Week 13 - Antipsychotics (FGAs and SGAs) Flashcards
What was the first antipsychotic that was created?
Chlorpromazine (Thorazine)
FGA: MOA
Reduces dopaminergic neurotransmission in the four dopamine pathways by blocking D2 receptors
- Too much dopamine blockade leads to symptoms of Parkinsonism
True/False: Typical antipsychotics (FGAs) do not share the same primary MOA and differs in their therapeutic profiles
False - similar MOA and does not differ in therapeutic profile
But there are differences in secondary properties such as degree of muscarinic, histaminergic, and/or alpha adrenergic receptor antagonism
Are FGAs more benefitial for positive or negative symptoms?
Positive
Careful monitoring of what syndrome is necessary when taking a FGA?
Neuroleptic malignant syndrome (NMS)
- Extreme muscle rigidity, high fevers, coma, death
FGA: examples
- Haloperidol (Haldol)
- Fluphenazine (Prolixin)
- Thioridazine (Mellaril)
- Trifluoperazine (Stelazine)
FGAs differ in potency and side effects
- High potency
Examples: haloperidol, fluphenazine
- Carry increased risk of causing EPS
FGAs differ in potency and side effects
- Low potency
Examples: chlorpromazine, thioridazine
- Lower risk of EPS, but…
- Increased risk of anticholinergic side effects (dry mouth, constipation, urinary retention, blurred vision)
- Increased risk of antiadrenergic effects (orthostatic hypotension)
Acronym for undesirable effects seen with antipsychotics
STANCE
S: sedation, sunlight sensitivity skin effects, sexual side effects
T: tardive dyskinesia
A: anticholinergic effects and agranulocytosis
N: neuroleptic malignant syndrome
C: cardiac arrhythmias (orthostatic hypotension)
E: extrapyramidal symptoms, akathisia endocrine effects (increased prolactin eye effects)

What medications could be prescribed if a patient develops EPS?
Benzotropine, trihexyphenidyl, diphenhydramine
What medications could be prescribed if a patient develops tardive dyskinesia?
Diphenhydramine
What medications could be prescribed if a patient develops pseudo-Parkinsonism?
Trihexyphenidyl or benztropine
How soon will symptoms of EPS appear after administration?
Occurs soon after administration, remits after d/c of medication
- Acute dystonia* - occurs hours to 5 days
- Akathisia* (inner feeling of restlessness) - days to months
- Akinesia* (decrease in voluntary movements) - days to weeks
- Parkinsonism: thorazine shuffle
How soon after administration will symptoms of tardive dyskinesia present?
- Late onset - occurs months after initation of therapy
- Commonly persists after d/c
- Can be irreversible
How is there an increase in prolactin levels (associated with EPS effects)?
Blockade of dopamine receptors in the tuberoinfundibular tract results in the increased secretion of prolactin
- Results in breast enlargement, galactorrhea, amenorrhea, inhibited orgasm in women, impotence in men
What classification of medication is not associated with an increase in prolactin levels?
- Serotonin dopamine antagonist (SDA)* - with the exception of risperidone (Risperdal)
- Drugs of choice for persons experiencing disturbing side effects from increased prolactin
Do atypical antipsychotics (SGAs) have more of an effect on positive or negative symptoms?
Both positive and negative
- Low EPS and less hyperprolactinemia compared to FGAs
- Have an antidepressant action
SGA: MOA
Blockade of D2 dopamine receptors
- Higher ratio interactions w/ serotonin receptor subtypes (e.g. 5-HT2A)
Can atypical antipsychotics (SGAs) also be used for depression?
Yes - interacts w/ dopamine and serotonin receptors
- Serotonin and/or norepinephrine reuptake inhibition
- Alpha-2 antagonism
- All the (-pines) and (-dones)
Can antipsychotics be used to treat mania?
Yes - both FGAs and SGAs
- SGAs have greater efficacy for nonpsychotic mania
Can antipsychotics be used to treat anxiety?
Controversial use of SGAs for anxiety and PTSD
Quetiapine (Seroquel) has clinical evidence for use in anxiety disorders
Pros of the sedating actions of antipsychotics
With short term treatment, sedation is a desired therapeutic effect when patients are aggressive, agitated, or needing sleep induction
Cons of the sedating actions of antipsychotics
With long term treatment, sedation is a side effect to be avoided because diminished arousal, sedation, and somnolence can lead to cognitive impairment
Which antipsychotics are more sedating: (-pines) or (-dones)?
(-pines)