
