Phenothiazides - Antipsychotic Drugs and Mood Stabilizers Flashcards
Chloropromazine
low potency- need high doses
Higher anti-Ach activity- decreased extrapyramidal effects
Dose individualized- erractic absorbtion
side effects: sleepiness, restlessness, ANS sx, extrapyramidal effects, anticholinergic, alpha blockade, Seizure threshold decreased
Caution: epilepsy and wd from CNS depressants
TX: schizophrenia, pre-anaesthic, premature ejaculation, severe itch release, psychotic episodes, alcoholic hallucinations, psychosis c drug abuse
Fluphenzine
High potency- more selective for DA receptors/dec. anti-ach activity (causes extrapyramidal effects)
Thioridazine
low potency- need high doses
Higher anti-Ach activity- decreased extrapyramidal effects
Dose individualized- erractic absorbtion
side effects: sleepiness, restlessness, ANS sx, extrapyramidal effects, anticholinergic, alpha blockade, histamine blocker
Caution: epilepsy and wd from CNS depressants
TX: schizophrenia, preanaesthic, premature ejaculation, severe itch release, psychotic episodes, alcoholic hallucinations, psychosis c drug abuse
Prochlorperazine
antiemetic
Haloperidol
Greater potency at D2 receptor and some effect on a1 and 5-HT2, no cholinergic effect
concentration greater in the brain>blood, slow metabolism
oral, Injected in acute psychotic situations
extrapyramidal SX
tx: hallucinations in etoh, tourettes,
Trifluoperazine
High potency - less anticholinergic, extrapyramidal common
Thiothiexene
similar to phenothiazines
Pimozide
Similar to halperidol (binds only to D2)
High extrapyramidal effects, moderate sedative/anti-ach effects, EKG: lengthens QT interval
tx: motor/phonic in Tourettes
Molindone
Blocks D2, moderate sedation, increase in motor activity, mild euphoria
side effects: High extrapyramidal effects, xerotomia, constipation, hypotension, sinus tachy, syncope
Loxapine
Similar to phenothiazines- Use when others don’t work
Lowers seizure threshold (greater risk)
Lithium
Mood stabilizer - bipolar
MOA: dec the turnover and release of NE and DA, dec. production if IP3 and DAG, uncouple G protein (TSH, polyuria, etc.)
- onset of action is slow- begin with antipsychotic until mania is controlled
USE: to prevent mania and depression and decrease suicide risk
- competes with NA for reabsorption (dec Na in tubules, inc. Li reabsorption- inc. blood levels)
–> low Na diet, thiazide diuretics, NSAIDS
Side effects: Tremor, Nausea, headache, dec. thyroid function, renal - nephrogenic diabetes insipidus (lithium blocks ADH), weight gain
May be used in pregnacy in second and third trimester
Toxicity: plasma levels >2.0: mild sx (nausea, vomiting, memory loss)
plasma levels >2.5 : vomiting, cardiac effects, seizures, renal failure, etc.
Lithium drug interactions
antidepressant: inc. mania
antipsychotic: safe
benzo: helps control mania
diruetics: thiazides- increase Na excretion, inc. Li blood concentration
NSAIDS: dec. lithium clearance and inc. blood levels
Na: low Na intake, sweating etc. - decrease Na and inc. Li levels
Anticonvulsants used as mood stabilizer
Valproic acid Carbamazepine Lamotrigine Topiramate Gabapentin
