psych pharm 2

Low potency - low affinity for DA receptors -> higher dose is required

• Chlorpromazine (Thorazine)
• Thioridazine (Mellaril)

lower incidence of EPS and NMS, higher incidence of anticholinergic and anti histaminic SEs, more likely to cause seizures

High potency for DA receptors -> lower dose

• Haloperidol (Haldol)
• Fluphenazine (Prolixin)
• Trifluoperazine (Trilafon)
• Perphenazine (orap)

higher incidence of EPS and NMS, lower incidence of anticholinergic and anti histaminic SEs

treat positive psych sxs - hallucinations, delusions

AntiDA (EPS), AntiHAM, Weight gain, increased liver enzymes, jaundice, ophthalmologic probs, dermatologic problems, seizures, tardive dyskinesia

• EPS:
• 1. Parkinsonism: mask-like face, cogwheel rigidity, pill-rolling tremor
• 2. akathisia: subjective anxiety/restlessness, objective fidgetiness
• 3. Dystonia: sustained contraction of muscles of neck, tongue, eyes (PAIN)
• 4. Hyperprolactinemia -> decreased libido, galactorrhea, gynecomastia, impotence, amenorrhea, osteoporosis

TX EPS - STOP meds, give antiparkinsonisn/anticholengeric/antihistamines ie: amantadine (Symmetrel), Benadryl, benztropine (Cogentin)

• 1. AntiHistaminic - sedation
• 2. AntiAlpha Adrenergic - orthostatic hypotn, cardiac abnormalities, sexual dysfunction
• 3. AntiMuscarinic - anticholengeric: dry mouth, tachycardia, urinary retention, blurry vision, constipation

Mellaril -> irreversible retinal pigmentation

Chlorpromazine -> deposits in lens/cornea, blue/gray skin discoloration

choreoathetoid movements of mouth and tongue that may occur in pts on neuroleptics for >6 mts

esp in older women

50% remit, 50% PERMANENT

MED EMERGENCY - 20% mortality rate, preceded by catatonic state

• SXS: FALTER
• Fever, Autonomic instability (tachy, labile htn, diaphoresis), Leukocytosis, Tremor, Elevated creatine phosphokinase, Rigidity (lead pipe)

stop meds, supportive care (cooling/hydration)

sodium dantrolene, bromocriptine, amantadine

block DA & 5HT receptors, associated with fewer SEs (rarely EPS, tradive, NMS)

More important for treating negative sxs -> first line for sz

• Clozapine (Clozaril)
• Risperidone (risperdal)
• Quetiapine (seroquel)
• Olanzapine (Zyprexa) - also for mania
• Ziprasidone (Geodon) - also for mania

1% -> agranulocytosis and 2/5% -> seizures

need weekly blood draws to check WBCs

hyperlipidemia, glucose intolerance, weight gain, liver toxicity

need to monitor LFTs

less weight gain

cataracts in dogs -> slit lamp studies

"anti-manic"= used to treat acute mania and prevent relapses (ie Lithium, carbamazepine, valproic acid)

also used for: dual therapy in refractory depression, with antipsychotics in SZ, tx alcoholism, treat aggression and impulsivity.

Tx acute mania and prophylaxis for manic/depressive episodes of bipolar

mech - alter neuronal Na transport

secreted by kidneys and takes action in 3-5 days

• narrow therapeutic range = effective 0.7-1.2 (can still be toxic)
• toxic > 0.5 (causes altered mental status, coarse tremors, convulsions, death)
• Lethal > 2

tremor, sedation, ataxia, thirst, metallic taste, polyuria, edema, weight gain, GI problems, benign leukocytosis, thyroid enlargement, HYPOTHYROID, NEPHROGENIC DI

tx mixed episodes and rapid cycling bipolar, manage trigeminal neuralgia

Blocks Na channels and stops APs

onset of action in 5-7 days

skin rash, drowsiness, ataxia, slurred speech, leukopenia, hyponatremia, aplastic anemia, agranulocytosis,

Elevates LFTs -> need pretx blood LFTs and CBC

NOT in preg -> neural tube defects

tx - mixed manic episodes and rapidly cycling bipolar d/o

mech - increase GABA in CNS

sedation, weight gain, alopecia, hemorrhagic pancreatitis, hepatotoxicity, thrombocytopenia

NOT in preg -> neural tube defects

monitor LFTs and CBC

• (ie benzos, barbs, buspirone)
• Depress CNS -> sedation
• USES = anxiety d/o, muscle spasm, seizures, sleep d/o, alcohol w/d, anesthesia induction

• 1st line
• safe at high doses (unlike barbs)
• SEs = drowsiness, impair intellectual functioning, decreased motor coordination
• TOXIC = resp depression in OD (esp with Alcohol)

• Long Acting (1-3 days)
• alcohol detox, presurgery anxiety

• Long Acting - 1-3 days
• rapid onset, tx anxiety and seizure control

• rapid onset
• tx insomnia

• Intermediate acting (10-20 hrs)
• tx panic attack

• Intermediate acting (10-20 hrs)
• tx panic attack, anxiety

• Intermediate acting (10-20 hrs)
• tx panic attack, alcohol w/d

• Intermediate acting (10-20 hrs)
• tx insomnia

• Rapid onset (3-8 hrs)
• tx insomnia

• Shrt term tx insomnia
• selectively bind benzo binding site on GABA receptor
• NO anticovulsant/muscle relaxor properties, no w/d, minimal rebound insomnia, little/no tolerance
• NOT bnzo, but acts like one

• use = alternative to BDZ/venlafaxine for treating GAD
• Slower onset of action than BZD (1-2 wks)
• Mech = 5HT partial agonist
• does NOT increase CNS depression of alcohol
• low potential for abuse/addiction

Tx= autonomic effects of panic attacks or performance anxiety (palpitations, tachy, sweating), akathisia