antipsychotics pharm

Question 1

what’s tardive dyskinesia?

Answer 1

it’s coordinated, rythmic, and abnormal sucking, chewing, lip pursing

develops after months or years of treatment, antiparkinsonians actually make it worse, and it’s uncurable and persists after the discontinuation of treatment

Question 2

chlorpromazine

Answer 2

typical antipsychotic

antagonist at D2 dopamine, alpha-adrenergic, cholinergic receptors

ameliorates the ‘positive’ symptoms of schizophrenia

orthostatic
hypotension, hyperprolactinemia (esp. with halo), weight gain, sedation (more for chlorpromazine than for halo.), anticholinergic effects, some blood dyscrasias
Neurological (more pronounced with halo): parkinsonism, dystonias, akathisias (these 3 relieved by benztropine or trihexiphenidyl), & tardive dyskinesia (no way of treating)

Question 3

haloperidol

Answer 3

typical antipsych

antagonist at D2 receptor

ameliorates the ‘positive’ symptoms of schizophrenia

Both cause: orthostatic
hypotension, hyperprolactinemia (esp. with halo), weight gain, sedation (more for chlorpromazine than for halo.), anticholinergic effects, some blood dyscrasias
Neurological (more pronounced with halo): parkinsonism, dystonias, akathisias (these 3 relieved by benztropine or trihexiphenidyl), & tardive dyskinesia (no way of treating)

Question 4

risperidone

Answer 4

‘ATYPICAL’
ANTIPSYCHOTICS

blocks D2 dopamine and 5HT2A receptors

effective in treating both positive and negative symptoms

Some hyperprolactinemia, and extrapyramidal effects at higher doses

Question 5

clozapine

Answer 5

ATYPICAL’

blocks D4 receptors more potently than D2 and inverse agonist at 5HT2A receptors

best drug for relieving symptoms, even in problem schizophrenics

very mild extra-pyramidal side effects & no tardive dyskinesia, BUT agranulocytosis can be fatal

Question 6

olanzapine

Answer 6

ATYPICAL’

blocks D2 & D4 equally, and blocks 5HT2A receptors

good at relieving both positive and negative symptoms

some extrapyramidal side effects & some elevation of prolactin

Question 7

quetiapine
ziprasidone

Answer 7

ATYPICAL’

both block 5HT2A more potently than they block D2, also block H1 histamine receptors

both good at relieving both positive and negative symptoms

both cause a modest elevation of prolactin and some extrapyramidal side effects. Less weight gain with ziprasidone than with other atyps

Question 8

aripiprazole

Answer 8

DOPAMINE SYSTEM STABILIZER

partial agonist at D2 dopamine and 5HT1A receptors; antagonist at 5HT2A receptor

seems as good as ‘atypical’ antipsychotics

Fewer side effects reported than most other antipsychotics, so far
there is less weight gain with aripip. than with atypicals.