Flashcards in Antipsyschotics Deck (18):
antipsychotic drugs aka
chlorpromazine (Thorazine), haloperidol (Haldol), thioridazine (Mellaril), and fluphenizine (Prolixin).
First gen is indicated for positive/negative symptoms?
positive symptoms - by primarily blocking dopamine
Side effects of first general antipsychotics
(a) Anticholinergic side effects - dry mouth, blurred vision, urinary retention, constipation, and tachycardia. low potency
Extrapyramidal side effects are most likely with high-potency. (e.g., haloperidol and fluphenizine) and include parkinsonism (resting tremor, muscle rigidity, slowed movement), dystonia (uncontrollable muscle contractions), akathisia (a sense of inner restlessness), and tardive dyskinesia.
is potentially life threatening, begins after long-term drug use, and is more common in women and older adults. It starts with involuntary, rhythmic movements of the tongue, face, and jaw and, over time, may also affect the limbs and trunk. Tardive dyskinesia is irreversible for some patients and is treated by gradually withdrawing the drug, administering a benzodiazepine, or switching to a second-generation antipsychotic.
Neuroleptic malignant syndrome (NMS)
is a rare life-threatening side effect. Its symptoms include muscle rigidity, a high fever, autonomic dysfunction (e.g., unstable blood pressure, tachycardia, excessive sweating), and an altered mental state (e.g., confusion, combativeness). Treatment involves having the person stop taking the drug at the first sign of symptoms and providing him/her with supportive therapy (e.g., hydration, cooling).
Second generation antipsychotics (atypical)
These drugs exert their therapeutic effects primarily by blocking dopamine (especially D3 and D4) receptors and serotonin receptors.
(Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and aripiprazole (Abilify). Tx for schizophrenia and MDD
Tx efficacy for SGA -
There’s evidence that the SGAs are as effective as or more effective than the FGAs for treating the positive symptoms of schizophrenia and more effective than the FGAs for treating the negative symptoms, although this may be true for only some SGAs . The SGAs are less likely than the FGAs to cause extrapyramidal side effects; however, they can cause anticholinergic effects, neuroleptic malignant syndrome, and metabolic syndrome. Metabolic syndrome involves substantial weight gain, high blood pressure, insulin resistance, hyperglycemia, and increased risk for diabetes mellitus and heart disease.
clozapine and, to a lesser extent, other SGAs can cause agranulocytosis, which is a potentially life-threatening condition that involves a dangerously low white blood cell count and requires regular white blood cell monitoring.
Antidepressant types (five)
SSRI's SNRI's, MAOI,s TCA's, and NDRI's
SSRI's - tx for MDD, PDD, dysphoric disorder, OCD, panic disorder, generalized anxiety disorder, PTSD, bulimia nervosa, and premature ejaculation. - Block reuptake - AGNOIST. enhane serotonin
The SSRIs include fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), and citalopram (Celexa). - take 2-4 weeks to work
Also, combining an SSRI with an MAOI, lithium, or other serotonergic drug can cause serotonin syndrome, which is potentially fatal and involves extreme agitation, confusion, autonomic instability, hyperthermia, tremor, seizures, and delirium. Treatment for serotonin syndrome requires immediate withdrawal of the serotonergic drugs and providing appropriate medical interventions for its symptoms.
treat major depressive disorder, social anxiety disorder, and neuropathic pain and other pain disorders. may be more effective for severe depression.
venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq). inhibition of the reuptake of serotonin and norepinephrine at synapses.
NDRI's - inhibiting the reuptake of norepinephrine and dopamine at synapses
bupropion (Wellbutrin, Zyban), which is used to treat major depressive disorder and assist with smoking cessation
TCA's - major depressive disorder, panic disorder, obsessive-compulsive disorder (especially clomipramine), and neuropathic pain (especially nortriptyline and amitriptyline)
amitriptyline (Elavil), imipramine (Tofranil), clomipramine (Anafranil), nortriptyline (Pamelor), and doxepin (Sinequan).
inhibiting the reuptake of norepinephrine, serotonin, and dopamine at synapses.
The side effects of the TCAs include cardiovascular effects (e.g., hypertension, tachycardia, orthostatic hypotension), anticholinergic effects, sedation, weight gain, and sexual dysfunction. Because they’re cardiotoxic and lethal in overdose, the TCAs must be prescribed with caution for patients who have heart disease or are suicidal.
MAOI's - These drugs are useful for patients with treatment-resistant depression or atypical depression, which involves reversed vegetative symptoms such as hypersomnia, increased appetite, and reactive dysphoria.
phenelzine (Nardil), isocarboxazid (Marplan), and tranylcypromine (Parnate)
deactivates norepinephrine, serotonin, and dopamine, and the MAOIs increase the levels of these neurotransmitters by inhibiting the activity of this enzyme.