Psychotherapeutic Drugs Flashcards
Central Nervous System
Excitatory NT : 5-HT (serotonin), glutamate, NE
Inhibitory NT : GABA, glycine
Both NT : Dopamine (major NT)
Psychosis
Increase Serotonin and Dopamine
Dopamine Hypotheses in Mesocortical Pathway
Dopamine → from brain to prefrontal lobe cortex
LOW transmission of Dopamine
Result: Negative Symptoms
Dopamine Hypotheses in Mesolimbic pathway
Dopamine → midbrain to nucleus accumbens
High neurotransmission of Dopamine
Result: Positive Symptoms
Nigrostriatal Pathway
Substantia nigra to Striatum
Inhibition of this pathway → Extrapyramidal side effects
Tuberoinfundibular Pathway
Hypothalamus to the pituitary inhibits release of prolactin
Inhibition leads to hyperprolactinemia
Negative Symptoms
Alogia (low verbal output)
Anhedonia - unable to feel pleasure
Avolition - lack of motivation / drive
Associality
Apathy
Flattening of affect - monotonous voice / one facial expression
Positive Symptoms
Hallucination (auditory)
Delusions (false belief)
Paranoia
Persecutory
Grandiose
Disorganized thoughts / speech
Bizarre behavior
Typical Anti-Psychotics
Receptor blockade: D2 > 5HT2
Positive symptoms: Effective
Negative symptoms: Less Effective
EPS: More
Tardive dyskinesia: More
Atypical Anti-psychotics
Receptor blockade: 5HT2 > D2
Positive symptoms: Effective
Negative symptoms: More effective
EPS: Less
Tardive dyskinesia: Less
First Generation / Typical Antipsychotics / Traditional
a. Phenothiazines (-azine)
Aliphatic (-promazine)
eg. Chlorpromazine
*Piperazines (-phenazine)
eg Fluphenazine
Piperidines (-ridazine)
eg.Thioridazine
b. Butyrophenones
* Haloperidol
* Droperidol
c. Thioxanthines (-thix)
High Potency 1st gen Typical
Fluphenazine
Trifluoperazine
Thiothixene
Haloperidol
Low potency typicals
Chlorpromazine
Intermediate Potency
Loxapine
Most cardiotoxic and can cause blindness
Thioridazine
Adverse Effects of Typical Antipsychotics
EPS
Tardive dyskinesia
Anticholinergics (Chlorpromazine, Thioridazine, Prochlorperazine, Clozapine)
Neuroleptic Malignant Syndrome
Atypical Antipsychotics Agents MOA
MOA: blocks D4 receptors & 5-HT
receptors
Second Generation / Atypical Antipsychotics
a. -zapine
* Clozapine
* Olanzapine
* Quetiapine
b. -xapine
* Loxapine
c. -peridone
* Risperidone - first line; does not have muscarinic effects
* Paliperidone
* Ziprasidone
Others
* Apipiprazole
* Amisulpride
* Molindole
First atypical antipsychotic drugs
Clozapine
-less EPS
Adverse Effects of Clozapine
Sedation, ANS
Fatal Agranulocytosis (monitor for 6 mos.)
Olanzapine
Fewer ANS
No Agranulocytosis reports
SE: Sedation, Wt gain
Risperidone S/Es
Orthostatic hypotension
Cardiotoxic (QT interval prolongation)
First drug approved to treat irritability in autistic children
Aripiprazole
Partial agonist at dopamine and 5-HT1A receptors
Aripiprazole
EPS
a. Akathisia (uncontrolled restlessness)
b. Dystonia / Retrocollis / Torticollis /
Twisting of the neck
c. Pseudoparkinsonism
Management of Neuroleptic Malignant Syndrome (NMS)
Dantrolene
Bromocriptine
Other effects of Antipsychotics
- Seizure - Clozapine
- Agranulocytosis
* low basophil, neutrophil, eosinophil count!
* Neutropenia effect : (bacterial infection)
* ***Clozapine - requires WBC monitoring
every week for the 1st 6 months of therapy and every 3 weeks thereafter - Cardiac Effects
* myocarditis - Clozapine
* QT prolongation: Thioridazine, Ziprasidone - Corneal/Lens deposit
- Retinal deposit
* Thioridazine (can cause blindness) - Weight gain
* common to 2nd generation antipsychotics except AMA: Aripiprazole, Molindole, Amsulpride - Increased risk of DM
