Neuroleptics Flashcards
what is neurosis?
Neurosisis a class offunctional mental disorders involvingdistresswith neither delusions nor hallucinations, whereby behavior is not outside socially acceptable norms maladaptive learned behavior
what is psychosis?
Psychosis is given to the more severe forms of psychiatric disorders, during which hallucinations, delusions and impaired insight may occur
loss of contact with reality (lack of reality testing)
disruption of brain function
neurochemical imbalance induced by:
Drugs/chemicals
Neurodegeneration
Genetic abnormality
what are some neuroleptics and what are the atypical drugs?
Typical Antipsychotics (relative potency in mg): Pimozide (1) Haloperidol (2) Fluphenazine (2) Zuclopenthixol (multiple preps, 4) Trifluoperazine (5) Perphenazine (10) Loxapine (10) Thioridazine (100) Chlorpromazine (100)
Atypical Antipsychotics (relative potency high low): Risperidone (IM as well) (High) Olanzapine Aripiprazole Ziprasidone Clozapine Quetiapine (Low)
Atypical means substantially lower risk of extrapyramidal side effects
what are positive and negative symptoms?
In describing mental disorders, especially schizophrenia, symptoms can be divided into positive and negative symptoms.
Positive symptoms:
symptoms that most individuals do not normally experience but are present in the disorder. It reflects an excess or distortion of normal functions (ie experiences and behaviours that have been added to a person’s normal way of functioning.
Negative symptoms:
symptoms that are not present or that are diminished in the affected persons but are normally found in healthy people. It reflects a diminution or loss of normal functions (ie something that has been taken away from a person’s normal way of functioning).
what is the dopamine hypothesis of Schizophrenia?
Dopamine Hypothesis of Schizophrenia
anti-schizophrenia drugs are dopamine D2 antagonists
DA receptor over-stimulation mimics schizophrenia
amphetamine psychosis
psychosis as an adverse effect of therapy in Parkinson’s Disease
BUT
DA antagonists reduce the positive symptoms (like hallucinations) but not the negative symptoms of schizophrenia
when should you use antipsychotics and what are the long-acting preparations?
Antipsychotics
Rational use:
No reason to combine antipsychotics
Choosing an antipsychotic:
All antipsychotics are equally effective
Atypical antipsychotics are as effective as typical but have better side effect profiles
Choose a drug that the patient has responded to in the past or that was used successfully in a family member
Duration: minimum 6 months, usually for life
Long-Acting Preparations:
Antipsychotics formulated in oil for deep IM injection
Received on an outpatient basis
Indications: individuals with schizophrenia or other chronic psychosis who relapse because of non-adherence
Side effects: risk of EPS (extrapyramidal symptoms), parkinsonism, increased risk of neuroleptic malignant syndrome (NMS)
Look at the pathophysiology of schizophrenia vs. mechanism of action of antipsychottics. (it’s a table)
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For typical antipsychotics with is haloperidol like?
Haloperidol (high potency):
blocks D1 and D2 dopamine receptors
has only dopamine related side effects:
Extrapyramidal symptoms, hyperprolactinemia, anti-emetic (make you nauseous) , tardive dyskinesia.
for typical antipsychotics what is zuclopenthixol?
Zuclopenthixol (moderate potency):
blocks D1 and D2 dopamine receptors
Has 3 main forms:
Zuclopenthixol dihydrochloride – used for patients who are compliant with oral meds
Zuclopenthixol acetate – used in acute sedation of psychotic patients (2-3 days sedation)
Zuclopenthixol decanoate – long acting IM injection for poor compliant patients (weekly)
has only dopamine related side effects:
Extrapyramidal symptoms, hyperprolactinemia, anti-emetic, tardive dyskinesia.
for typical antipsychotics what is chlorpromazine ?
Chlorpromazine (low-potency):
DA antagonist
Affect extrapyramidal system, pituitary, chemoreceptor trigger zone
can illicit tardive dyskinesia (TD)
Weak alpha-adrenergic antagonist (postural hypotension)
muscarinic antagonist (Constipation, sedation, hypotension, anxiolytic)
histamine antagonist (sedation, itching, etc.)
In some countries, such as the United States of America, injections of antipsychotics such as haloperidol can be ordered by a court at the request of a psychiatrist.
for atypical antipsychotics what is clozapine (clozaril)?
clozapine (Clozaril®):
D1, D2, 5HT2 antagonist
effective on both positive and negative symptoms
little or no extrapyramidal symptomsbut weight gain
BUT:
bone marrow suppression produces agranulocytosis and death
mandatory weekly blood testing required
for atypical antipsychotics, what is risperidone (Risperdal)?
D2 and 5-HT2 antagonist
at optimal doses, reduces positive and negative symptoms with little or no EPS or other side effects
for atypical antipsychotics, what is olanzapine (zyprexa)?
D2 and 5HT2 antagonist
reduces positive and negative symptoms with little or no side effects (other than weight gain, dizziness and dry mouth)
seems to halt progression of schizophrenia
for atypical antipsychotics, what is quetiapine (Seroquel)?
D1, D2, 5HT1a, 5HT2 antagonist
actions similar to risperidone and olanzapine
BUT CHEAPER
look at toronto notes for comparison of commonly used atypical antipsychotics (table in the notes)
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