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23 Cards in this Set
- Front
- Back
Neuroleptics
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1st generation antipsychotics; 60-70% effective for positive sx
propensity to cause movement disorders Block D2 receptors in mesolimbic system (differing affinities) |
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Atypical Antipsychotics
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block 5-HT > D2 (releases the negative feedback on DA release)
improved treatment of neg sx, less burden for causing EPS enhanced cognition |
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Clozapine (Clozaril)
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best atypical antipsychotic for refractory cases and neg sx, NO TD!
BUT: agranulocytosis (MUST monitor WBC), anticholinergic toxicity, sz, orthostasis, sedation, MOST weight gain, sialorrhea, death! |
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Risperidone (Risperdal)
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atypical antipsychotic (good for neg sx)
SE: reduced EPS and TD, initial orthostasis worst prolactin elevation!!! approved for use in BPD) |
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Olanzapine (Zyprexa)
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atypical antipsychotic
SE: huge weight gain +/- hyperglycemia Can be used in "loading strategy" approved for BPD |
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Quetiapine (Seroquel)
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atypical antipsychotic
SE: almost no EPS/TD, cataracts, hyperprolactinemia BID dosing recommended Approved for acute mania of BPD |
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Ziprasidone (Geodon)
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atypical antipsychotic
SE: QT hypertension(screening EKG), NO weight gain!! BID dosing recommended Approved for acute mania of BPD |
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Aripiprazole (Abilify)
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D2 partial agonist
SE: weight neutral, non-sedating, prolactin-sparing Approved for BPD |
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Depot Antipsychotics
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lower relapse rates in some studies
Risperdal (Consta) Fluphenazine (Prolixin) Haloperidol (Haldol) |
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Akathisia
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most common extrapyramidal side effect
"inner restlessness" Tx: B-blockers, benzodiazepine, anticholinergics, anti-parkinson agents |
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Acute Dystonias
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EPS (most likely in young male pts)
Many variations (spasms of...) Tx: Benadryl, antihistamines, anticholinergics, benzodiazepines, B-blockers |
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Parkinsonism
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EPS (more common in elderly)
Due to imbalance of Ach/DA in basal ganglia, usually reversible Tx: anticholinergics, dopaminomimetics Watch out for anticholinergic toxicity, memory loss, TD!! |
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Tardive Dyskinesia
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Choreoathetoid mvmts of tongue, mouth, limbs, trunk.
Gets better with relaxation Female, diabetic, organic brain syndrome, mood disorders No effective Tx! Clozaril does NOT cause TD! |
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Neuroleptic Malignant Syndrome
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D2 blockade in hypothalamus
Fever, rigidity, autonomic instability, altered conscious, elevated CPK, leukocytosis Tx: stop drug!, supportive |
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Neuroendocrine Effects
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Prolactin elevation (D2 blockade in anterior pituitary)
-Menstrual abnormalities, galactorrhea/gynecomastia, decreased libido/anorgasmia, decreased testosterone levels |
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Cardiovascular
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Orthostatic Hypotension (a-1 block)
-low potency neuroleptics, risperidone, clozapine QT prolongation -thioridazine, ziprasidone |
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Anticholinergic
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dry mouth, blurred vision, constipation, urinary retention, confusion, nasal congestion, tachycardia, ejaculatory inhibition
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Weight Gain
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CLOZAPINE, OLANZAPINE
Quetiapine Risperidone Haloperidol, aripiprazole, chlorpromazine molindone, zipirasidone (no weight gain!) |
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INHIBITORS of metabolism of antipsychotics
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Fluvoxamine, cimetidine, ketoconazole, others
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INDUCERS of metabolism of antipsychotics
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carbamazeipine, phenytoin, phenobarbital, cigarette somking
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Low Potency Antipsychotics
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Thorazine (chlorpromazine) - photosensitivity
Mellaril (Thioridazine) - ejaculation inhibition, prolonged QT, pigmentary retinopathy Both: sz, orthostatic hypotension |
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Medium Potency Antipsychotics
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Serentil (Mesoridazine)
Moban (Molindone) - NO weight gain! Loxitane (Loxapine) Trilafon (Perphenazine) Stelazine (Trifluoperazine) |
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High Potency Antipsychotics
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Navane (Thiothixene)
Prolixin (Fluphenazine) Haldol (Haloperidol) |