CNS DRUGS - ANTIPSYCHOTICS AND LITHIUM Flashcards
TYPICAL (CLASSICAL) ANTIPSYCHOTICS MOA
MOA: Block more D2 receptors > 5HT 2A receptors
TYPICAL OR ATYPICAL?
Addresses positive symptoms (Hallucinations) of schizophrenia but not much effect on negative symptoms (emotional blunting, social withdrawal, lack of motivation)
TYPICAL (CLASSICAL) ANTIPSYCHOTICS
High potency typical antipsychotics (i.e. Haloperidol, droperidol): higher chances of causing ______
extrapyramidal symptoms (EPS)
Low potency typical antipsychotics (i.e. Thioridizine, Chlorpromazine): lower chances of causing EPS, more likely to cause _______
sedation and postural hypotension (due to alpha receptor blockade)
ATYPICAL ANTIPSYCHOTICS MOA
MOA: Block 5HT 2A receptors > D 2 receptors
Atypical antipsychotics address both ________
positive and negative effects of schizophrenia
TYPICAL OR ATYPICAL?
lesser propensity to cause EPS compared to its typical counterparts, but has a higher propensity in causing metabolic derangements (weight gain, endocrine problems)
ATYPICAL ANTIPSYCHOTICS
schizophrenia is caused by a relative _____ of dopamine in specific neuronal tracts in the brain
EXCESS OR LACK?
EXCESS
Typical antipsychotics (Phenothiazine)
CHLORPROMAZINE [C]
THIOTHEXENE [C] (Thioxanthene), FLUPENTIXOL (Thioxantene), PROMETHAZINE, PROCHLORPERAZINE [C], LEVOMEPROMAZINE
typical antipsychotic that can cause Corneal and lens deposits
CHLORPROMAZINE [C]
Typical antipsychotic (Piperdine)
THIORIDAZINE [C]
FLUPHENAZINE [C], PERPHENAZINE [C], TRIFLUOPERAZINE [C]
typical anti psychotic that can cause Retinal Deposits
THIORIDAZINE [C]
_________ has the most muscarinic blockade therefore has the least EPS amongst the typical antipsychotics
THIORIDAZINE [C]
differentiate CHLORPROMAZINE AND CHLORPROPAMIDE
CHLORPROMAZINE - typical anti psychotic
CHLORPROPAMIDE - surfonylurea
Typical antipsychotic (butyrophenone)
HALOPERIDOL [C]
DROPERIDOL [C]
_______ causes the most extrapyramidal symptoms and neuroleptic malignant syndrome of all typical anti-psychotics
HALOPERIDOL [C]
DOC for refractory and suicidal schizophrenia
CLOZAPINE [B]
Atypical antipsychotic (Dibenzodiazepine)
CLOZAPINE [B]
highest tendency to cause weight gain amongst your atypicals
Clozapine and Olanzapine
Only antipsychotic that reduces the risk of suicide
CLOZAPINE [B]
feared complications of clozapine
Agranulocytosis and seizures
cause MINIMAL or NO increases in prolactin and has a reduced rish of EPS (reflected by minimal D2 antagonism)
Olanzapine, Quetiapine and Aripiprazole
atypicals that are LEAST LIEKLY to cause tardive dyskinesia
Quetiapine and Clozapine
Drug used for sleep maintenance and promotion
QUETIAPINE
compared to all the other atypicals, has the highest propensity for causing hyperprolactinemia (amenorrhea, galactorrhea)
RISPERIDONE [C]
Only antipsychotic approved for schizophrenia in the
youth
RISPERIDONE [C]
atypical antipsychotic that has the greatest risk for QT prolongation (and hence don’t combine with drugs that will have the same effect i.e thioridazine, class I and III anti arrhythmics)
ZIPRASIDONE [C]
Least sedating atypical antipsychotic
ARIPIPRAZOLE [C]
What are the features of neuroleptic malignant syndrome?
Mnemonic: “FEVER”
Fever
Elevated CPK
Rigidity
Encephalopathy
Vitals unstable
give examples of ATYPICAL ANTIPSYCHOTICS
Amisulpride Aripiprazole Asenapine Blonanserin Carpipramine Clocapramine Clotiapine Clozapine Iloperidone Lurasidone Mosapramine Olanzapine Paliperidone Perospirone Quetiapine Remoxipride Risperidone Sertindole Ziprasidone Zotepine
drug that causes EBSTEIN ANOMALY
LITHIUM
DOC for bipolar disorder
Lithium
Lithium mnemonic lifted from USMLE:
“LiTHIUM”
Low Thyroid hormone, Heart (Ebstein anomaly), Insipidus (nephrogenic diabetes insipidus, Unintentional Movement (tremor)
NEWER AGENTS USED FOR BIPOLAR DISORDER
Carbamazepine
Lamotrigine
Valproic Acid / Divalproex
