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ADPY 7500 > Typical Antipsychotics > Flashcards

Typical Antipsychotics Flashcards

1
Q

What do typical antipsychotics vary in?

A

Vary in potency but all have similar efficacy.

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2
Q

What are the traits of Low-Potency, Typical Antipsychotics?

A
  • Have a lower affinity for DA receptors and therefore a higher dose is required. Potency refers to the action on DA receptors, not the level of efficacy
  • Higher incidence of anticholinergic and antihistaminic side effects than high-potency traditional antipsychotics
  • Have a lower incidence of EPS and neuroleptic malignant syndrome
  • As a group, they have more lethality in overdose due to QTc prolongation and the potential for heart block and ventricular tachycardia.
  • Rare risk for agranulocytosis, and they have a slightly higher seizure risk than higher-potency medications
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3
Q

What are the two main Low-Potency Typical Antipsychotics?

A
  1. Chlorpromazine (Thorazine)

2. Thioridazine (Mellaril)

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4
Q

What are the traits of Chlorpromazine (Thorazine)?

A
  • Commonly causes orthostatic hypotension
  • Can cause bluish skin discoloration
  • Can lead to photosensitivity
  • Can treat nausea and vomiting, as well as intractable hiccups
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5
Q

What is the unique feature of Thioridazine (Mellaril)?

A

Associated with retinitis pigmentosa.

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6
Q

What are the traits of Midpotency, Typical Antipsychotics?

A

Have midrange properties

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7
Q

What are the four main Midpotency Typical Antipsychotics?

A
  1. Loxapine (Loxitane)
  2. Thiothixene (Navane)
  3. Trifluoperazine (Stelazine)
  4. Perphenazine (Trilafon)
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8
Q

What are the traits of Loxapine (Loxitane)?

A

Higher risk of seizure, Metabolite is an antidepressant

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9
Q

What is a trait of Thiothixene (Navane)?

A

Can cause ocular pigment changes

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10
Q

What are the traits of High-Potency, Typical Antipsychotics?

A
  • Have greater affinity for DA receptors, and therefore a relatively low dose is needed to achieve effect.
  • Cause less sedation, orthostatic hypotension, and anticholinergic effects
  • Greater risk for extrapyramidal symptoms and tardive dyskinesia
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11
Q

What are the three main High-Potency Typical Antipsychotics?

A
  • Haloperidol (Haldol)
  • Fluphenazine (Prolixin)
  • Pimozide (Orap)
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12
Q

What is unique about Haloperidol (Haldol) and Fluphenazine (Prolixin)?

A

Decanoate (long term injection) form available

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13
Q

What is unique about Pimozide (Orap)?

A

Associated with heart block, ventricular tachycardia, and other cardiac effects

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14
Q

What are high-potency neuroleptics often used for?

A

Often given as IM injection to treat acute agitation or psychosis.

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15
Q

Risperidone (Consta) and Paliperidone (Sustenna) also have…

A

…long-acting injectables, but they are more expensive.

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16
Q

How do typical antipsychotics treat the positive symptoms of schizophrenia?

A

Positive symptoms are thought to be treated by action of medication in the mesolimbic dopamine pathway. The mesolimbic pathway includes the nucleus accumbens, the fornix, the amygdala and the hippocampus.

17
Q

What causes negative symptoms of schizophrenia?

A

Due to DA action in the mesocortical pathway

18
Q

What is the physiologic cause for extrapyramidal symptoms?

A

They are thought to occur through the DA pathways in the nigrostriatum

19
Q

What causes increased prolactin with typical antipsychotics?

A

Increased prolactin is related to dopamine action in the tuberoinfundibulnar area.

20
Q

What are the antidopaminergic effects of typical antipsychotics?

A

EPS (Parkinsonism - bradykinesia, masklike face, cogwheel rigidity, pill-rolling tremor, Akathisia - subjective anxiety and restlessness, objective fidgetiness. Patients may report a sensation of inability to sit still, Dystonia - sustained painful contraction of muscles of neck (torticollis), tongue, eyes (oculogyric crisis). Life-threatening if they involve the airway or diaphragm.)
Hyperprolactinemia - Can lead to decreased libido, galactorrhea, gynecomastia, impotence, amenorrhea, osteoporosis

21
Q

What are the Anti-HAM effects of typical antipsychotics?

A

Cause by actions on Histamine, Adrenergic and Muscarinic receptors.

  • Antihistaminic - results in sedation, weight gain
  • Anti-alpha1 adrenergic - results in orthostatic hypotension, cardiac abnormalities, and sexual dysfunction
  • Antimuscarinic - anticholinergic effects: results in dry mouth, tachycardia, urinary retention, blurry vision, constipation, and precipitation of narrow-angle glaucoma
22
Q

How do you treat EPS?

A

Reduce the dose of the antipsychotic and administer an anticholinergic medication such as benztropine (Cogent), an antihistaminergic medication such as diphenhydramine (Benadryl), or an antiparkinsonian medication such as amantadine (Symmetrel).

23
Q

What is unique about Clozapine?

A

It is the first atypical antipsychotic and is less likely to cause tardive dyskinesia.

24
Q

What important potentially permanent side effect can typical antipsychotics cause?

A

Tardive Dyskinesia (TD)

25
Q

What is Tardive Dyskinesia?

A
  • Choreoathetoid (writhing) movements of mouth and tongue (or other body parts) that may occur in patient who have used neuroleptics for greater than 6 mo.
  • Most often occurs in older women
  • Though 50 percent of cases will spontaneously remit, many cases may be permanent.
26
Q

How do you treat Tardive Dyskinesia?

A

Discontinuing current antipsychotic if clinically possible and changing to a medication with less potential to cause tardive dyskinesia.

27
Q

What is a less common side effect of Typical Antipsychotics?

A

Neuroleptic Malignant Syndrome

28
Q

What is Neuroleptic Malignant Syndrome?

A
  • Though rare, occurs most often in young males early in treatment with both atypical and typical antipsychotics
  • It is a medical emergency and has a 20 percent mortality rate if left untreated
29
Q

What are the symptoms of Neuroleptic Malignant Syndrome?

A

FALTERED: Fever (most common presenting symptom), Autonomic instability (tachycardia, labile hypertension, diaphoresis), Leukocytosis, Tremor, Elevated creatine phosphokinase (CPK), Rigidity (lead pipe rigidity is considered almost universal), Excessive sweating (diaphoresis), Delirium

30
Q

What is the treatment for Neuroleptic Malignant Syndrome?

A

Involves discontinuation of current medications and administration of supportive care (hydration, cooling, etc.)

31
Q

What is the chance of developing Tardive Dyskinesia?

A

There is a roughly one percent chance of developing TD for each year on a typical antipsychotic.

32
Q

What is the onset time line for Acute dystonia, EPS/Akathisia and TD?

A 
Neuroleptic side effects:
-Acute dystonia: Hours to days
-EPS/Akathisia: Days to months
-TD: Months to years
Abnormal Involuntary Movement Scale (AIMS) can be used to quantify and monitor for tardive dyskinesia.
33
Q

Treatment for side effects:

A

Sodium dantrolene, bromocriptine and amantadine are infrequently used because of their own side effects and unclear efficacy.

34
Q

What should be remembered about typical antipsychotic side effects?

A
  • This is not an allergic reaction.
  • Patient is NOT prevented from restarting the same neuroleptic at a later time
  • Elevated liver enzymes, jaundice
35
Q

What are ophthalmologic problems caused by typical antipsychotics?

A

Irreversible retinal pigmentation with high doses of thioridazine, deposits in lens and cornea with chlorpromazine

36
Q

What are dermatologic problems caused by typical antipsychotics?

A

Rashes and photosensitivity (blue-gray skin discoloration with chlorpromazine)

37
Q

Typical antipsychotics and seizures:

A

Antipsychotics lower seizure thresholds. Low-potency anti-psychotics are more likely to cause seizures than high potency.

ADPY 7500 (11 decks)

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