Term
| "Positive" Symptoms of Schizophrenia |
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Definition
| delusions, hallucinations, flight of thought |
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Term
| "Negative" Symptoms of Schizophrenia |
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Definition
| social withdrawal, dementia, blunted affect |
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Term
| Pharmacological Effects of Most Antipsychotics (chlorpromazine (Thorazine) - GOLD STANDARD) |
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Definition
| Effects: antipsychotic - alleviation of psychotic symptoms without depressing most intellectual fcns (greater affect against "positive" symptoms), decreased initiation of behavior, decreased interest in environment; effects develop over 2-4 wks; allows pt to fcn better (NOT CURE); effects perceived as unpleasant; Sedation - early in tx, tolerance develops; Inhibition of conditioned avoidance response in animals; Lowers seizure threshold; Antiemetic; Poikilothermic Effect; Antihistaminic; CV - orthostatic hypotension, tachycardia, cardiac arrest, sudden death; inhbiton of sexual ejaculation; endocrine effects (prolactin secretion, affects other hormones); weight gain; possible Teratogenic effects |
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Term
| chlorpromazine (Thorazine) |
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Definition
| first modern antipsychotic; traditional antipsychotic standard; aliphatic phenothiazine |
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Term
| Toxic Effects of Antipsychotics |
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Definition
| high "margin of safety" - acute poisoning not a problem; Idiosyncratic/allergic rxns - blood dyscrasias, jaundice, skin rashes, phototoxicity, retinopathy; Extrapyramidal Motor Symptoms (EPS): acute dystonic reaction, akathisia, parkinsonism, neuroleptic malignant syndrome (NMS), tardive dyskinesia |
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Term
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Definition
| EPS side effect: bizarre muscle spasms, facial grimacing, twitching, torticollis; early in tx; Tx: remove drug or add centrally-acting anticholinergic (trihexyphenidyl [Artane]) |
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Term
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Definition
| EPS side effect: compelling need to be in motion --> fidgeting or pacing, mistaken for psychotic agitation; onset early tx; Tx: add anticholinergic med or remove causative drug, also can use propranolol & benzodiazepines |
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Term
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Definition
| EPS side effect: similar to Parkinson's dx - tremor & muscle rigidity; Develops early in therapy; Tx: remove drug or administer anticholinergic |
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Term
| Neuroleptic Malignant Syndrome (NMS) |
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Definition
| EPS side effect: stupor, severe rigidity, hyperthermia (can be fatal); develops early in therapy, persists weeks after drug is stopped; Tx: treat with dantrolene [Dantrium] - inhibits release of Ca from SR; or tx with bromocryptine [Parlodel] - dopamine agonist |
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Term
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Definition
| EPS side effect: involuntary movements (sucking lips, jaw movements, protrusion of tongue, choreiform movements) of face & extremities - due to too much DA activity compared to ACh; develops after long-term therapy; more common in females; symptoms often appear upon removal of medication; Tx: supress symtpoms by giving MORE antipsychotic drug, made WORSE by anticholinergic drugs; Tx: NO ADEQUATE tx for this SE, to reduce risk --> use lowest possible drug dose to control dx symptoms |
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Term
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Definition
| aliphatic phenothiazine with NO antipsychotic activity; used as an antihistamine - mainly for antiemetic properties |
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Term
| thioridazine (Mellaril), mesoridazine (Serentil) |
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Definition
| piperidine phenothiazine; more anticholinergic activity; fewer EPS SEs; significant sedation; more Cardiotoxicity |
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Term
| trifluoperazine (Stelazine) |
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Definition
| piperazine phenothiazine; more potent; LESS sedation; LESS anticholinergic activity; MORE EPS |
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Term
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Definition
| piperazine phenothiazine; similar to trifluoperazine; LONG ACTING FORMS (decanoate, enanthate) given by DEPOT injection every 2 wks to ensure pt compliance |
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Term
| prochlorperazine (Compazine) |
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Definition
| piperazine phenothiazine; antipsychotic activity similar to trifluoperazine but commonly used as ANTIEMETIC |
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Term
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Definition
| butyrophenone; LESS anticholinergi activity; MORE EPS; LESS sedation; available in LONG ACTING DEPOT form (Decanoate) |
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Term
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Definition
| 2nd generation antipsychotic; preferentially blocks mesolimbic D4 receptors, also blocks 5-HT2 receptor, also has strong anticholinergic activity; LOW EPS; MOST EFFICACIOUS but 2nd line due to GRANULOCYTOPENIA, AGRANULOCYTOSIS; other SEs: seizures, WEIGHT GAIN, TYPE-2 DM, myocarditis; HIGH COST; also approved for suicidal behavior |
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Term
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Definition
| analog of clozapine; similar to clozapine but DOES NOT cause bone marrow toxicity; SEs: weight gain, hyperglycemia; more EPS; Used for tx of schizophrenia, mania |
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Term
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Definition
| newer antipsychotic; blocks both DA & 5-HT receptors; LESS EPS; SEs: weight gain, hyperglycemia; VERY WIDELY USED; Depot formulation available |
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Term
| quetiapine (Seroquel), ziprasidone (Geodon), paliperidone (Invega) |
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Definition
| newer antipsychotics; similar to clozapine in MoA; effective against both POSITIVE & NEGATIVE symptoms; very low EPS; DO NOT cause agranulocytosis; EXPENSIVE; Less efficacious than older 2nd generations; Similar metabolic SEs |
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Term
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Definition
| newest antipsychotic; MoA: partial agonist/antagonist of D2 & 5-HT1a receptors; Tx: against positive & negative symptoms, also approved for mania; LESS EPS; less efficacious than other 2nd gens but LESS tendency to cause weight gain & hyperglycemia |
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Term
| Clinical Uses of Antipsychotics |
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Definition
| psychosis (schizophrenia); severe acute mania & bipolar disorder; organic brain syndromes; drug-induced psychotic rxns; depression with psychotic syndromes; tic disorders; antiemetics; intractable cough |
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