Exam 4 - Antipsychotics Flashcards
What are 4 typical antipsychotics?
- Chorpromazine
- Haloperidol
- Fluphenazine
- Thiothixene
What are 5 atypical antipsychotics?
- Clozapine
- Risperidone
- Olanzapine
- Quetiapine
- Aripiprazole
Which med is a mood stabilizer?
Lithium
What are 3 stimulants?
- Amphetamine
- Methylphenidate
- Modafinil
Chlorpromazine (Thorazine)
Class: Typical antipsychotic, low potency
MOA: D2 antagonist
SE: Very sedative (H1 antagonist), orthostatic hypotension (a1 adrenergic antagonist), wt gain, extrapyramidal effects (movement disorders)
Haloperidol (Haldol)
Class: Typical antipsychotic, high potency
MOA:
SE: Sig extrapyramidal effects, orthostatic hypotension, mild sedation, wt gain
*MC used antipsychotic
Fluphenazine
Class: Typical antipsychotic, high potency
MOA:
SE: Sig extrapyramidal effects, lower orthostatic hypotension, lower sedative effects, wt gain
Thiothixene
Class: Typical antipsychotic
MOA:
SE: Extrapyramidal effects, orthostatic hypotension, wt gain
Clozapine (Clozaril)
Class: Atypical antipsychotic
MOA: 5-HT2 antagonist, D4 receptor antagonist, weak D2 antagonist
SE: wt gain and hyperlipidemia/hyperglycemia, seizures, agranulocytosis, sedation, constipation, orthostatic hypotension, sexual side effects
Uses: Refractory schizophrenia
Risperidone (Risperdal)
Class: Atypical antipsychotic
MOA: 5-HT2 antagonist, D2 antagonist
SE: elevated prolactin, small increase in wt/lipids, extrapyramidal side effects, sexual side effects
Uses: bipolar disorder, adjunct for PTSD
Olanzapine (Zyprexa)
Class: Atypical antipsychotic
MOA: 5-HT2 antagonist, D2 antagonist, H1 antagonist, a1 antagonist, D4/D1 antagonist
SE: wt gain, increased lipids, hyperglycemia/DM, decreased seizure threshold, slight sedation, sexual side effects
Quetiapine (Seroquel)
Class: Atypical antipsychotic
MOA: 5-HT2 antagonist, D2 antagonist, a1, M1,3 & H1 antagonist
SE: prolonged QTc interval, int wt gain, low risk of extrapyramidal effects or tardive dyskinesia
Uses: bipolar disorder
Aripiprazole (Ability)
Class: Atypical antipsychotic
MOA: 5-HT2 antagonist, D2 partial antagonist, D4, a1. H1, D1 antagonist
SE: small increase in wt and lipids
Lithium
Class: Mood stabilizer
MOA: blocks phosphoinositide metabolism
Slow onset (5-7d)
SE: fine hand tremor, mental fatigue, cognitive at high doses, EEG changes, wt gain (increased appetite), polydipsia, polyuria, edema (Na retention), decreased thyroid function, thyroid enlargement
low therapeutic index > serum levels must be monitored regularly
Elimination: renal >adjust for renal pts (diuretics, ACE inhibitors effects elimination)
Uses: tx of manic and acute phase of bipolar disorder and prevent recurrences
Amphetamine (Adderall)
Class: Stimulant
MOA: releases catecholamines and 5-HT
-Stimulating the release of norepinephrine, dopamine and serotonin from
presynaptic nerve terminals, and inhibit the uptake of neurotransmitter into
the synaptic vesicles and reverse the monoamine transporters responsible
for the reuptake of the catecholamines and serotonin.
*Onset 20-60min, up to 6hr duration, 10hr (Adderall XR)
Uses: narcolepsy, ADHD
Methylphenidate (Ritalin, Methylin)
Class: Stimulant MOA: releases catecholamines and 5-HT SE: insomnia, abdominal pain, wt loss, suppression of growth in children *onset 30-60min, duration 5hrs Uses: narcolepsy, ADHD
Modafinil (Provigil)
Class: Stimulant
MOA: inhibits NET/DAT, increases synaptic concentrations of NE, DA, 5-HT
SE: mild increase in BP/HR
Uses: Narcolepsy
What are side effects of antipsychotics?
- Movement disorders – due to blockade of D2 receptors in the basal ganglia
a. Parkinson-like symptoms – also called “extrapyramidal side effects”, reversible with
lowered dose.
Symptoms - Bradykinesia, rigidity, variable tremor, mask facies, shuffling gait
b. Akathisia - Subjective and objective restlessness
c. Acute dystonia - Spasm of muscles of tongue, face, neck, back
d. Neuroleptic malignant syndrome – resembles severe form of Parkinsonism. Extreme
rigidity, fever, unstable blood pressure, myoglobinemia; can be fatal
e. Tardive dyskinesia: can be irreversible – involuntary movement (tic-like) of face, lips,
tongue and eyelids. This is due to supersensitivity of the D2 receptors after prolonged
receptor blockade. - Sedation – due to H1 and/or muscarinic receptor antagonism.
- Orthostatic hypotension – due to 1 adrenergic receptor antagonism
- Hyperprolactemia – blockade of dopamine inhibition of prolactin release.
Excess prolactin will inhibit the release of GnRH and the hypothalamic-pituitary- gonad axis.
This can result in amenorrhea, breast engorgement, galactorrhea, and sexual dysfunction
and infertility in women and men. - Metabolic syndrome - Weight gain stimulates appetite, diabetes, dyslipidemia (elevated
triglycerides). - Anticholinergic (muscarinic antagonist) – dry mouth, constipation, urinary retention, blurred
vision - Cardiovascular – ventricular arrhythmias and sudden cardiac death due to prolonged QTc.
Primarily due blockade of IKr. - Sexual Dysfunction – decrease libido, erectile dysfunction, delayed ejaculation, anorgasmia.
What are S&S of overdose of an overdose on Lithium?
Acute toxicity and overdose: vomiting, profuse diarrhea, coarse tremor, ataxia, coma and convulsions and is dependent on serum concentrations. Severe toxic symptoms include mental confusion, hyperreflexia, gross tremor, dysarthria, seizures, and cranial nerve and focal neurological signs, progressing to coma and death.
What are SE of Adderall?
Elation and euphoria, enhance wakefulness, elevate mood, self-confidence, ability to concentrate, increase motor and speech activities and decrease fatigue.
Increase the rate and depth of respiration though stimulation of the medullary respiratory centers. Decrease appetite and decrease food intake. At high doses amphetamines can produce sterotyed behavior similar to high doses of cocaine. High doses of amphetamine will produce alterations in perception and psychotic effects which are probably due to the release of serotonin.
Amphetamines also increase diastolic and systolic blood pressure and a reflex bradycardia. At high doses arrhythmias may occur.
Following extended use of amphetamines or large doses, individuals may be depressed and fatigued and sleep.
