Antipsychotic Drugs

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Author:
ncappadonia
ID:
115318
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Antipsychotic Drugs
Updated:
2011-11-08 16:43:55
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Antipsychotic Drugs
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Psych Antipsychotic Meds
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  1. High Potency Drugs
    - Fluphenazine (Prolixin)

    - Haloperidol (Haldol)

    - Thiothixene (Navane)

    - Trifluoperazine (Stelazine)
  2. Low Potency Drugs
    - Chlorpromazine (Thorazine)

    - Thioridazine
  3. Anticholinergic Side Effects
    • - constipation
    • - decreased sweating
    • - dry mouth
    • - dilated pupils
    • - blurred vision
    • - slowed bowel and bladder

    *results from blockade of cholinergic receptors

    *goes with low potency, typical, first generation antipsychotics
  4. Antiadrenergic Side Effects
    • - hypotension
    • - orthostatic hypotension
    • - in response reflex tachycardia can occur - antipsychotics prescribed cautiously for individual with severe hypotension, heart failure, or hx or arrhythmias

    *goes with low potency, typical, first generation antipsychotics
  5. Cardiac Arrhythmias
    • - lengthen QT interval
    • - leads to "torsades de pontes"
    • - ECG monitoring is very important

    • *goes with atypical, second generation antipsychotics
  6. EPSE Side Effects
    • Akathisia: Restlessness
    • -restless legs, jittery feelings, nervous energy
    • -most common, responds poorly to treatment

    • Akinesia: slow motion
    • -weakness, fatigue, painful muscles, and anergia
    • -this responds to anticholinergics

    • Dystonia: Freezing
    • -abnormal postures caused by involuntary muscle spasms
    • -elicit a sustained, twisted, and contracted positioning or the limbs, trunk, neck, or mouth

    Parkinsonism: rigidity, tremor

    • Tardive Dyskinesia
    • -develops after 6 months of therapy
    • -does not respond to anticholinergics (they actually typcially worsen the sx)
    • -sx: tongue writhing, tongue protrusion, teethe grinding, and lip smacking
    • -sx stop with sleep
    • -prevention is key

    • Pisa Syndrome
    • - leaning to one side
    • - older individuals are particularly susceptible
    • - increase doses of antiparkinsonian drugs may be helpful

    • Neuroleptic Malignant Syndrome
    • - potentially lethal
    • - not r/t toxic drug levels, can occur after only a few doses
    • - onset typically within 1 week
    • - *cardinal sign: increased temp (101-103, but can get up to 108)
    • - other sx: tremors, impaired ventilation, altered LOC, and autonomic hyperactivity
    • - dantrolene (dantrum): skeletal muscle relaxant and bromoctiptine (parlodel): dopamine agonist are drugs of choice for tx
    • - antipsychotics should not be reinstituted for atleaste 2 weeks after resolucion of NMS sx

  7. Metabolic Syndrome
    - most common in atypical

    • - insulin resistance
    • - results in type 2 diabetes with associated problems of hyperglycemia, obesity, increased lipid levels, coagulation abnormalities, and HTN
    • - clozapine and olanzapine: most likely to cause
  8. Gastrointestinal Side Effects
    - atypical

    • - weight gain
    • - crave carbohydrates
  9. IMPORTANT TO KNOW:
    - alcohol, antihistamines, antianxiety drugs, antidepressants, barbituates, meperidine, and morphine have s/e that can cause profound CNS depression when mixed with antipsychotics

    - antipsychotics are most effective in treating + symptoms
  10. Chlorpromazine (Thorazine)
    • - first developed
    • - anticholinergic and antiadrenergic s/e
    • - causes significant weight gain

    *low potency traditional antipsychotic
  11. Thioridazine
    • - cases of sudden death linked to this drug
    • - very therapeutic in children with behavioral problems
    • - max 800 mg/day because possible pigmental retinopathy

    *low potency traditional antipsychotic
  12. Fluphenazine (Prolixin)
    • - can be given as long term IM every 2-3 weeks
    • - good for noncompliant med pts

    *high potency traditional antipsychotic
  13. Haloperidol (Haldol)
    • - most frequently prescribed
    • - used in older adults and pediatric psychiatry
    • - can be given IM every 2-4 weeks and beneficial for patients to struggle with med compliance

    *high potency traditional antipsychotic
  14. Atypical Drugs
    • - increase effectiveness in tx of - sx
    • - dopamine increase in frontal lobe
  15. Clozapine (Clozaril)
    • - gold standard for schizophrenia management
    • - serious s/e: agranulocytosis (abs neutrophil count below 500, can be caused by bone marrow suppression)
    • - only prescribed if nothing else works
    • - causes significant anticholinergic s/e, orthostatic hypotension, sedation and weight gain, sexual dysfunction
    • - dose related seizures, excessive salvation
    • - *report dyspnea, fever, chest pain, palpitations, tachycardia, and other sx of heart failure

    *atypical, second generation antipsychotic
  16. Risperidone (Risperdal) & Palperidone (Invega)
    • - treats sx of + and - schizophrenia
    • - has very few s/e
    • - s/e: orthostatic hypotension, sedation, appetite stimulation, insomnia, agitation, headache, anxiety, rhinitis
    • - long acting Im form is available

    *atypical, second generation antipsychotic
  17. Olanzapine (Zyprexa)
    • - anticholinergic s/e, sedation, weight gain, orthostatic hypotension
    • - IM form available
    • - effective in tx of acute mania and bipolar

    *atypical, second generation antipsychotic
  18. Quetiapine (Seroquel)
    • - s/e: orthostatic hypotension, sedation, appetite stimulation
    • - effective for (+) and (-) sx of schizophrenia

    *atypical, second generation antipsychotic
  19. Ziprasidone (Geodon)
    • - effective in treating (+) and (-) sx of schizophrenia
    • - decreases depression and anxiety
    • - s/e: nausea, dyspnea, abdominal pain, constipation, somnolence, insomnia, cryzal symptoms
    • - *linked to cardiac problems r/t lengthening the QT interval
    • - IM form is available
    • - *absorption increases when given with food

    *atypical, second generation antipsychotic
  20. Aripiprazole (Abilify)
    • - dopamine system stabilizer
    • -3rd generation
    • - decreases (+) symptoms
    • - patients begin to feel better with increased energy as (-) sx subside
    • - very good s/e profile
  21. Asenaphine (Saphris)
    • - available only in sublingual tablet
    • - tx acute schizophrenia and bipolar disorder
    • - more effective in cognitive and (-) sx

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