Anti-Psychotics Flashcards
(27 cards)
Psychosis
broad group of thought (as opposed to mood disorders)
Mania
abnormally, persistently elevated expansive or irritable mood with increased activity and energy
Schizophrenia
prototype psychotic disorder characterized by abnormal behavior, inability to think coherently, and comprehend reality and limited illness insight
Bipolar disorder
mood disorder characterized by episodes of mania or hypomania intespersed with episodes of major depression
Schizoaffective disorder
mental disorder with features of schizophrenia and a mood disorder
Neuroleptic
major tranquilizers, outdated, first generation anti-psychotics
Positive symptoms
beyond what is considered normal cognition (delusions), perception (auditory hallucinations) and affect
usually respond well to meds
ex: delusions, thoughts, disturbances, inappropriate affect, altered motor function
Negative symptoms
deficit of normal emotional responses
do not respond well to meds
ex: poverty of speech and thought, loss of emotion, lack of spontaneity and motivation, social isolation
Cognitive dysfunction
best predictor of poor functional outcomes
Dopamine hypothesis of Schizophrenia
- Excess mesolimbic dopamine (positive symptoms) = neuroleptics block D2 receptors in CNS or deplete dopamine from nerve terminal
- Deficit of mesocortical dopamine (negative symptoms) - neuroleptics make worse
Mesolimbic-mesocortical
emotional and cognitive circuitry
learning and memory
D2 antagonist target
Nigostratal
Movement
Parkinson = degeneration
related to mesolimbic, if mesolimbic decreases, then parkinsonian symptoms develop
Tuberoinfundibular
prolactin secretion -> hyperprolactinemia
increase DA = inhibition of prolactin
-> inhibit DA = increase prolactin
= weight gain and sexual dysfunction
Medullary-periventricular
eating behavior
DA antagonist = anti-emetic
Typical antipsychotics
First generation used for (+) symptoms, more side effects associated with extrapyramidal side effects (EPSE) and tardive dyskinesia (TD) high affinity for D2 receptor and block very cheap and still used
Atypical antipsychotics
Second generation
used for (+) & (-) symptoms and cognitive dysfunction
less side effects
associated with lower risk of EPSE/TD but HIGHER risk of weight gain and adverse metabolic effects
Typical mechanism
Dopamine D2 receptor antagonists
>60% receptor occupancy
Atypical mechanism
affinity for 5HT2A (Serotonin) is greater than D2
allows to treat negative symptoms and decreased EPSE
Pharmacokinetics for anti-psychotics
Highly lipophilic, orally or parenteral
Onset is rapid
Long half life (20-40 hours)
Extensive metabolism (CYP2D6)
EPSE symptoms w/ 80% receptor occupancy
Akathisia - restlessness
Parkinsonism - tremor, shuffling gait,
Dystonias - muscle spasm
Tardive dyskinesia - chronic use, oral facial dystonia
Neuroleptic malignant syndrome
Rare, life-threatening
Tetrad: AMS, hyperthermia, extreme muscle rigidity, autonomic dysfunction
Require drug withdrawal
Haloperidol (Haldol)
Prototype first generation
Higher risk, less sedating
1st drug for schizophrenia, tourettes tics, behavioral problems in children
ICU delirium, OCD, sedation of agitated patients
Chlorpromazine
Low potency
Low risk of EPSE, more sedating
tx: psychosis, N/V, severe behavioral problems in children, dementia behavior
Clozapine
UNIQUE - good for negative s/s
Recalcitrant schizophrenia & suicidal behavior w/ schizoaffective patients
Risk of agranulocytosis* - lethal! = last resort if other antipsychotics haven’t worked
no risk of EPSE
