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43 Cards in this Set
- Front
- Back
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What is the Dopamine Hypothesis?
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+ 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 |
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What is the receptor binding profile of antipsychotics?
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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 |
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What is depot dosing?
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PROLONGED RELEASE
why? non-adherance, IM, DOA 2-4 weeks, stabilze first with oral HALOPERIDOL DECANCATE or FLUPHENAZINE DECANCATE |
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What is EPS? Extra Pyramidal Side Effects
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MOA --- DA suppresses ACH activity
If DA is blocked, ACH increases increased ACH = EPS |
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What are the types of EPS?
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Akathisia (restlessness)
Dystonia Parkinsonism (shuffle, gait, tremor, rigidity) |
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Benztropine
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MOA: Anticholinergic
TREAT EPS AE: dry mouth, constipation, blurry vision, urinary retention, confusion |
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Trihexphenidyl
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MOA: Anticholinergic
TREAT EPS AE: dry mouth, constipation, blurry vision, urinary retention, confusion |
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Diphenhydramine
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MOA: Antihistamine
TREAT EPS AE: dry mouth, sedation |
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Amentadine
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MOA: DA AGONIST
TREAT EPS Irrribility, Agitation, and hallucinations |
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Propranolol
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MOA: beta blocker
TREATS EPS fatigue, bradycardia, decreased exercise, tolerance |
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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 |
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What is the tx for tardive dyskinesia?
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slozapine: atypical antipsychotic
Vitamin E used for prevention |
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What is neuroleptic Malignant Syndrome?
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severe muscular rigidity
hyperthermia, tachy, diaphoresis LOC change elevation of CK level Seen in high dose escalation more common in males and younger patients |
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What is the tx for neuroleptic Malignant Syndrome?
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D?C antipsychotics
treat symptoms> heparin, DA agonist, muscle relaxants |
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What are the AE of typcial antipsychotics?
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lactation, amenorhea, changes in libido, gyncomastia, leukopenia, agranulocytosis, thrombocytopenia, weigth gain, hyperglycemia, rash, photosensitivity, blurry vision, pigmentation retinopathy, lens opacities
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4 key things about typical antipsychotics
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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 |
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What is the target for novel drug therapy for schizophrenia?
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ease of admin, less EPS, TD
minimal cardiac or sexual side effects decreased drug interaction minimal prolactin elevation |
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What receptors do atypical antipsychotics target?
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5HT2 (antagonist)
increase DA in the frontal cortex and nigrostriatal pathway D2 (antagonist) in mesolimbic pathway |
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What are the names of atypcial agents?
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aripiprazole
clozapine olanzapine quetiapine risperidone ziprasidone |
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What is the warning for atypical antipsychotics?
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increased mortality in elderly w/dementia
cardiovascular or pneumonia |
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Clozapine
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schizo
reduce suicidal, EPS TD increase hemotologic effects increase cardio complications |
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Clozapine and agranulocytocis
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wkly CBC
after 6 months- bi-weekly after 1 year- monthly stop @ 3000 WBC or ANC 1500 (or below) |
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Clozpine
AE |
wt gain
hyperlipdemia hyperglycemia orthostatic hyptension tachycardia hypertermia hyperalvation seizures anticholinerfic effets sedation |
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Risperidone
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schizo and manic of mixed bi polar
no hematologic less sedation dose related to EPS rxn |
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Risperidone
AE |
wt gain
elevated prolactin orthostatic hypotension tachycardia akathsia |
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what is Risperdal Consta?
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long acting injectable
overlap IM with PO 25 mg IM |
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Olanzapine
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schoz, mixed bipolar
favorable TD profile EPS dose related no benzodiazephines |
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Olanzapine AE
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wt gain
orthostatic hypotension sedation transient increases in liver fxn test |
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Quetiapine AE
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wt gain
orthostatic hypotension sedation |
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Quetiapine
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schizo/ manic episode of bipolar
low EPS and anticholinergic activity adjust dose for elderly and liver impaired dog got cataracts |
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Ziprasidone
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schizo
manic bipolar IM for acute muscular agitation in schizo risk for QT wave problems |
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Ziprasidone AE
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headache
somnolence dizziness GI |
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Aripiprazole
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schizo , bipolar mania
newest novel mechanism of action- D@ receptor partial agonist and 5HT2A antagonist |
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Aripiprazole AE
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anxiety
insomnia nausea headache dizziness |
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Class side effects of atypical antipsychotics
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weight gain
hyperglycemia hyperlipidemia |
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What are the consequences of blocking the D2 dopaminergic receptors?
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EPS; Prolactin release
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What are the consequences of blocking the H2 histaminergic receptors?
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sedation
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What are the consequences of blocking the muscarinic receptors?
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cholinergic: dry mouth, blurred vision, urinary retention, constipation, tachycardia
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What are the consequences of blocking the alpha-adrenergic receptors?
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Orthostatic hypotension; reflex tachycrdia
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What are the consequences of blocking the 5 HT2 serotoninergic receptors?
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weight gain
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What are the two main types of antipsychotics used in the classical catagory?
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phenothizines "zines"
Butyrophenone - HALOPERIDOL |
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What are the four types of EPS?
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acute dystonia
parkinsonism akathsia TD |
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Haloperidol
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high potency neuroleptics
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