Lecture 32 - Antipsychotic drugs

Question 1

what are the two classes of antipsyhcotic drugs

common mechanism for each

what is the most concerning side effect of each

Answer 1

typicals — antiD2
EPS is most concerning side effect

atypicals – anti D2 (but also anti 5HT)
Weight gain is most concerning side effect

Question 2

Dopamine projections:

what regions of the brain mediate what symptoms/side effects

Answer 2

Nigrostriatal – EPS

Mesolimbic – too much DA = positive sx

Mesocortical – too little DA = negative sx + cognitive sx

Tuberoinfundibular = HPA; decreased DA = galactorrhea

Question 3

Typicals – two classes; name some drugs

what are the differneces

Answer 3

high affinity for D2 – Try to Fly High
(Trifluoperazine, Fluphenazine, Haloperidol)
High D2 affinity – EPS side effects, but few alpha 1, M1, H1 side effects

Low affinity D2 - Cheating thieves are low
(Chlorpormazine, Thioridazine)
Lower D2 affinity = fewer EPS side effects; higher M1, H1, alpha 1 side effects

Question 4

Evolution of EPS:

Answer 4

dystonia
akathisia
bradykinesia
tardive dyskinesia

Question 5

Atypical Drugs –
Mechanisms
benefits of these mechanisms

Most concerning side effect

Answer 5

Anti 5HT + Low affinity Anti DA
good for negative and postive symptoms
no risk for EPS

Serotonin inhibits DA release; therefore by blocking 5HT can increased DA release and target negative symptoms, but there is some blockage of DA so as not to induce postive symptoms

most concerning side effect: weight gain and potential for DM

Question 6

Name the atypical drugs

Answer 6

Its atypical for old closets to risper from apip to zip

Olanzapine 
Clozapine
Quietipine (seroquel)
Risperidone (rispderdol)
Aripiprazole -- abilify 
ziprasidone -- geodon

Question 7

side effect profile of Clozapine

Answer 7

M1 -- anticholinergic (anti sludge) 
				A1 -- Low BP, dizziness
				H1 -- Drowsiness, weight gain 
				5HT2C -- weight gain
				Neutropenia (Agranulocytosis) in .5-2% of patients; life threatening