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23 Cards in this Set

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Neuroleptics
1st generation antipsychotics; 60-70% effective for positive sx
propensity to cause movement disorders
Block D2 receptors in mesolimbic system (differing affinities)
Atypical Antipsychotics
block 5-HT > D2 (releases the negative feedback on DA release)
improved treatment of neg sx, less burden for causing EPS
enhanced cognition
Clozapine (Clozaril)
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!
Risperidone (Risperdal)
atypical antipsychotic (good for neg sx)
SE: reduced EPS and TD, initial orthostasis
worst prolactin elevation!!!
approved for use in BPD)
Olanzapine (Zyprexa)
atypical antipsychotic
SE: huge weight gain +/- hyperglycemia
Can be used in "loading strategy"
approved for BPD
Quetiapine (Seroquel)
atypical antipsychotic
SE: almost no EPS/TD, cataracts, hyperprolactinemia
BID dosing recommended
Approved for acute mania of BPD
Ziprasidone (Geodon)
atypical antipsychotic
SE: QT hypertension(screening EKG), NO weight gain!!
BID dosing recommended
Approved for acute mania of BPD
Aripiprazole (Abilify)
D2 partial agonist
SE: weight neutral, non-sedating, prolactin-sparing
Approved for BPD
Depot Antipsychotics
lower relapse rates in some studies
Risperdal (Consta)
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Akathisia
most common extrapyramidal side effect
"inner restlessness"
Tx: B-blockers, benzodiazepine, anticholinergics, anti-parkinson agents
Acute Dystonias
EPS (most likely in young male pts)
Many variations (spasms of...)
Tx: Benadryl, antihistamines, anticholinergics, benzodiazepines, B-blockers
Parkinsonism
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!!
Tardive Dyskinesia
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!
Neuroleptic Malignant Syndrome
D2 blockade in hypothalamus
Fever, rigidity, autonomic instability, altered conscious, elevated CPK, leukocytosis
Tx: stop drug!, supportive
Neuroendocrine Effects
Prolactin elevation (D2 blockade in anterior pituitary)
-Menstrual abnormalities, galactorrhea/gynecomastia, decreased libido/anorgasmia, decreased testosterone levels
Cardiovascular
Orthostatic Hypotension (a-1 block)
-low potency neuroleptics, risperidone, clozapine
QT prolongation
-thioridazine, ziprasidone
Anticholinergic
dry mouth, blurred vision, constipation, urinary retention, confusion, nasal congestion, tachycardia, ejaculatory inhibition
Weight Gain
CLOZAPINE, OLANZAPINE
Quetiapine
Risperidone
Haloperidol, aripiprazole, chlorpromazine
molindone, zipirasidone (no weight gain!)
INHIBITORS of metabolism of antipsychotics
Fluvoxamine, cimetidine, ketoconazole, others
INDUCERS of metabolism of antipsychotics
carbamazeipine, phenytoin, phenobarbital, cigarette somking
Low Potency Antipsychotics
Thorazine (chlorpromazine) - photosensitivity
Mellaril (Thioridazine) - ejaculation inhibition, prolonged QT, pigmentary retinopathy
Both: sz, orthostatic hypotension
Medium Potency Antipsychotics
Serentil (Mesoridazine)
Moban (Molindone) - NO weight gain!
Loxitane (Loxapine)
Trilafon (Perphenazine)
Stelazine (Trifluoperazine)
High Potency Antipsychotics
Navane (Thiothixene)
Prolixin (Fluphenazine)
Haldol (Haloperidol)