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Antipsychotic Drugs (Atypical antipsychotics (Def'n (all require…
Antipsychotic Drugs
Atypical antipsychotics
Def'n
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all require monitoring for metabolic syndrome: weight gain, dyslipidemia, glucose intolerance
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Pathways
Mesolimbic pathway - 5HT-2A receptor blockade does NOT reverse effects of D2 blockade - + s/s effectively reduced
Mesocortical - more 5HT-2A receptors than D2 --> DA release > DA blockade -- increased DA can improve - s/s and cognitive fct
Nigrostriatal pathway - 5HT-2A blockade --> increase of DA level - more DA to compete for recpetors - reversing blockade and decreasing EPS
Tuberoinfundibular pathway - serotonin increases prolactin, DA decreases prolactin - depending on drug, 5HT blockade can mitigate effects of DA blockade
Risperidone
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sedation, orthostatic hypotension
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Olanzapine
Weight gain, sedation, orthostatic hypotension, anticholinergic
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Quetiapine (seroquel)
significant H1 blockade --> sedation, weight gain
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also off-label for insomnia, anxiety
Ziprasidone (geodon)
less risk of weight gain, more of sedation, orthostatic hypotension
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Clozapine
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SE: sedation, weight gain, salivation, metabolic syndrome
SERIOUS SE: agranulocytosis, seizures, myocarditis - tracking system, frequent CBC
used for refractory patients, reduces suicide risk, can improve TD
Typical Antipsychotics
Mechanism
D2 receptor antagonist
dopamine pathways
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mesocortical: midbrain to cortex --> blockade leads to DA deficiency --> negative s/s and cognitive slowing
nigrostriatal: SN to basal ganglia - DA blocks Ach release, so DA receptor blockade leads to Ach oveactivity (anticholinergic drugs to tx mvmt disorder)
EPS
Drug-induced Parkinsonism; tx: drugs w/ anticholinergic - benztropine, trihexyphenidyl, diphenhydramine
Akathisia: urge to move - psychological, not mvmt disorder; tx w/ beta-blocker (propranolol) or benzos
Dystonia: painful muscle spasms - 90% w/in 5 days of tx; types: oculogyric crisis, torticolis, trismus (jaw), buccolinqual crisis; tx:
diphenhydramine or benztropine IM
Tardive dyskinesia: continual blockade of DA receptors --> upreg and hyperkinetic mvmt disorder; orofacial chorea
tuberoinfundibular: hypothalamus to pituitary; DA inhibits prolactin secretion; elevated prolactin levels - galactorrhea, amenorrhea, sexual dysfct, weight gain
M1 muscarinic blockade (anticholinergic) - side effects: drowsiness, dry mouth, blurred vision, constipation, confusion, urinary retention
A1 adrenergic blockade - drowsiness, orthostatic hypotension, dizziness
H1 histamine blockade - drowsiness, weight gain
Low potency typicals
Chlorpromazine (thorazine): less likely to cause EPS, more likely to cause sedation and orthostatic hypotension
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