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43 Cards in this Set

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What is the Dopamine Hypothesis?
+ symptoms of schizo due to overactive DA system
DA receptors blocked with D2 antagonists > symptoms improve
DA levels are increased by drugs like amphetamines or methylphenidate > psychotic symptoms emerge or worsen
What is the receptor binding profile of antipsychotics?
D2 receptors antagonist> relieves psychosis and may produce EPS
alpha 1 receptro antagonist> orthostatic hypotension
muscarinic receptor antagonist> anticholinergic effects (dry mouth, constipation, urinary retention, blurry vision)
Histamine receptor antagonist> sedation and weight gain
What is depot dosing?
PROLONGED RELEASE
why? non-adherance, IM, DOA 2-4 weeks, stabilze first with oral
HALOPERIDOL DECANCATE or FLUPHENAZINE DECANCATE
What is EPS? Extra Pyramidal Side Effects
MOA --- DA suppresses ACH activity
If DA is blocked, ACH increases
increased ACH = EPS
What are the types of EPS?
Akathisia (restlessness)
Dystonia
Parkinsonism (shuffle, gait, tremor, rigidity)
Benztropine
MOA: Anticholinergic
TREAT EPS
AE: dry mouth, constipation, blurry vision, urinary retention, confusion
Trihexphenidyl
MOA: Anticholinergic
TREAT EPS
AE: dry mouth, constipation, blurry vision, urinary retention, confusion
Diphenhydramine
MOA: Antihistamine
TREAT EPS
AE: dry mouth, sedation
Amentadine
MOA: DA AGONIST
TREAT EPS
Irrribility, Agitation, and hallucinations
Propranolol
MOA: beta blocker
TREATS EPS
fatigue, bradycardia, decreased exercise, tolerance
What is
TARDIVE DYSKINESIA?
symptoms: mouth/tongue movement, facial tic, head nodding, jerky movement
causes: advance aging, affective disorder, female, smoker, length of neuroleptic treatment
What is the tx for tardive dyskinesia?
slozapine: atypical antipsychotic
Vitamin E used for prevention
What is neuroleptic Malignant Syndrome?
severe muscular rigidity
hyperthermia, tachy, diaphoresis
LOC change
elevation of CK level
Seen in high dose escalation
more common in males and younger patients
What is the tx for neuroleptic Malignant Syndrome?
D?C antipsychotics
treat symptoms> heparin, DA agonist, muscle relaxants
What are the AE of typcial antipsychotics?
lactation, amenorhea, changes in libido, gyncomastia, leukopenia, agranulocytosis, thrombocytopenia, weigth gain, hyperglycemia, rash, photosensitivity, blurry vision, pigmentation retinopathy, lens opacities
4 key things about typical antipsychotics
1. rarely alleviates - symptoms
2. may cause EPS, TD, sedation, cognitive impairment, cardiovascular effects and sexual dysfunction
3. 50% of patients don't respond
4. non- compliance is high due to AE
What is the target for novel drug therapy for schizophrenia?
ease of admin, less EPS, TD
minimal cardiac or sexual side effects
decreased drug interaction
minimal prolactin elevation
What receptors do atypical antipsychotics target?
5HT2 (antagonist)
increase DA in the frontal cortex
and nigrostriatal pathway
D2 (antagonist) in mesolimbic pathway
What are the names of atypcial agents?
aripiprazole
clozapine
olanzapine
quetiapine
risperidone
ziprasidone
What is the warning for atypical antipsychotics?
increased mortality in elderly w/dementia
cardiovascular or pneumonia
Clozapine
schizo
reduce suicidal, EPS TD
increase hemotologic effects
increase cardio complications
Clozapine and agranulocytocis
wkly CBC
after 6 months- bi-weekly
after 1 year- monthly
stop @ 3000 WBC or ANC 1500 (or below)
Clozpine
AE
wt gain
hyperlipdemia
hyperglycemia
orthostatic hyptension
tachycardia
hypertermia
hyperalvation
seizures
anticholinerfic effets
sedation
Risperidone
schizo and manic of mixed bi polar
no hematologic
less sedation
dose related to EPS rxn
Risperidone
AE
wt gain
elevated prolactin
orthostatic hypotension
tachycardia
akathsia
what is Risperdal Consta?
long acting injectable
overlap IM with PO
25 mg IM
Olanzapine
schoz, mixed bipolar
favorable TD profile
EPS dose related
no benzodiazephines
Olanzapine AE
wt gain
orthostatic hypotension
sedation
transient increases in liver fxn test
Quetiapine AE
wt gain
orthostatic hypotension
sedation
Quetiapine
schizo/ manic episode of bipolar
low EPS and anticholinergic activity
adjust dose for elderly and liver impaired
dog got cataracts
Ziprasidone
schizo
manic bipolar
IM for acute muscular agitation in schizo
risk for QT wave problems
Ziprasidone AE
headache
somnolence
dizziness
GI
Aripiprazole
schizo , bipolar mania
newest
novel mechanism of action- D@ receptor partial agonist and 5HT2A antagonist
Aripiprazole AE
anxiety
insomnia
nausea
headache
dizziness
Class side effects of atypical antipsychotics
weight gain
hyperglycemia
hyperlipidemia
What are the consequences of blocking the D2 dopaminergic receptors?
EPS; Prolactin release
What are the consequences of blocking the H2 histaminergic receptors?
sedation
What are the consequences of blocking the muscarinic receptors?
cholinergic: dry mouth, blurred vision, urinary retention, constipation, tachycardia
What are the consequences of blocking the alpha-adrenergic receptors?
Orthostatic hypotension; reflex tachycrdia
What are the consequences of blocking the 5 HT2 serotoninergic receptors?
weight gain
What are the two main types of antipsychotics used in the classical catagory?
phenothizines "zines"
Butyrophenone - HALOPERIDOL
What are the four types of EPS?
acute dystonia
parkinsonism
akathsia
TD
Haloperidol
high potency neuroleptics