First-Generation Antipsychotics Flashcards
Just in terms of names, what are the first-generation antipsychotics?
Haldol (haloperidol) –think of Van Gogh’s halos
Drugs that end in -azine: trifluoperazine, chlorpromazine, thioridazine, and fluphenazine (think of Starry Gazing)
All first-generation antipsychotics work by _______________.
blocking postsynaptic D2 receptors in the CNS (think of the two cuts ropes held by Van Gogh) especially in the striatal and mesolimbic systems
Which of the first-generation antipsychotics are high potency?
Haldol (the halos floating “high”) and the drugs with -flu- in them (“fluing” high with trifluperazine and fluphenazine)
In terms of gross categories, how do the side effects of high and low potency first-generation antipsychotics compare?
High: more specific binding to D2 receptors leads to a greater chance of extrapyramidal effects (motor)
Low: less specific binding to D2 receptors leads to greater chance of antimuscarinic effects, anti-alpha-1 effects (specifically orthostatic hypotension), and antimuscarinic effects (specifically sedation) –think of the Alice party, the extinguished alpha candle held by the nurse, and the sunflowers with bees being swatted
FGAs are better at blocking the __________ effects of schizophrenia.
positive (e.g., hallucinations)
In addition to treating acute psychosis, FGAs also treat ______________.
acute agitation/aggression and Tourette’s
Pharmacokinetically, most FGAs are _____________.
lipid-soluble with high protein binding –leads to a long, tapering half life
Describe the side effects of high-potency FGAs.
Torticollis and other forms of acute dystonia (including oculomotor symptoms)
What is akathisia?
Subjective restlessness with the inability to sit still (“Aye KAn’t THIt”)
Other than acute dystonia, what other side effects do high-potency FGAs cause?
Akathisia (restlessness) and Parkinson’s – think of the guy jumping out of his chair (unable to sit) and the guy getting into the carriage with cog wheels
Tardive dyskinesia presents after ______________.
months to years of treatment with high-potency FGAs
True or false: patients with drug-induced Parkinson’s should be treated with L-dopa.
False! Giving a dopamine agonist will likely trigger psychotic symptoms. Instead, give an antimuscarinic for the motor symptoms – such as trihexyphenidyl or benztropine
High-potency FGAs can also cause __________ in women.
symptoms of prolactinemia (breast soreness and galactorrhea)
All FGAs –and especially the high potency ones –can cause a life-threatening condition characterized by lead-pipe rigidity, agitation, fever, and tachycardia (dysautonomic regulation). What is it?
Neuroleptic malignant syndrome (“Now More Spicy”)
Sliding down the banner, the escaping asylee represents the side effects of _____________.
Torsades (the twisting banner) and seizure (because he’s shaking)
