dopamine
CNS function
reward, emotion, cognition, memory, motor activity
increased dopamine
schizophrenia
over stimulates sensory cortex
decreased dopamine
parkinsons
less stimulation of motor cortex
endocrine function dopamine
regulate prolactin secretion from pituitary gland
dopamine
cardio
N.E./E. release
low con = vasoDILATION
high con = vasoCONSTRICTION
schizophrenia pathophys
excessive dopamine
5HT2A agonism
Glutamate antagonism
positive symptoms of schizophrenia
increased DA to sensory cortex
hallucinations, delusions, paranoia
negative symptoms of schizophrenia
decrease DA to frontal cortex
social withdrawal, lack of personal hygiene
which antipsychotic is good for POSITIVE symptoms
first generation and second generation antipsychotics effective
which antipsychotic for NEGATIVE symptoms
second generation antipsychotics
antipsychotic BBW
elderly patients with dementia psychosis are at higher risk of death
FGA antipsych
have more ____, less ___
more extrapyramidal symptoms (EPS) and tardive dyskinesia
doesn’t block negative symptoms
SGA MOA
blocks 5TH2 receptors – reducing negative symptoms
antipsychotic
anticholinergic side effects
dry mouth
constipation
blurred vision
urinary hesitancy
antipsychotic system side effects (8)
- sedation
- orthostatic hypotension
- anticholinergic
- EPS
- endocrine
- weight gain
- sexual dysfunction
- QT prolongation
- agranylocytosis
EPS symptoms
- parkinsonism
- dystonia
- akathisia
- tardive dyskinesia
parkinsonism
bradykinesia, rigidity, tremor, akinesia
respond to anticholinergics (benadryl)
dystonia
torticollis, larynogospasm
anticholinergics
difficult movements
akathisia
somatic restlessness
inability to stay calm
reduce antipsychotic dose or switch age
beta blockers work
tardive dyskinesia
abnormal, involuntary orofacial movements “lip smacking”
can be irreversible with continued drug exposure
DON’T GIVE ANTICHOLINERGICS
endocrine effects of antipsychotics
prolactin secretion
galactorrhea, menstrual changes
rare but severe side effect of antipsychotics
agranulocytosis
neuroleptic malignant syndrome
dopamine antagonism drugs
significant fever (103-108) absence of GI elevated CK (muscle rigidity/cell lysis) --> kidney dysfunction
NMS treatment
dantrolene IV skeletal muscle relaxant to prevent
FGAs
- Chlorpromazine
- Fluphenazine
- Haloperidol (Haldol)
- Loxapine
- Perphenazine
- Pimozide
- Thiothizene
- Thioridazine
- Tricluroperazine
IM FGAs
chlorpromazine
fluphenazine
haldol
LAI FGAs
fluphenazine
haldol
chlorpromazine side effects
hypercholestolemia/weight gain/DM
anticholinergic S.E.
orthostatic hypotension
thiothizene S.E.
anticholinergics and orthostatic HTN
MC s.e. of all FGAs
weight gain
EPS and prolactin
SGA drug list
- ariprprazole/abilify
- asenapine
- brexpiprazole
- caripraszine
- clozapine
- iloperidone
- lurasidone
- olanzapine
- paliperidone
- pimacanserin
- quetiapine
- risperadone
- ziprasidone
aripiprazole
abilify
olanzapine
zyprexa
quetiapine
seroquel
risperidone
risperidal
ziprasidone
geodon
LAI SGAs
abilify
paliperidone
risperidone
IM SGA
abilify
zyprexa
clozapine S.e.
weight gain and diabetes
hypercholesterolemia
anticholinergics
olanzapine s.e.
weight gain and diabetes
hypercholesterolemia
prolactin elevation and EPS symptoms of SGA
paliperidone
risperidone
antipsychotics with QTC prolongations
IV halloo or Ziprasidone
apriprazole
moa, brand, …
5HT1 partial agonist
low risk for EPS, high akathisia
abilify maintena ( long lasting injectable)
lurasidone
Latuda
lurasidone gen
theorized to have beneficial cognitive and anxiolytic effects (5HT1 and 5HT1 antagonism)
Paliperidone
active metabolite of risperidone
available as monthly injection (Invega Sustenna)
ridperidone unique to
hyperprolactinemia
watch doses – EPS
long acting (Risperdal Consta) every 2 weeks
quetiapine
high histamine affinity, lowest EPS risk
preferred for parkinson’s psychosis
agranulocytosis is common for which medication
clozapine
req. ANC monitoring
clozapine
only use for treatment resistant schizoprehnia (lack of response in 2+ trials)
need an 8 week trial
CATIE trial
difference between FGA and SGA are not as great as we thought
still SGA has less sideeffects
PORT recommendations
first episode of schizophrenia
use any agent other than clozapine or olanzapine
pregnancy special populations
risks for mom or baby
caution with clozapine/olanzapine with breastfeeding CROSSES into breastmilk
geriatric special populations
avoid sedation, orthostatic hypotension
more prone to QTc prolongation