Typical Antipsychotics Flashcards
primary use of anti-psychotics
schizophrenia, other disorders with psychotic features (schizoaffective d/o, mood d/o or brief psychotic d/o)
other names for typical antipsychotics
also called 1st generation antipsychotics, traditional antipsychotics or conventional antipsychotics
chlorpromazine
thorazine
fluphenazine
prolixin
haloperidol
haldol
pimpzide
orap
MOA of typicals
dopamine antagonists
what is the efficacy of typicals related to?
binding to dopamine D2 receptors
are the typicals all equally effective?
yes BUT side effects are related to binding to the D2 receptors
high affinity typical agents
Haldol, Orap and Prolixin also called high potency effective at lower doses extrapyramidal symptoms (EPS)
low affinity typical agents
Thorazine
also called low potency
need larger doses to be effective
less EPS, MORE anticholinergic, histamenergic and adrenergic SE
what hinders absorption of typicals?
smoking, coffee, antacids and food
when is steady state reached for typicals?
3-5 days
how are typicals metabolized?
CYP450 (watch with liver disease)
indication for typicals
schizophrenia schizoaffective d/o mania with psychotic features depression with psychotic features delusional disorder severe agitation and violent behavior tourette's syndrome borderline personality disorder (only if psychotic sx) dementia and delirium
what do typicals do for schizophrenia?
reduce acute symptoms
POSITIVE symptoms, NOT negative
decreased risk of exacerbation after remission obtained by using med
what are typicals commonly combined with for the treatment of mania with psychotic features?
antimanic agents - Lithium, Tegretol or Lamictal
why? steady action of antimanic agents takes time but antipsychotics work faster (taper when antimanics are therapeutic)
follow blood levels
what are typicals commonly combined with for the treatment of depresison with psychotic features?
antidepressants
when can typicals be used for severe agitation and violent behavior?
regardless of the cause of behavior and also in dementia patients with aggressive behavior (use lowest effective dose in elderly to decrease risk of hypotension)
which typicals can be used for tourette’s?
Haldol and Orap
what hypertension med can also be used for tourette’s? and why?
clonidine (catapress)
lower risk of neurological side effects
cardiac side effects from typicals
decreased cardiac contractility, increased circulating levels of catecholamines
EKG changes from typicals
prolong QT, ST depression, blunt T waves and Torsades
Possible blood cell side effect from typicals
agranulocytosis - usually in elderly females during the first 4 months, but can occur at anytime - MUST train pts to report persistent sore throats, infections or fever
what hormone could typicals cause an increased secretion of?
prolactin - breast enlargement, galactorrhea, amenorrhea, inhibited sexual function
what does thorazine increase the risk of?
seizure, jaundice, bluish skin discoloration, granular deposits in the lens/cornea, hypotensive/anticholinergic effects, agranulocytosis, significant EKG changes, lethality in overdose
IM typical antipsychotics
Haldol and prolixin
