Antipsychotics Flashcards Preview

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Flashcards in Antipsychotics Deck (21):
0

Quetiapine

Atypical
MOA: blockade of the 5TH2A more so than dopamine D2
Uses: psychotic disorder, bipolar disorder

1

Haloperidol

Typical
High potency
MOA : blockade of dopamine D2 receptors
Uses : psychotic disorder and Tourette's syndrome

2

Perphenazine

Typical
Medium potency
MOA : blockade of dopamine d2 receptors
Uses: psychotic disorder, nausea, vomiting, migraine

3

Risperidone

Atypical
MOA: blockade of the 5TH2A more so than dopamine D2
Uses: psychotic disorder, bipolar disorder

At high doses can cause EPS

6

Olanzapine

Atypical
MOA: blockade of the 5TH2A more so than dopamine D2
Uses: psychotic disorder, bipolar disorder

7

Thioridizine

Typical
Low potency
MOA: Blockade of d2
Uses : psychotic disorder


Can cause retinal deposits and arrhytmias

8

Aripiprazole

Atypical
MOA: blockade of the 5TH2A more so than dopamine D2
Uses: psychotic disorder, bipolar disorder

10

Droperidol

Typical
MOA: blockade dopamine d2 and other mechanisms
Uses: nausea, vomiting, migraine

12

Clozapine

Atypical
MOA: blockade of the 5TH2A more so than dopamine D2
Uses: psychotic disorder, bipolar disorder, schizophrenia refractory to other agents


Works for pts that no other drug works for. But has terrrrribbbllleee side effectsso it isn't used much. May cause Agranulocytosis

13

Ziprasidone

Atypical
MOA: blockade of the 5TH2A more so than dopamine D2
Uses: psychotic disorder, bipolar disorder


Can cause cardiac arrhythemia and has the risk of death- due to prolongation of the QT interval by inhibiting the rapidly activating delayed rectifier potassium current -> torsades arrhythmia

14

Clinical properties of typical antipsychotics

1. High extrapyramidal symptoms compared to atypically
2. Enhance negative symptoms by blocking reward mechanisms

15

Pharmacological properties of typical antipsychotics

Bind tightly to dopamine D2 receptors in all pathways causing a long lasting blockade -> undesirable side effects

16

Common Side effects of typicals and their treatment

Acute dystonia: involuntary contractions - treat with anticholinergics ( benztropine) or diphenhydramine. Low potency less likely to cause this

Parkinsonism : Diego blockade of nigrostriatal dopaminergic path. Treat with anticholinergics or amantadine

Akathisia: motor restlessness and the urge to move. Treat: reducing doses, add propranolol, maybe uses benzodiazepines or anticholinergics

________________
all the above are early onset and reversible

Tardive dyskinesia: involuntary movements of the lips, face, tongue and limbs. In pts exposed to antipsychotics for more than 3 months, can be irreversible. May be due to super sensitivity of dopamine receptors in caudate. Treated by reducing the dose, discontinuing the drug, switching to an atypical. DONT use anticholinergics it will worsen this.

17

Common side effects of typicals because of blockade of other receptors.

Alpha adrenergic. - orthostatic hypotension and sexual dysfunction
Muscarninc- constipation, dry mouth, urinary retention , visual problems
Histamine and muscarinic - sedation
Dopamine d2 in pituitary- increase prolactin -> galactorrhea and amenorrhea
Weight gain
Decrease in seizure threshold

Rarely: neuroleptic malignant syndrome treat with dantrolene and dopamine agonist ( bromocriptine)

18

Clinical properties go atypicals

1. Low EPS compared to typicals
2. Effective for both positive and negative symptoms

19

Pharmacological properties of atypicals

1. Serotonin antagonist at 5HT2A receptors
2. Dopamine D2 antagonist with rapid dissociation
3. Dopamine D2 partial agonist ( aripiprazole)

20

Side effects of atypicals

Low EPS and low anticholinergic symptoms compared to typicals

Cardiometabolic risk - blocking histamine h1 and 5HT2C receptors at the hypothalamus increase appetite and thus weight gain and increased TG, insulin resistance, diabetes and cardiovascular events

Sedation - blocking m1, h1 and alpha adrenergic receptors.

21

Prochlorperazine

Typical
MOA: blockade dopamine d2 and other mechanisms
Uses: nausea, vomiting, migraine

23

Metoclopramide

Typical
MOA: blockade dopamine d2 and other mechanisms
Uses: nausea, vomiting, migraine

28

Chlorpromazine

Typical
Low potency
MOA : blocks d2 receptors
Uses : psychotic disorder, nausea , vomiting, migraine

31

Fluphenazine

Typical
High potency
MOA : blockade of dopamine D2 receptors
Uses: psychotic disorder