Anti-psychotic drugs Flashcards
(32 cards)
What percentage of the schizophrenic population attempts suicide?
20-40%
How does PCP (phencyclidine) work?
PCP blocks the NMDA glutamate receptor and causes psychosis in many individuals
- Sometimes this psychosis never subsides
What are the typical antipsychotics (neuroleptics)?
D2 blockers (with extrapyramidal symptoms):
Chlorpromazine (Thorazine)
Perphenazine (Trilafon)
Haloperidol (Haldol)
Fluphenazine (Prolixin)
What are the effects of typical antipsychotics?
Days: calm behavior, improve sleep, decrease confusion.
Days to weeks: decrease psychotic symptoms
Weeks to months: improve insight?
In what ways are typical antipsychotics limited?
- Negative symptom improvement minimal
- Cognitive improvement usually minimal
- Disability may remain
What typical antipsychotics are low potency?
Chlorpromazine (Thorazine)
Perphenazine (Trilafon) ———–mid range
*low potency => use more mg to have an effect
What typical antipsychotics are high potency?
Haloperidol (Haldol)
Fluphenazine (Prolixin)
What are the side effects of low potency typical antipsychotics?
- Dry mouth, blurred vision, constipation, urinary retention, hypotension, sedation, weight gain
- Less acute dystonia, NMS
- Parkinsonism, akathesia, tardive dyskinesia
- Prolactin elevation (dopamine blocks prolactin secretion)
What are the side effects of high potency typical antipsychotics?
- More acute dystonia, NMS
- Parkinsonism, akathesia, tardive dyskinesia
- Prolactin elevation
What are the neurological side effects of neuroleptics (i.e. typical antipsychotics)?
- Acute dystonia
- Parkinsonism
- Akathisia
- Tardive dyskinesia (25%)
- “Rabbit” syndrome
What is neuroleptic malignant syndrome (due to neuraleptics)?
- Fever
- Rigidity
- Elevated CPK
Minor manifestations:
- tachycardia
- abnormal BP
- tachypnea
- altered consciousness
- diaphoresis
What are the benefits of atypical/novel antipsychotic drugs?
- Less EPS
- Less prolactin elevation (except risperidone, paliperidone)
- Fewer relapses
- Fewer neurological side effects
- Useful in affective psychosis (also bipolar)
- Role in suicidal patients – clozapine data
- Role in comorbid substance use –clozapine data
What are the major atypical/novel antipsychotic drugs?
- clozapine
- olanzapine
- aripiprazole
Others:
- risperidone
- quetiapine
- ziprasidone
- iloperidone
- asenapine
- lurasidone
- paliperidone
What is the action of clozapine?
Clozapine is a weak DA D2 receptor antagonist
- Potent antagonism at 5HT2 and NE α2 receptors
What are the benefits of Clozapine?
- Dramatically effective for positive and some negative symptoms.
- Minimal EPS effects.
- Minimal prolactin elevation
- Less relapse
- Can help with substance abuse remission
What side effects are associated with clozapine?
- Agranulocytosis
- Seizures
- Myocarditis
- Weight gain, glucose and lipid dysregulation
- Tachycardia, hypotension
- Drooling
- Sedation
- Liver function changes
What is the action of risperidone?
First post-clozapine atypical antipsychotic
- 5HT2/D2 ratio similar to clozapine
- alpha 2 receptor effects, strong D2 receptor blocker, some serotonin effects
*Fewer relapses than haloperidol
What are the side effects of risperidone?
EPS (higher doses), prolactin elevation
What is the action of olanzapine?
5HT/D2 receptor blockade similar to clozapine
What are the improvements in olanzapine?
Low EPS, low prolactin elevation
What are the side effects of olanzapine?
weight gain, glucose/lipid dysregulation, sedation
What is the mechanism of action of quetiapine?
5HT/D2 ratio receptor blockade similar to clozapine
What is quetiapine generally used for?
Quetiapine is a commonly used anti-psychotic for sedation
What are the improvements in quetiapine?
Few serious side effects
Minimal EPS
Minimal prolactin elevation
