Neuropharm Antipschotics Flashcards
Antipsychotic drugs
Treat positive symptoms of schizophrenia, psychosis, Tourette’s syndrome and acute episodes of mania
How do antipsychotic drugs work
Blocking dopamine D2 receptors, increasing cAMP
Antipsychotics are highly ____ soluble. Where stored
Lipid
Fat
Removed very slowly from the body
2 categories of antipsychotics
High and low potency
Side effects of antipsychotics
Common
Endocrine and muscarinic to motor
___ is an endocrine side effect to dopamine antagonism
Galactorrhea
___ ___ is a stereotypic oral-facial movement, typically lip smacking, which is often seen in patients taking antipsychotic medications
Tardive diskinesia
How do antipsychotic drugs work
Block cholinergic receptors causing patients to display antimuscarinic effects, such as constipation and dry mouth
Block a1 receptors leading to hypotension
Side effect antipsychotic drug
Neuroleptic malignant syndrome and extrapyramidal symptom
Indications for antipsychotic drugs
Schizophrenia, psychosis, mania and tourettes
What antipsychotic is used to treat tourettes
Fluphenazine
What is Tourette’s
An inherited neuropsychiatric disease characterized by motor tics and phonic tics
MOA antipsychotics
Stored in fat and slowly removed, having a long half life
Block dopamine receptors D2
Where is D2
Mesolimbic and mesocortical areas of the CNS
What happens when block D2
Increase in intracellular concentration of cAMP
Side effects of antipsychotic drugs
Galactorrhea
Tardive dyskinesia
Anticholinergic
Alpha 1 antagonist
Galactorrhea and antipshycotics
Endocrine side effect related to dopamine antagonism
Spontaneous outflow of milk from the breasts due to hyperprolactinemia stemming from dopamine antagonism
Antipsychotics and tardive dyskinesia
Common extrapyramidal side effect seen in patients with long term treatment with antipsychotic drugs
Lip smacking
Anticholinergic and antipsychotic drugs
Antipsychotic drugs also. Block cholinergic receptors, leading to antimuscarinic effects.
Anticholinergic symptoms
Dry mouth and constipation
A1 antagonism and antipsychotics
Can lead to hypotension
Low potency antipsychotic drugs
More favorable in some patients due to low potency-which allowspatients to control daily dosing with more freedom
Chlorpromazine and thioridazine
Antipsychotics low potency
Indications for low potency antipsychotics
Schizophrenia, mania psychosis and anxiety
How do low potency antipsychotics work
Block D2 receptor in mesolimbic and mesocortical areas of CNA leading to an increase of intracellular concentration of the second messenger cAMP
Thioridazine side effects
Retinal deposits
A blockade-hypotension and anorgasmia
Anticholinergic effects
Chlorpromazine side effects
Deposited in cornea and is phototoxic . After sunlight exposure it can lead to color blindness or corneal pigmentation
A blockade effects which can lead to hypotension and anorgasmia
Anticholinergic effects
Antihistamine-which counteract the extrapyramidal symptoms experienced with antipsychotics
Thioridazine indications
Schizophrenia and psychosis
Can lead to extrapyramidal symptoms, neuroleptic malignant syndrome, impotence and autonomic side effects
Retinal deposits
A1 antagonist effects of low potency antipsychotic drugs
A1 antagonists effects lead to hypotension and impotence or anorgasmia
Anticholinergic effects of low potency antipsychotics
Dry mouth, urination difficulty, constipation, induction of glaucoma, postural hypotension, and sinus tachycardia
Less common in low potency though!
High potency antipsychotics are used for what
Schizophrenia, mania, agitation , delirium, anxiety and tourettes
How do high potency antipsychotics work
Blocking D2 receptors which by various pathways lead to increased cAMP.
Examples of high potency antipsychotic medications
Fluphenazine, trifluoperaine, heloperidol
Side effects of high potency antipsychotic drugs
Extrapyramidal symptoms and neuroleptic malignant syndrome-long period of time after take drug
Dystonia, torticollis -short term (hours to days after drug)
Parkinsonian symptoms and can display various forms of tardive dyskinesia
Risk of antipsychotic medications
Neuroleptic malignant syndrome
Fluphenazine
Treats psychosis and schizoprenia
Half like 15-30 hours
Trifluoperazine
Treat schizophrenia and anxiety
Haloperidol
Schizophrenia, acute psychosis and delirium
Prob with haloperidol
Serious side effects and is very potent.
Side effects of high potency antipsychotics
Extrapyramidal symptoms
Short term-dystonia and torticollis
Long term-tardive dyskinesia and parkinson-like symptoms
Extrapyramidal symptoms
Movement disorders related to administration of high potency antipsychotics, as well as antiemetics,and SSRI.
Dystonia, tortocollis, akathisia, and Parkinsonism seen more often with high potency antipsychotics
Dystonia
Sustained muscle contraction, which can displayed by repetitive twitching and abnormal posture.this is an acute extrapyramidal symptom
Parkinson like symptoms
After weeks of treatment with high potency antipsychotics
Patients display muscle stiffness, pill-rolling tremor and decreased movement
Atypical antipsychotics
Tranquillizing drugs used to treat psychiatric disorders
Indications for atypical antipsychotics
Positive and negative symptoms of schizophrenia, mania, tourettes, bipolar, OCD, and depression
MOA atypical antipsychotics
Varied effects on 5HT2 dopamine a and H1 receptors
Side effects atypical antipsychotics
Less anticholinergic and extrapyramidal side effects than typical counterparts but can cause seizure, prolonged QT syndrome, agranulocytosis and weight gain
Examples of atypical antipsychotic drugs
Olanzapine, clozapine, quetiapine, risperdone, aripiprazole and ziprasidone
Which atypical antipsychotic has been linked to prolonged AT interval
Ziprasidone
Which atypical antipsychotic causes seizures more often
Clozapine
Which atypical antipsychotic causes agranulocytosis
Clozapine-monitor weekly
Which atypical antipsychotics cause weight gain
Olanzapine and clozapine
Atypical antipsychotics have ___ extrapyramidal side effects than typical antipsychotics
Fewer
More favorable!
Atypical antipsychotics have ___ anticholinergic side effects than typical antipsychotics.
Fewer
Neuroleptic malignant syndrome
Severe neurological complication of typical antipsychotic and neuroleptic medications
Symptoms of neuroleptic malignant syndrome
FEVER
Fever, encephalopathy (delirium, stupor coma), unstable vital signs as a result of autonomic instability (tachycardia, hypertension, dyspnea, diaphoresis), elevated CPK enzymes, rigidity of their muscles (lead pipe rigidity with increased tone and stable resistance to all ranges of motion)
Reversal agent used to treat neuroleptic malignant syndrome
Dantrolene sodium
Or
Bromocriptine
Dantrolene sodium
Direct acting skeletal muscle relaxing agent and is very effective in treating neuroleptic malignant syndrome
Bromocriptine
Dopaminergic agonist
Bc NMS occurs as a result of dopaminergic receptor blockade , dopaminergic agonists are used to treat this condition (it restores lost dopaminergic tone in patients with neuroleptic malignant syndrome)
Use for 10 days then taper down
*can also use amantadine
Why get fever with NMS
Hypothalamic dopamine receptor blockade
How high are CPK enzymes in NMS
100 IU/L
Haloperidol
Most common used first generation antipsychotic medication
High potency antipsychotic