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Antipsychotics
Uses/ Indications
Antipsychotics
Well make the distinction between the
older, original drugs, which well call: Traditional Antipsychotics
Traditional Antipsychotics
Serendipity dirty drugs All have similar efficacy and work in a
similar fashion Dopamine blockade (D2)
Traditional Antipsychotics
Only treat the positive symptoms of
Schizophrenia (ie, delusions, hallucinations, disorganized thought/speech)
Side Effects
Neurological: Secondary Negative Symptoms Extrapyramidal Side Effects Non-Neurological
Extra-Pyramidal
The fine modulators of movement Outside the primary motor tract ie, Basal Ganglia
Acute Dystonia Parkinsonism Akathisia NMS: Neuroleptic Malignant Syndrome TD: Tardive Dyskinesia
Acute Dystonia
Acute onset of muscle
cramping/rigidity
Parkinsonism
Looks just like Parkinsons, but its
drug-induced
Treatment: anticholinergic
medications
Akathisia
Subjective sense of inner restlessness #1 reason for noncompliance Often confused with agitation,
worsening psychosis
NMS
Neuroleptic Malignant Syndrome
NMS
Form of Delirium Medical Emergency Triad of Musculoskeletal Changes
(Rigidity), Autonomic Instability (Blood Pressure, Pulse, Temperature fluctuations), and Mental Status Changes (Confusion, disorientation, mutism, etc.)
NMS Treatment
Discontinuation of offending
medication, supportive therapy
Tardive Dyskinesia
A Combination of Choreiform and Athetoid Movements
Tardive Dyskinesia
Involuntary Choreiform + Athetoid
Face most often affected Highest risk is from chronic use of
(Choreoathetoid) movements
antipsychotic medications
Tardive Dyskinesia
Often irreversible Best treatment is thus, prevention
dysfunction
Classification of Antipsychotics
Based on potency, or dosing
equivalency:
Potency Matters
High Potency
More EPS
Less other side effects
Low Potency
More orthostasis, sedation, anticholinergic effects Less EPS
NEW TOPIC
ATYPICAL ANTIPSYCOTICS
Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripiprazole (Abilify)
Atypical Antipsychotics
All are FDA approved to treat
Schizophrenia
Atypical Antipsychotics
Potential for weight gain Potential for Dyslipidemias Risk of developing Type II Diabetes
CLOZAPINE (Clozaril)
Gold standard of atypicals Effectively treats many refractory The closest thing to a treatment for
TD cases
Has Many Side Effects Sedation Orthosasis Anticholinergic Hypersalivation Weight gain
Clozapine (Clozaril)
Clozapine (Clozaril)
Adverse Drug Reactions Seizures Agranulocytosis (must monitor blood
counts weekly)
RISPERIDONE (Risperdal)
Dose-related Extra Pyramidal Side
Effects
Risk of Stroke
OLANZAPINE (Zyprexa)
QUETIAPINE (Seroquel)
Cataracts in Beagle Dogs
ZIPRASIDONE (Geodon)
Potential for cardiac conduction
problems
ARIPIPRAZOLE (Abilify)
Newest atypical antipsychotic Generally well tolerated
Were Done!
Stay Tuned...