504-2 Pharm: Psychiatric Disorder Drugs

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504-2 PHARM: PSYCHIATRIC DISORDER DRUGS

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504-2 PHARM: PSYCHIATRIC DISORDER DRUGS

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Name 4 antipsychotic drugs

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1. thorazine
2. haldol
3. clozaril
4. abilify

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Name 4 antidepressant drugs

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1. tofranil
2. prozac
3. nardil
4. parnate

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Name 2 antimanic and mood stabilizing drugs

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1. lithium
2. carbamezapine

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What's the mechanism of antipsychotic drugs?

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All block dopamine receptors

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Clinical dose for controlling shizophrenia correlates with what?

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Correlates with binding to D2 subtypes of dopamine receptors.

NOTE: 3 subtypes of dopamine receptors: D2, D3, D4.

Site of action: limbic system

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Side affects of antipsychotic drugs?

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1. extrapyramidal (disorder in movements)
2. sedative
3. hypotensive

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Of the 3 side effects mentioned, which drug produces the highest sedative effects?

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Chlorpromazine (thorazine)

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Highest extrapyramidal effect?

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Haloperidol (haldol)

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Receptors that antipsychotic drugs block and the effects resulting from it?

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1. alpha-1 adrenergic: hypotension
2. H1-histamine: sedation
3. muscarinic cholinergic: sedation, dry mouth)
4. 5HT2 serotonin: may contribute to antipsychotic actions of some drugs.

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Degree of receptors blocked by chlorpromazine?

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Alpha-1 = 5HT2 > D2 > D1

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.... by haloperidol?

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D2 > D1 = D4 > alpha-1 > 5HT2

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.... by clozapine?

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D4 = alpha 1 > 5HT2 > D2 = D1

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Which antipsychotic drugs are considered typical and atypical?

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Typical: chlorpromazine and haloperidol.

Atypical: clozapine and aripiprazole.

NOTE: typical and atypical classification is based on their ability to elicit extrapyramidal motor side effects.

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Typical antipsychotic drugs produce what two major types of extrapyramidal syndromes?

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1. acute dyskinesias (parkinsonism, akathisia, dystonia)
2. tardive dyskinesia: due to supersensitive of D2 receptors.

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Why does atypical drugs show a low incidence of extrapyramidal side effects?

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Due to rapid dissociation from D2 receptors.

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Why is aripiprazol unique among antipsychotic drugs?

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It's a partial agonist, therefore low incidence of extrapyramidal effects.

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Agranulocytosis can be caused by which antipsychotic drug?

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Clozapine

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Hyperprolactinemia can be caused by what mechanism?

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Antipsychotic drugs having high affinity for D2 dopamine receptors.

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Therapeutic uses of antipsychotic drugs?

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1. schizo
2. mania
3. Tourrette's syndrome
4. HD

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What are some behavioral effects of tricyclic antidepressants?

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1. not euphoric
2. if given to non-depressed individuals--> causes sleepiness, blurred vision.
3. Issue of patient compliance.
Cannot be given on an as-needed basis.

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Side effects of tricyclic antidepressants?

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1. sedation
2. arrhythmias
3. tachycardia
4. tremor

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Drug interactions of tricyclic antidepressants?

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1. potentiate effects of CNS depressants and alcohol.
2. block antihypertensive effects
3. potentiate CV effects of catecholamine.

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Fluoxetine

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A selective serotonin re-uptake inhibitors.

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Behavioral effect using fluoxetine?

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1. dulling effect
2. therapeutic latency effect

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Mechanism of action of fluoxetine?

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Selective 5HT uptake inhibitor

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Two examples of MAO inhibitors

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1. phenelzine (nardil): hydrazine
2. tranylcyprominate (parnate): non-hydrazine

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Behavioral effects using MAO inhibitors?

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Psychomotor stimulant

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Mechanism of action of MAO inhibitors?

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1. irrev. inhibition of MAO
2. leads to increased levels of NE, 5HT, and DA.

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Side effects of MAO inhibitors?

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1. hypotension
2. tremors, insomnia (excessive stimulation of CNS)

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What are the therapeutic uses of antidepressants?

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1. depression
2. panic disorder
3. O/C disorders
4. bulimia

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Haloperidol

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Tx acute mania leading to rapid calming effect.

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Antimanic drugs include which ones?

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1. antipsychotic drugs (i.e. haloperidol)
2. lithium
3. carbamazepine
4. valproic acid

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Behavioral effect of using lithium?

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Calming effect

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Mechanism of action of lithium?

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1. inositol phosphate metabolism
2. glycogen synthase kinase-3

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Margin of safety for lithium?

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Therapeutic index of 2-3

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Carbamazepine and valproic acid

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Anti-epileptic drugs

Mood stabilizers