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23 Cards in this Set
- Front
- Back
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extrapyramidal side effects are less likely with what type of antipsychotics?
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atypical antipsychotics (clozapine and respiradone)
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what is the mechanism of action of all antipsychotic drugs?
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dopamine receptor antagonists especially D2 DA receptors.
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describe the relationship between the clinical potencyof antipsychotics and their ability to block DA receptors?
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it is direct (linear)
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what area of the brain is responsible for controlling extrapyramidal aspects of movement?
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basal ganglia (thus blocking DA here results in extrapyramidal side effects)
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possible sites of action for antipsychotics?
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limbic system (mesolimbic, mesocortical or mesocorticolimbic systems)
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how do antipsychotics affect the endocrine system in the CNS? what are hormonal side effect of these drugs?
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affect the hypothal. decreased secretion of pituitary hormones and less urinary concentrations of gonadotropins, estrogen, and progestins leading to galactorrhea (wierd bc for some reason prolactin release is stimulated), gynecomastia, and amenorrhea
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antipsychotic drugs block DA in the chemoreceptor trigger zone even in low doses; this causes what?
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anti-emetic action
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what are antipsychotic effects on the PNS?
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alpha adrenergic antagonism (block NE - orthostatic hypotension, failure to ejaculate, impotence (para)) and anticholinergic action (weak antimuscarinic activity - blurred vision, dry mouth, constipation)
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what are the effects of antipsychotics on the kidneys?
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decreased absorption of water and electrolytes from a decrease in antidiuretic hormone. (these are both weak diuretic actions).
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CV system effects from antipsychotics?
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direct and indirect (via actions in CNS and autonomic reflexes) effects. peripheral alpha adrenergic blockade resulting in orthostatic hypotension and reflex tachycardia (esp in elederly)
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rational in selecting the most appropriate antipsychotic?
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trial and error for symptom control or select one with least side effects that will be detrimental to the patient. No drug is superior in terms of controlling the symptoms
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when pt compliance is a problem, how should antipsychotics be prescribed?
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via a depot preperation
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describe the side effects of potent neuroleptics?
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decreased autonomic effects (less CV, less sedation, etc) but increased extrapyramidal effects
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describe the side effects of less potent neuroleptics
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autonomic toxicity, but less extrapyramidal especially the atypical antipsychotics
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describe the therapeutic index of antipsychotics.
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it is high, very few deaths or OD
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DA receptor blockade in the basal ganglia can result in what?
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parkinson's syndrome, akathesia, and dystonia
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describe the signs of acut dystonia. When is it an issue during antipsychotic treatment? How do you treat it?
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facial grimacing, torticollis, oculogyric crisis. During initation of therapy. Anticholinergic antiparkinsonian agents
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in treating with antipsychotics, when is parkinsonian syndrome a concern? How do you treat it? What can make it worse?
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during the first month of therapy. Anticholinergic antiparkinsonian agents. L Dopa can worsen the psychosis.
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describe the signs of neuroleptic malignant syndrome. When is it a risk during antipsychotic treatment? Treatment?
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resembles severe parkinsonism: catatonia and stupor with autonomic instability (labile pulse and BP with high fever). Concern during treatment and weeks after neuroleptic administration is stopped. This is a medical emergency which can be fatal, first stop neuroleptic administration and administer supportative care to get fever down and levels back to normal. Dantrolene can be administered but not any antiparkinsonian agents.
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when is akathesia a concern with anticonvulsant treatment? How do you treat it?
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within first 30 days. Reduce the dose or give propranol (B blocker) or antianxiety agents
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what causes tardive dyskenisa?
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over expression of DA receptors bc they are all being blocked.
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what antipsychotics are less likely to cause tardive dyskinesia? What are they more likely to cause?
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atypical antipsychotics. Seizures and agranulocytosis
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what is the therapy for tardive dyskinesia?
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none, prevention is best
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