Pharm psych - Neuroleptics and Mood Stabilizer Flashcards
Typical and atypical antipsychotics work on which receptors?
1) Block dopamine D2 receptors 2) Block both D2 and serotonin 2A receptors
Although atypical antipsychotics are used to treat dementia and delirium, there is increased risk of what in the elderly?
All-cause mortality and stroke
What are the first line antipsychotic drugs?
Both typical and atypical antipsychotics.
What are examples of low potency antipsychotics?
Chlorpromazine (thorazine), thioridazine (mellaril)
Low potency typical antipsychotics have higher incidence of [ ], lower incidence of [ ], and more lethality due to [ ]
1) Higher incidence of anticholinergic and antihistaminic side effects compared to high potency antipsychotics 2)lower incidence of EPS and NMS 3) more lethality due to QTC prolongations with potential for heart block and ventricular tachycardia
With low potency typical antipsychotics what is the risk for agranulocytosis and seizure compared to high potency drugs.
Rare agranulocytosis. Higher risk for seizure compared to the high potency neuroleptics.
What are the side effects of chlorpromazine and what can it also treat?
Orthostatic hypotension, bluish skin discoloration, cause photosensitivity. Deposits in lens and cornea. It can also treat nausea and vomiting and intractable hiccups
What is thioridazine a/w?
retinitis pigmentosa
What are examples of mid potency antipsychotics?
Loxapine (loxitane), thiothixene (navane) - can cause ocular pigment change, trifluoperazine (stelazine) - can reduce anxiety, perphenazine (trilafon).
What are exmaples of high potency antipsychotics?
Haloperidol (haldol), fluphenazine (prolixin), pimozide(orap)
High potency antipsychotics have greater risk for?
EPS and tardive dyskinesia.
Pimozide is what kind of drug? What is it a/w
High potency antipsychotic. A/w heart block, ventricular tachycardia, other cardiac effects.
What is a deconoate form of drug?
Long acting IM form. Available for haldol and fluphenazine - useful if patient doesn’t like taking medications
Positive sx of schizophrenia thought to be treated by action of medications in which pathway?
Mesolimbic dopamine pathway = includes nucleus accumbens, amygdala, fornix, and hippocampus
Negative sx of schizophrenia thought to occur due to?
dopamine action in the mesocortical pathway
EPS sx thought to occur due to?
Dopamine pathways in nigostriatum.
Increased prolactin is due to dopamine action in?
Tuberoinfundibular pathway
What are the major side effects of typical antipsychotics?
1) anti-dopaminergic i.e. EPS and hyperprolactinemia 2) Anti-HAM (histamine, adrenergic, muscarinic) 3) Tardive dyskinesia and less commonly, NMS, elevated liver enzymes/jaundice, skin discoloration, ophtho issues
What are the anti-dopaminergic effects of typical antipsychotics?
1) EPS - Parkinsonism, Akathisia, dystonia 2) Hyperprolactinemia.
Neurolopetic Malignant Syndrome is characterized by?
FALTERED. - Fever(most common sx), autonomic instability (HTN, tachycardia, diaphoresis), leukocytosis, tremor, elevated CPK, rigidity, excessive sweating, delirium
Antipsychotics lower the threshold for?
Seizures
What percent chance is there of developing tardive dyskinesia for every year on antipsychotics?
1%
What is the onset of acute dystonia, EPS/akathisia, TD?
Hours to days, days to months, months to years.
Main differences in side effects of atypical antipsychotics vs typical
Less EPS, tardive dyskinesia, and NMS. May be more effective at treating negative sx of schizophrenia
Atypicals are also used to treat?
Acute mania, bipolar disorder and as adjunctive medications in unipolar depression.sometimes used in personality disorders and certain childhood psych disorders.
What are the major atypical antipsychotics?
Clozapine (clozaril), risperidone (risperdal), quetiapine (seroquel), aripiprazole (abilify), olanzapine (zyprexa), and ziprasidone (geodon).
What is Consta?
Long acting injectable form of risperidone
What are some of the key points of clozapine (clozaril)
Only antipsychotic to show decreased suicide risk; less likely to cause tardive dyskinesia, a/w tachycardia and hypersalivation, 2-5% incidence of seizures; 1-2% incidence of agranuolcytosis; more anticholinergic side effects than other atypical or high potency typicals; development of myocarditis. STOP clozapine if absolute neutrophil count drops below 1500/microL.
What is the mechanism of aripiprazole (Abilify)
Unique mechanism of partial D2 agonism.
Newer, expensive atypical antipsychotics?
PAI - paliperidone (invega), asenapine (saphris), iloperidone (Fanapt)
What are the main side effects of atypical antipsychotics?
Metabolic syndrome, weight gain, hypeglycemia, hyperlipidemia, QTC prolongation, liver function - need yearly monitoring for elevated LFTs and ammonia, some anti-HAM effects.
Which mood stabilizer is the only one shown to reduce suicidality
Lithium
What can be used as an adjunct to mood stabilizers to treat acute mania
Antipsychotics
What are mood stabilizers used for?
Treat acute mania and prevent relpases of manic episodes in both bipolar and schizoaffective disorders.
What are the commonly used mood stabilizers?
Lithium and anticonvuslants - particularly lamotrigine, valproate and carbamazepine.
What is lithium used for?
drug of choice for acute mania, prophylaxis for both manic and depressive episodes in BP and schizoaffective disorders. Used also in cyclothyia and unipolar depression.
What is the therapeutic range for lthium
0.6-1.2. Toxic>1.5, lethal >2.0
Prior to initiating lithium, patients should have what?
EKG, blood count, basic chemistries, thyroid function tests, pregnancy test. Note lithium is metabolized by kidney. Beware of kidney function
What is onset of action and how often should blood levels be hecked
Onset 5-7 days. Check in 5 days, and then every 2-3 days until therapeutic.
What pain med should you not prescribe to a patient taken lithium
IBUprofen
What are the side effects of lithium
Weight gain, sedation, nephrogenic diabetes, clinicians should monitor lithium levels, TSH, and kidney function, fine tremor; GI disturbance’ thryoid enlargement/hypothyroidism; EKG changes, benign leukocytosis; Ebstein’s anomaly, cardiac defect in babies to moms taking lithium
When prescribing lithium, it is important to monitor what levels?
Thyroid, creatinine and lithium
Patients on clozapine should have what tests done routinely?
WBC counts to monitor for agranulocytosis. Perform weekly for first 6 months and then decrease frequency thereafter
How do you tx extrapyramidal sx?
Reducing the dose of antipsychotic, introducing anticholinergic like benztropine (cogentin), and an antihistaminergic (benadryl), or antiparkinsonian medicaton like amantadine
