Psychopharmacology Flashcards
Reasons to use Psychopharmacology Medications
Symptom control, May increase compliance with other therapy
Major Drug Classifications
Antipsychotics (neuroleptics)
Antianxiety agents
Antidepressants (mood elevators) Tricyclic antidepressants
Serotonin norepinephrine reuptake inhibitors (SNRIs)
Monoamine oxidase inhibitors (MAOIs)
Antimanic agents
Stimulants
Anticholinergics (antiparkinson agents)
Herbs and naturopathic remedies
Antipsychotics
Target symptoms: psychosis – group of mental disorders classified by a marked thought disturbance and an impaired perception of reality
Ex: schizophrenia, psychotic depression, paranoid disorders
Types:
- Conventional
- Atypical
Absorption: variable Metabolism: liver Excretion: slow accumulates in fatty tissues 1/2 life of 24 hours or more
Schizophrenia Background
It is believed that Schizophrenia must be treated in a multifaceted fashion
While medication is the first line treatment counseling, social and family services should be provided for proper treatment of patients
Further developments in pharmacological treatments should increase functioning of patients in society by reducing side effects with more selective drugs
Schizophrenia Etiology
Schizophrenia is a misregulation of information in the brain
Many different NT pathways are hypothesized to be involved in the biological basis of the disorder
Genetics may be an important role
The environment may trigger a possible genetic predisposition
Schizophrenia Symptoms
Schizophrenia has been broken down into two sets of symptoms
Positive and Negative
Positive symptoms for Schizo
On the test Positive Symptoms: Hallucinations Delusions Disorganized Speech, Behavior and Movements Increase in goal directed activity Illogical thoughts
Negative symptoms for Schizo
On the test Blunted affect Impaired emotional responsiveness Apathy Loss of motivation and interest Social withdrawal
Antipsychotics Preparations
Oral, IM, Depot: haloperidol and fluphenazine
Antipsychotics Side effects
Cardiovascular - orthostatic hypotension, arrhythmias, prolonged QTc interval on electrocardiogram (ECG)
Weight-gain: blocking histamine receptor
Endocrine and sexual: block dopamine, interfere with prolactin
Blood Dyscrasias - agranulocytosis
Antipsychotic Medication Categories
Conventional antipsychotics primarily treat the positive symptoms associated with schizophrenia
block all dopamine receptors as well as cholinergic, norepinephrine, and histamine receptors
Atypical antipsychotics have a much more tolerable adverse effect profile and target both the positive and negative symptoms of schizophrenia
more specific for dopamine2 receptors, serotonin, and norepinephrine receptors
Antipsychotic Meds Conventional
Chlorpromazine (Thorazine), Thioridazine (Mellaril) Fluphenazine (Prolixin) Trifluoperazine (Stelazine) Perphenazine (Navane) Thiothixene (Navane) Haloperidol (Haldol)
Antipsychotic Meds Atypical/Novel
Atypical or Novel Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripiprazole (Abilify)
Risperidone/Risperdal
Available in regular tabs, IM depot form and rapidly dissolving tablet
- Functions more like a typical antipsychotic at doses greater than 6mg
- Increased extrapyramidal side effects (dose dependent)
- Most likely atypical to induce hyperprolactinemia
- Weight gain and sedation (dosage dependent)
Olanzapine (Zyprexa)
- Available in regular tabs, immediate release IM, rapidly dissolving tab
- Weight gain (can be as much as 30-50lbs with even short term use)
- May cause hypertriglyceridemia, hypercholesterolemia, hyperglycemia (even without weight gain)
- May cause hyperprolactinemia (< risperidone)
- May cause transaminitis (2% of all patients)
Quetiapine (Seroquel)
- Available in a regular tablet form only
- May cause transaminitis (6% of all patients)
- May be associated with weight gain, though less than seen with olanzapine
- May cause hypertriglyceridemia, hypercholesterolemia, hyperglycemia (even without weight gain), however less than olanzapine
- Most likely to cause orthostatic hypotension
Ziprasidone (Geodon)
- Available regular tabs and IM immediate release form
- Clinically significant QT prolongation in susceptible patients
- May cause hyperprolactinemia (< risperidone)
- No associated weight gain
- Absorption is increased (up to 100%) with food
Aripiprazole (Abilify)
- Unique mechanism of action as a D2 partial agonist
- Available in regular tabs and immediate release IM formulation
- Early data indicates low EPS, no QT prolongation, low sedation
- CYP2D6 (fluoxetine and paroxetine), 3A4 (carbamazepine and ketoconazole) interactions that the manufacturer recommends adjusted dosing. Could cause potential intolerability due to akathisia/activation.
- Not associated with weight gain
Clozapine (Clozaril)
- Available in 1 form- a regular tablet
- Is reserved for treatment resistant patients because of side effect profile
- Associated with agranulocytosis (0.5-2%) and therefore requires weekly blood draws x 6 months, then Q- 2weeks x 6 months)
- Increased risk of seizures (especially if lithium is also on board)
- Associated with the most sedation, weight gain and transaminitis
- Increased risk of hypertriglyceridemia, hypercholesterolemia, hyperglycemia, including nonketotic hyperosmolar coma and death with and/or without weight gain
Antipsychotics: Side Effects
Neurological (Extrapyr-amidal) DA-block -Non-Neurological (Low Potency) Histaminergic: Sedation, Wt gain Anticholinergic: Perypheral & Central Alpha-Adrenergic: Orthostasis, EKG Endocrine-Sexual: PRL, 5-HT Hematologic: Agranulocytosis Eye & Skin: retinopathy, photosensitivity Seizure threshold: lowered Liver: cholestatic jaundice CPZ
Antipsychotic Adverse Effects
- Tardive Dyskinesia (TD)-involuntary muscle movements that may not resolve with drug discontinuation- risk approx. 5% per year
- Neuroleptic Malignant Syndrome (NMS): Characterized by severe muscle rigidity, fever, altered mental status, autonomic instability, elevated WBC, CPK and LFTs. Potentially fatal.
- Extrapyramidal side effects (EPS): Acute dystonia, Parkinson syndrome, Akathisia
Agents for Extrapyramidal Side effects
- Anticholinergics such as benztropine, trihexyphenidyl, diphenhydramine
- Dopamine facilitators such as Amantadine
- Beta-blockers such as propranolol
- Need to watch for anticholinergic SE particularly if taken with other meds with anticholinergic activity, i.e. TCAs
Psychiatric Uses Of Antipsychotic Drugs
- Schizophrenia: Acute and Chronic Maintenance
- Psychotic Depression (With Antidepressants)
- Acute Mania (With Lithium)
- Autism (For Control of Aggressive Behaviors)
- Gilles de la Tourette’s Syndrome – Chronic Tics
- Severe Agitation In Intellectually Disabled and In Alzheimer’s Patients
