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51 Cards in this Set

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  • Back
Distinction of atypical antipschotics
Work on negative symptoms and cognitive defects
Less extrapyramidal SE
Work on patients refractory to 1st line AP's
Prototype Antipyschotics
Chlorpromazine

T-1/2 = 30 hrs
Mechansims of actions
Dopamine antagonist
alpha 1 antago
cholinergic antag
H1 antag
Ca, Na, channel blocker
2 phases of action for chlorpromazine
1st rapid sedation = chemical straight jacke

2nd anti-schizopheric (2-3 weeks)
things not improved by chlorpromazine
insight memory, judgement and orientation
Two types of side effects for cholpromazine
early onset: parkinson-like, akathisia, dystonia

late onset: tardive dyskinesia
What drug can be used to prevent or reverse the extrapyramidal effects of chlorpromezine
anti-muscarinic drugs (atropine)

CMZ un-inhibits ACh neurons leading to excess motion
Side Effects of CMZ
Oversedation and Seizure
alpha1: orthostasis (tolerance develops)
tachycardia
Quinidine-like on heart (long QT)
anti-ACh: dry-mouth, constipation, urine retention
DA block: Galactorrhea, amenorrhea (upreg prolactin)
Neuroleptic malignant syndrome
Tx Neurolepic malignant syndrom
dantrolene iv (muscle relaxant)
bromocriptime (D2 ag)
Fluphenazine decanoate
CMZ analog in depot form for increased compliance
association between sedation and hypotension
both alpha 1, direct correlate
association betwen sedation and potency
Low Potency has high sedation
High potency has low sedation
association between extrapyramidal side-effects and potency
High Potency = High extrapyramidal side effects
association between extrapyramidal side effects and anticholinergic effects
inverse: natural anti-ACh blocks extrapyramidals
Low potentcy AP's
Chlorpromazine
Thioridazine
High potency AP's
Haloperidol
Fluphenazine
Fluphenazine
High potency AP

Low sedation, Lo Orthostasis
High Extra pyramidal
Low anticholinergic
Clozapine
atypical AP with more anticholinergic effects (low EPS)

5-HT2 blocker in addition to D blocker
Major side effect of Clozapine
1-2% agranulocytosis (weekly WBC needed)
Side effects of clozapine
agranulocytosis
weight gain and diabetic exacerbation from 5-HT2 block
Atypical AP's
clozapine
Olanzapine
Risperidone
Olanzapine
Atypical AP
Anti-Depressants regulate which factor to improve mood
Brain Derived Neurotrophic Factor (BDNF)

Upreg by DNA so several weeks needed to see effect
TCA's
amitriptyline nortriptyline
imipramine desipramine
Common Side Effects of TCA's
sedation
insomnia
fine tremor
Problems with high dose TCA's is susceptible patients
Mania (bipolar)
Seizure (epileptic)
Toxic Psychosis (very high dose)
Peripheral SE of TCA's
Like CMZ
Orthostasis (alpha 1)
quinidine like effect (cardiac channels)
Anti-ACh
Weight gain
Dosing consideration for TCA
Give only 1 weeks dose because 10-20 time daily dose is lethal
Alternative uses for TCA's
REM sleep supression
OCD (clomipramine)
TCA for OCD
Clomipramine
Prototype SSRI
Fluoxetine (Prozac)
Difference between SSRI and TCA
No alpha, H, or ACh or cardiac activity so no peripheral toxicity.
common side effects of SSRI
insomnia, nausea, sexual side effects

Serotonin syndrome if used with MAOI
SSRI's should not be used with this other drug
MAOI

Serotonin syndrome
Four SSRI's
Fluoxetine
Sertraline
Fluvoxamine
Paroxetine
Buproprion
Stimulant, not sedative

Helpful in smoking withdrawl
Non-selective MAOI's
Phenelzine
Tranylcypromine
tranylcypromide
MAOI
Side Effects of MAOI
Like TCA's
Drug interactions with MAOI's
Tyramine (HTN)
SSRI's (Serotonin Syndrome)
L-Dopa (agitation HTN)
Meperidine (fatal)
Use of Meperidine with phenylelzine
Potentially fatal.

Should not be used until MAOI has be discontinued for at least 2 weeks
Serotonin Syndrome
Hyperthermia
Muscle Rigidity
Myoclonus
Lithium
Treats manic episode by returning patient to normal, not just sedating them

Depletely IP3 in nerves to dampen effects of stimulants
Kinetics of Li
Oral medication, secreted by kidney

Secretion lowered when Na is readbsorbed (hypovolemia, na restriction, chronic thiazides)
Very low therapeutic index
Side effects of Li carbonate
Gi distress, tremor
Ataxia drowsiness
Cardiac Tox (QRS widening)
Hypothyroidism
Renal toxicity (polyuria, blocks ADH)
Treatment of a manic episode
Antipyschotic initally (CMZ) and lithium which takes 5-6 days to take effect. Continue Li for prophylaxis
Drug interactiongs of Li
Diuretics
anticholinergics (including TCA's) if severe polyuria is present (causes urinary retention)
Li alternatives
Carbamazepine: works like Li for prophylazis on subpopulation
Valproate: Broad Spec anti convulsant for Bipolar
Alzheimer treatment
anti-AChE drugs to up ACh levels
(tacrine, donezepil) don't stop progressgion
NSAIDs
Mematine: blocks pathologic, not physiologic stim of NMDA receptors. Stops progression
Mematine
blocks pathologic, not physiologic stim of NMDA receptors. Stops progression of alzheimers
Donezepil
Anti-AChE used to tx symptomso of Alzheimer's