psych pharm 2

  1. Typical Antipsychotics - low potency
    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
  2. Typical Antipsychotics - high potency
    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
  3. Typical Antipsychotics - usage
    treat positive psych sxs - hallucinations, delusions
  4. Typical Antipsychotics - SEs
    AntiDA (EPS), AntiHAM, Weight gain, increased liver enzymes, jaundice, ophthalmologic probs, dermatologic problems, seizures, tardive dyskinesia
  5. Typical Antipsychotics - AntiDA
    • 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)
  6. Typical Antipsychotics - anti-HAM
    • 1. AntiHistaminic - sedation
    • 2. AntiAlpha Adrenergic - orthostatic hypotn, cardiac abnormalities, sexual dysfunction
    • 3. AntiMuscarinic - anticholengeric: dry mouth, tachycardia, urinary retention, blurry vision, constipation
  7. Typical Antipsychotics - opthalmologic/dermatologic problems
    Mellaril -> irreversible retinal pigmentation

    Chlorpromazine -> deposits in lens/cornea, blue/gray skin discoloration
  8. Typical Antipsychotics - Tardive Dyskinesia
    choreoathetoid movements of mouth and tongue that may occur in pts on neuroleptics for >6 mts

    esp in older women

    50% remit, 50% PERMANENT
  9. Typical Antipsychotics - Neuroleptic Malignant Syndrome sxs
    MED EMERGENCY - 20% mortality rate, preceded by catatonic state

    • Fever, Autonomic instability (tachy, labile htn, diaphoresis), Leukocytosis, Tremor, Elevated creatine phosphokinase, Rigidity (lead pipe)
  10. Typical Antipsychotics - Neuroleptic Malignant Syndrome tx
    stop meds, supportive care (cooling/hydration)

    sodium dantrolene, bromocriptine, amantadine
  11. Atypical Antipsychotics - Action
    block DA & 5HT receptors, associated with fewer SEs (rarely EPS, tradive, NMS)

    More important for treating negative sxs -> first line for sz
  12. Atypical Antipsychotics - Examples
    • 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
  14. Olanzapine
    hyperlipidemia, glucose intolerance, weight gain, liver toxicity

    need to monitor LFTs
  15. Quetiapine
    less weight gain

    cataracts in dogs -> slit lamp studies
  16. Mood stabilizers
    "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.
  17. Lithuim - use/mech
    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
  18. Lithium - therapeutic index
    • 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
  19. lithium - SE
    tremor, sedation, ataxia, thirst, metallic taste, polyuria, edema, weight gain, GI problems, benign leukocytosis, thyroid enlargement, HYPOTHYROID, NEPHROGENIC DI
  20. Carbamazepine (Tegretol) - use/action
    tx mixed episodes and rapid cycling bipolar, manage trigeminal neuralgia

    Blocks Na channels and stops APs

    onset of action in 5-7 days
  21. Carbamazepine (Tegretol) - SEs
    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
  22. Valproic Acid (Depakene) - use/mech
    tx - mixed manic episodes and rapidly cycling bipolar d/o

    mech - increase GABA in CNS
  23. Valproic Acid (Depakene) - SE
    sedation, weight gain, alopecia, hemorrhagic pancreatitis, hepatotoxicity, thrombocytopenia

    NOT in preg -> neural tube defects

    monitor LFTs and CBC
  24. Anxiolytics/Hypnotics
    • (ie benzos, barbs, buspirone)
    • Depress CNS -> sedation
    • USES = anxiety d/o, muscle spasm, seizures, sleep d/o, alcohol w/d, anesthesia induction
  25. Benzodiazepines
    • 1st line
    • safe at high doses (unlike barbs)
    • SEs = drowsiness, impair intellectual functioning, decreased motor coordination
    • TOXIC = resp depression in OD (esp with Alcohol)
  26. Chlordiazepoxide (Librium)
    • Long Acting (1-3 days)
    • alcohol detox, presurgery anxiety
  27. Diazepam (Valium)
    • Long Acting - 1-3 days
    • rapid onset, tx anxiety and seizure control
  28. Flurazepam (Dalmane)
    • rapid onset
    • tx insomnia
  29. Alprazolam (Xanax)
    • Intermediate acting (10-20 hrs)
    • tx panic attack
  30. Clonazepam (Klonopin)
    • Intermediate acting (10-20 hrs)
    • tx panic attack, anxiety
  31. Lorazepam (Ativan)
    • Intermediate acting (10-20 hrs)
    • tx panic attack, alcohol w/d
  32. Temazepam (Restoril)
    • Intermediate acting (10-20 hrs)
    • tx insomnia
  33. Triazolam (Halcion)
    • Rapid onset (3-8 hrs)
    • tx insomnia
  34. Zolpidem (Ambien)/ Zaleplon (Sonata)
    • 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
  35. Buspirone (BuSpar)
    • 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
  36. Propranolol
    Tx= autonomic effects of panic attacks or performance anxiety (palpitations, tachy, sweating), akathisia
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psych pharm 2
psych pharm