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72 Cards in this Set
- Front
- Back
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What are antipsychotics used for?
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Schizophrenia
Delusional Disorder Hallucinations |
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Anti-psychotics are also called...
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Neuroleptics
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*MOA of neuroleptics
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*Dopamine blockade
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Which ones are HIGH potency?
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Haloperidol
+ ThioTHIXene |
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Which ones are LOW potency?
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ChlorPROmazine (PRO is good!)
+ThioRIDazine |
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Metabolism of antipsychotics
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P450
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Onset of action
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Delayed weeks to months
SE's & Sedation occur rapidly tho |
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Do these drugs cure Schizo?
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NO. they only reduce the symptoms
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5 Main classes of antipsychotics:
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1.) Phenothiazines
2.) Butyrophenones 3.) Dibenzoxazepines 4.) Thioxanthines 5.) Benzisoxazoles |
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Prototype Phenothiazine
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Chlorpromazine
Remember, LOW potency! |
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Examples of Phenothiazines
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Chlorpromazine
Fluphenazine Thioridazine Perphenazine |
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SE of Thioridazine
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Pigmentary Retinopathy (RETINA)
HEART problems: Cardial arrhythmia/Conduction block |
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Examples of Butyrophenones
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Haloperidol
Droperidol |
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What else can Haloperidol be used for other than psychotic states?
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- Tourette's
- Huntington's - Phencyclidine overdose (DOC!) |
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SE's of Haloperidol that are esp. pronounced
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Extrapyramidal Side effects
(EPS) |
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Example of a Dibenzoxazepine
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Loxapine
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Example of Thioxanthenes
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Thiothixene
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USES of Traditional Antipsychotic agents
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- Tx of any agitated/psychotic state
- AntiEMETIC - Tourette's - Intractable Hiccups - Antipruritic tx |
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Which one is used as an ANTI-EMETIC?
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Phenothiazines
EXCEPT Thioridazine |
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Which one is used for Tourette's?
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HALOPERIDOL
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Which one is used for Intractable HICCUPS?
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Chlorpromazine
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Which one is used as ANTI-PRURITIC tx?
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Promethazine
(b/c of Histamine blockade) |
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What are the main SE of the Traditional antipsychotics?
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ALL have:
Sedation EPS antiCHOLINERGIC effects Alpha-Adrenergic effects: HYPOtension |
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HIGH potency drugs produce the most...
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EPS
(Haloperidol & Fluphenazine) |
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LOW potency drugs produce the most...
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Anti-cholinergic effects
(ChlorPROmazine & Thioridazine) |
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Thioridazine produces the most:
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Sedation
Anticholinergic effects Alpha adrinergic effects |
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Haloperidol and Fluphenazine produce the LEAST...
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Sedation!
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What is AKATHISIA?
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Motor restlesness
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What endocrine effects are seen with these drugs?
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Increased Prolactin
Galactorrhea Gynecomastia Amenorrhea infertility |
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List the EPS seen with Traditional Antipsychotics
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Akathisia
Parkonsonian syndrome Acute Dystonia rxns (dyskinesia) Neuroleptic malignant syndrome Tardive dyskinesia |
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Which symptom do you get with Chronic use of traditional antipsychotics?
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TARDIVE DYSKINESIA:
Rhythmic involuntary movements of the Tongue, lips or jaw. Puckering of mouth, or chewing movements |
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DOC for Phencyclidine Overdose =
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HALOPERIDOL!
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Is Tardive Dyskinesia reversible?
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Not usually...its pretty much IRREVERSIBLE
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What is an "acute dystonic rxn"?
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Prolonged muscle spasms of tongue, neck or face
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What do you give to treat a acute dystonic rxn?
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BENADRYL (Diphenhydramine)
or a Benztropine injection |
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Tx for Neuroleptic syndrome
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Dantrolene
A skeletal muscle relaxant |
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*Extrapyramidal dysfunction is more common with these agents, which block this subtype of Dopamine
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*Older antipsychotic agents which block
D2 receptors |
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*Side effects occuring in antipsychotics that block dopamine
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*Hyperprolactinemia
menorrhea galactorrhea confusion mood changes decreased sexual interest weight gain! |
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* Antipsychotics that reduce POSITIVE sx only
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* OLDER antipsychotics
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* Newer atypical antipsychotics that also improve some of the negative sx and help acute agitation
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* Olanzapine
Aripiprazole Sertindole & Clozapine (but has SE) |
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Why are newer antipsychotics drugs called "Atypical"?
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b/c they block Serotonin (5-HT2) receptors in addition to blocking Dopamine receptors!
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What class of drugs is Clozapine?
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Dibenzodiazepine derivative
It blocks serotonin and dopamine receptors |
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Clozapine is esp good at treating what aspect of Schizophrenia?
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the NEGATIVE such as:
- blunted emotion - withdrawal - reduced ability to form relationships |
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SE of Clozapine
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AGRANULOCYTOSIS
+ WEIGHT GAIN + Seizures Causes FEWER EPS than traditional antipsychotics |
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* Newer Atypical antipsychotic used for bipolar disorder, known to cause weight gain and adversely affects diabetes
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* Olanzapine
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* Antipsychotic used in the tx of psychiatric sx in patients with DEMENTIA
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* Risperidone
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* Agent more frequently assoc w/ EPS that can be treated with Benzodiazepine, diphenhydramine, or muscarinic blocker
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* Haloperidol
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* Drug used in neuroleptic malignant syndrome
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* Dantrolene
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* Atypical antipsychotic causing high PROLACTIN levels
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* Risperidone
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* Agents may exacerbate tardive dyskinesia (may be irreversible and there is no treatment)
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* Muscarinic blockers
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* Antipsychotic having the STRONGEST autonomic effects
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* Thioridazine
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* Antipsychotic having the WEAKEST autonomic effects
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* Haloperidol
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First-line agent for the tx of schizo b/c it is effective for both Negative & Positive sx
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RISPERIDONE
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Cardio effects of Risperidone
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Prolong QT intervals
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Which antipsychotic can be used for OCD and is effective against both + and - sx of schizo
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Olanzapine
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This antipsychotic is a partial D2 AGONIST
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Aripiprazole
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* Only phenothiazine NOT exerting antiemetic effects, can cause visual impairment due to retinal deposits, and high doses have been associated with ventricular arrhythmias
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*ThioRIDazine
does not get RID of vomiting |
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* Agent having NO effect on D2 receptors, Blocks D4, reserved for resistant schizo, and can cause fatal agranulocytosis
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* Clozapine
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* Antipsychotic not shown to cause tardive dyskinesia
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* Clozapine
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* Antipsychotics available in DEPOT preparation
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* Fluphenazine
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* Reduced seizure threshold
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* Low-potency typical antipsychotics and clozapine
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* Orthostatic hypotension and QT prolongation
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* Low potency & Risperidone
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* Increased risk of developing CATARACTS
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* Quetiapine
Cataracts are quiet and slow, they creep up on you when you're old!! |
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Which drug is both effective and safe to used in pregnant patients?
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Olanzapine!
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* Major route of elimination of Lithium
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* Kidneys
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* Pts being treated with Lithium, who are dehydrated, or taking diuretics concurrently, could develop
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* Lithium Toxicity
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* Drug increases the renal clearance hence DECREASES levels of Lithium
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* Theophylline
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* Lithium is associated with THIS CONGENITAL defect
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* Cardiac abnormalities and is contraindicated in pregnancy or lactation
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* DOC for Bipolar Affective Disorder
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* LITHIUM
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* Concern using Lithium
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* Low therapeutic index
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* SE of Lithium
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* Tremor, sedation, ataxia, aphasia, thyroid enlargement, and reversible DIABETES INSIPIDUS!
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Retinitis Pigmentosa =
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THIORIDAZINE!!
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