export_psychopharm 2 Flashcards
(140 cards)
Typical Antipsychotics Mechanism of Action
D2 antagonism
– secondary = blockage of muscarinic, a adrenergic, and histamine 1 receptors
mesolimbic pathway blockade responsible for
positive symptoms (delusions, hallucinations)
nigrostriatal pathway responsible for
EPS
tuberoinfundibular pathway responsible for
hyperprolactinemia
mesocortical pathway responsible for
worsening negative symptoms (alogia, avolition) and cognitive symptoms
side effects of high v. low potency
high - worse EPS
low - worse anticholinergic, anti-histaminergic, anti-adrenergic
indications for typical antipsychotics
schizophrenia, schizoaffective, brief psychotic disorder, substance and medication induced psychosis
- depression w/ psychotic features, acute manic, depressed and mixed manic states of bipolar disorder
- Tourette’s and Huntington’s
Adverse effects of typical antipsychotics
- EPS (akathisia, dystonia, parkinsonism)
- hyperprolactinemia
- sedation, weight gain, anticholinergic (dry mouth, constipation, blurry vision)
- tardive dyskinesia
- NMS (hyperpyrexia, autonomic instability, muscle rigidity, delirium)
treatment of akathisia
anticholinergics, beta blockers or benzos
treatment of dystonia
PO or IM anticholinergics
treatment of parkinsonism
anticholinergics, dopaminergic agents (amantidine) or beta blockers
anticholinergic side effects of typical antipsychotics
dry mouth, constipation, blurry vision, urine retention, confusion, EKG changes, orthostatic hypotension, decreased seizure threshold, sex dysfunction, dermatitis/photosensitivity
high potency typical antipsychotics
- haloperidol (PO, IM, depot)
- fluphenazine (prolixin) - PO, IM and depot
- pimozide (orap)
- thithixene (navane)
- trifluoperazine (stelazine)
mid potency typical antipsychotics
- perphenazine (trilafom) - PO, IM
- molindone (moban)
- loxapine (loxitane)
low potency typical antipsychotics
- chlorpromazine (thorazine) - highly sedating, significant hypotension and anticholinergic effects but low EPS
- mesoridazine (serentil)
- thioridazine (mellaril) - least EPS of all typicals, QT prolongation, retinitis pigmentosa at high doses
atypical antipsychotics mechanism of action
D2 antagonism and serotonin 2A antagonism
- also muscarinic, alpha adrenergic and histamine 1 to varying degrees
side effects of atypical antipsychotics
- metabolic problems (hyperglycemia, DM II, hyperlipidemia)
- lower incidence of TD, NMS and EPS (except risperidone)
- olanzapine/clozapine have highest risk of metabolic syndrome
indications for atypical antipsychotics
- all except clozapine - acute mania
* olanzapine and aripiprazole - prophylaxis of recurrent mania and bipolar maintenance
Clozapine mechanism of action
- 5HT2A, D1, D2, D4, H1, muscarinic and a1 antagonism
- most efficacious antipsychotic
clozapine indications/contraindications
- typical antipsychotic indications
- treatment of refractory schizophrenia
- schizophrenia concurrent with TD
- contra: granulocytopenia, diabetes/hyperlipidemia
clozapine adverse effects/toxicities
sedation, anticholinergic side effects, orthostatic hypotension, weigh gain, hypersalivation, seizures, metabolic problems, agranulocytosis
risperidone mechanism of action
5HT2A, D2 and a1 antagonism
- PO, dissolvable tab and IM forms
risperidone indications/contraindications
- typical antipsychotic indications
* acute mania
risperidone adverse effects/toxicities
- orthostatic hypotension, reflex tachy, dizziness, metabolic probs
- insomnia, agitation, weight gain, hyperprolactinemia
- at higher doses ( >6mg), EPS