module 3 antipsychotics Flashcards
D2 receptor family
medications that work here are used to tx schizophrenia
positive schizophrenia symptoms
things that are there that shouldnt be
- delusions
- hallucinations
- disorganized speech
- catatonic behavior
inc. activity of mesolimbic dopaminergic pathway
negative schizophrenia s/s
absence of things that should be there - flat affect - alogia (lack of speech) - avolition hypoactive to mesocortical dopaminergic pathway
mesolimbic pathway
excess DA -> positive s/s
mesocortical pathway
dec. DA -> negative s/s
can also cause ADHD
nigrostriatal pathway
dec. DA -> EPS, motor s/s
tuberinfundibular pathway
dec. DA -> inc. prolactin levels
- sexual dysfunction
- gynecomastia
- milk secretion
- menstrual cycle disturbances
typical antipsycholitcs
antagonize D2 receptors in all CNS dopaminergic pathways
- dec. positive s/s
typical antipsychotic AE on target
EPS: parkinsonian s/s
tardive dyskinesia: after chronic use
- repetitive involuntary movements of face, arms, trunk
neuroleptic malignant syndrome: rare, life-threatening
- catatonia, stupor, fever
inc. prolactin secretion
- amenorrhea, galactorrhea, false-positive pregnancy tests, gynecomastia, dec. libido
typical antipsychotic AE off target
muscarinic and A-antagonism
- anticholingergic
- orthostatic hypoTN
- failure to ejaculate
- sedation
typical antipsychotic AE and dose
higher potency: on target effects
lower potency: off target effects
atypical antipsychotics
more effective at tx negative s/s
- exception: risperidone
atypical antipsychotics MOA
hypothesized:
- 5HT2 and D2 antagonism
- D4 antagonism
relatively fast dissociation from D2: less EPS
typical antipsychotic low potency meds
chlorpromazine
thioridazine
mesoridazine
- inc H1 and M1 effects (off target)
typical antipsychotic middle meds
perphenazine
loxapine
typical antipsychotic high potency meds
haloperidol
fluphenazine
thiothixene
- dec. H1 and M1 effects
D2 saturation levels
40%: -> akathisia
60% -> improved + s/s
80% -> dystonias
typical antipsychotic DI
CYP2D6
tx muscle rigidity with
dantrolene
bromocriptine
tx dystonia with
anticholinergics
benzos
tx akathisia with
B-blockers: propranolol
benzos
tx parkinsonism with
anticholinergics: amantadine
neuroleptic malignant syndrome
rare, life-threatening analogous to serotonin syndrome - fever - muscle rigidity - inc. CPK, myoglobin (renal failure) - delirium - catatonia/stupor
atypical antipsychotic meds
aripiprazole olanzapine quetiapine risperidone ziprasidone clozapine haloperidol
