Behavioral Science - Antipsychotics
Terms
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- Neuroleptics
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1st generation antipsychotics; 60-70% effective for positive sx
propensity to cause movement disorders
Block D2 receptors in mesolimbic system (differing affinities) - Atypical Antipsychotics
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block 5-HT > D2 (releases the negative feedback on DA release)
improved treatment of neg sx, less burden for causing EPS
enhanced cognition - Clozapine (Clozaril)
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best atypical antipsychotic for refractory cases and neg sx, NO TD!
BUT: agranulocytosis (MUST monitor WBC), anticholinergic toxicity, sz, orthostasis, sedation, MOST weight gain, sialorrhea, death! - Risperidone (Risperdal)
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atypical antipsychotic (good for neg sx)
SE: reduced EPS and TD, initial orthostasis
worst prolactin elevation!!!
approved for use in BPD) - Olanzapine (Zyprexa)
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atypical antipsychotic
SE: huge weight gain +/- hyperglycemia
Can be used in "loading strategy"
approved for BPD - Quetiapine (Seroquel)
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atypical antipsychotic
SE: almost no EPS/TD, cataracts, hyperprolactinemia
BID dosing recommended
Approved for acute mania of BPD - Ziprasidone (Geodon)
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atypical antipsychotic
SE: QT hypertension(screening EKG), NO weight gain!!
BID dosing recommended
Approved for acute mania of BPD - Aripiprazole (Abilify)
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D2 partial agonist
SE: weight neutral, non-sedating, prolactin-sparing
Approved for BPD - Depot Antipsychotics
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lower relapse rates in some studies
Risperdal (Consta)
Fluphenazine (Prolixin)
Haloperidol (Haldol) - Akathisia
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most common extrapyramidal side effect
"inner restlessness"
Tx: B-blockers, benzodiazepine, anticholinergics, anti-parkinson agents - Acute Dystonias
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EPS (most likely in young male pts)
Many variations (spasms of...)
Tx: Benadryl, antihistamines, anticholinergics, benzodiazepines, B-blockers - Parkinsonism
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EPS (more common in elderly)
Due to imbalance of Ach/DA in basal ganglia, usually reversible
Tx: anticholinergics, dopaminomimetics
Watch out for anticholinergic toxicity, memory loss, TD!! - Tardive Dyskinesia
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Choreoathetoid mvmts of tongue, mouth, limbs, trunk.
Gets better with relaxation
Female, diabetic, organic brain syndrome, mood disorders
No effective Tx!
Clozaril does NOT cause TD! - Neuroleptic Malignant Syndrome
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D2 blockade in hypothalamus
Fever, rigidity, autonomic instability, altered conscious, elevated CPK, leukocytosis
Tx: stop drug!, supportive - Neuroendocrine Effects
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Prolactin elevation (D2 blockade in anterior pituitary)
-Menstrual abnormalities, galactorrhea/gynecomastia, decreased libido/anorgasmia, decreased testosterone levels - Cardiovascular
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Orthostatic Hypotension (a-1 block)
-low potency neuroleptics, risperidone, clozapine
QT prolongation
-thioridazine, ziprasidone - Anticholinergic
- dry mouth, blurred vision, constipation, urinary retention, confusion, nasal congestion, tachycardia, ejaculatory inhibition
- Weight Gain
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CLOZAPINE, OLANZAPINE
Quetiapine
Risperidone
Haloperidol, aripiprazole, chlorpromazine
molindone, zipirasidone (no weight gain!) - INHIBITORS of metabolism of antipsychotics
- Fluvoxamine, cimetidine, ketoconazole, others
- INDUCERS of metabolism of antipsychotics
- carbamazeipine, phenytoin, phenobarbital, cigarette somking
- Low Potency Antipsychotics
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Thorazine (chlorpromazine) - photosensitivity
Mellaril (Thioridazine) - ejaculation inhibition, prolonged QT, pigmentary retinopathy
Both: sz, orthostatic hypotension - Medium Potency Antipsychotics
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Serentil (Mesoridazine)
Moban (Molindone) - NO weight gain!
Loxitane (Loxapine)
Trilafon (Perphenazine)
Stelazine (Trifluoperazine) - High Potency Antipsychotics
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Navane (Thiothixene)
Prolixin (Fluphenazine)
Haldol (Haloperidol)