Pharm 23 Medications To Treat Psychosis

Front 1

Chlorpromazine
1) Drug class
2) Actions
3) Used to treat what
4) Side effects

Back 1

Thorazine
1) First generation antipsychotic, low potency, phenothiazine
2) Competitive inhibitor of D2 receptor
3) Psychosis
4) Sedation (from inhibition of H1 receptors), anticholinergic effects (dry mouth etc.), hypotension (alpha one block). Some EP effects as well as prolonged QT and NMS (neuroleptic malignant syndrome

Front 2

Chlorpromazine
5) Administration
6) Metabolism

Back 2

5) Oral or IM.
6) Plasma peak 2-4 hrs, plasma half life = 30hrs but longer in brain and metabolites therapeutic as well. Mostly protein bound. Peak levels varies significantly between patients.

Front 3

Thioridazine
1) Drug class
2) Actions
3) Used to treat what
4) Side effects
5) Administration

Back 3

Mellaril
1) Low potency, first generation antipsychotic, phenothiazine
2) D2 R inhibition
3) Psychosis
4) Same is chlorpromazine but especially long QT (worse)
5) Assume same as chlorpromazine

Front 4

Trifluoperazine
1) Drug class
2) Actions
3) Used to treat what
4) Side effects

Back 4

Stelazine
1) High potency first generation antipsychotic, phenothiazine
2) Competitively blocks D2 R
3) Psychosis
4) EP effects worse in high potency (due to N ring group). But all effects seen (not as bad for sedation, hypotension, or anticholinergic effects due to CF group)

Front 5

Haloperidol
1) Drug class
2) Actions
3) Used to treat what
4) Side effects
5) Metabolism

Back 5

1) High potency FGA, butyophenone
2) Competitive D2 R inhibitor
3) Tourette's and psychosis
4) Worse EP effects, and then the same as trifluoperazine.
5) Advantage over phenothiazines in that the metabolism is much simpler thereby allowing for a predictable relationship between blood levels and therapeutic response.

Front 6

List the side effects of FGA:
1) Antagonism of H1 R
2) Alpha 1 R block
3) Mucarinic R block
4) Cardiac
5) Neroleptic Malignant Syndrome

Back 6

1) Sedation: reduced interest and emotion, suppression of spontaneous movements, complex behavior, preservation of nociceptive avoidance
2) Orthostatic hypotension, epi reversal, ejaculation impairment
3) Dry mouth, vision problems, constipation, and urine retention
4) Prolonged QT
5) NMS - severe Parkinsonism with catatonia, tremor, autonomic instability

Front 7

List the side effects of FGA:
5) Extrapyramidal symptoms

Back 7

-Parkinsonism - sometimes alleviated with use of anticholinergic meds
-Akathisia - restless leg syndrome, can be treated with clonidine or benzos or beta blockers
-Dystonias - prolonged tonic muscle contractions
-Tardive dyskinesia (TD) - involuntary facial movements with prolonged use of FGA. Thought to result from DA supersensitivity (from increase in number and sensitivity of DR in nigrostriatal pathway) - drugs that increase cholinergic activity can help (choline, physostigmine)
-Neuroendocrine - gynecomastia

Front 8

Clozapine
1) Drug class
2) Action
3) Administration
4) Side effects

Back 8

Clozaril
1) Atypical or SGA
2) Acts at D2 and D4 R (less at D2 than FGA) as well as blocking 5HT2 R (which modulate DA transmission)
3) Oral administration
4) No EP, but Alpha 1 action, H1, and anticholinergic effects +
-Agranulocytosis in 1% --> weekly blood drawings required
-Seizures, dose dependent, can be prevented with use of valproic acid
-Gastric and cardiac effects
-Wt gain

Front 9

Risperidone
1) Drug class
2) Action
3) Administration
4) Side effects

Back 9

Risperdal
1) SGA
2) Acts at D2 and D4 R (less at D2 than FGA but more than clozapine) as well as blocking 5HT2 R (which modulate DA transmission)
3) Oral, some metabolized in liver
4) More EP effects than clozapine as well as hyperprolactinemia at high doses. Does not cause agranulocytosis and has lower seizure frequency than clozapine. Little effect on H1, alpha 1, and muscarinic R
-Least likely SGA to cause wt. gain

Front 10

Olanzapine
1) Drug class
2) Action
3) Administration
4) Side effects

Back 10

Zyprexa
1) SGA
2) Replacing risperiodone, as effective as Haldol for + sxs but more effective for - sxs. Blocks D2 (lower afinitiy than FGA), D4R, and 5HT2 R
3) -Less EP than risperidone but higher than clozapine
-Significant wt. gain
-Does not cause increase in prolactin secreation and women can become pregnant b/c will menstruate
-No agranulocytosis
-Can cause sedation via H1 R block

Front 11

Paliperidone
1) Drug class
2) Side effects

Back 11

Invega
1) SGA
2) Like risperidone but given once a day

Front 12

LY404039
1) Mechanism
2) Side effects
3) Treatment efficacy

Back 12

1) Activation of mGlu2/3 receptors
2) No EP, prolactin elevation or wt gain
3) Similar to olanzapine, + and - sxs treated