1. Phenothiazines
    • chlorpromazine
    • fluphenazine
    • thioridazine
  2. Thiozanthenes
  3. Butyrophenones
  4. atypicals
    • clozapine
    • olanzapine
    • riperidone
  5. antiemetics
    • promethazine
    • prochlorperazine
  6. Positive symptoms of schizophrenia:
    • hallucinations
    • false ideas/beliefs (delusions)
    • paranoid delusions
    • mood disturbances
    • confusion and suicidal thoughts
  7. Negative symptoms of schizophrenia
    • loss of normal function
    • social withdrawal
    • reduced speech and thought
    • Loss of energy and inability to exp mental or physical pleasure
  8. Etiology of schizophrenia:
    • Biochemical abnormality: inc. # of DA rec
    • Structural abnormalities: enlarged ventricles, atrophy of cortical layers, reduced volume of the basal ganglia
    • Functional abnormalities: reduced cerebral blood flow, reduced glucose utilization in prefrontal cortex
    • Genetic abnormalities: genetic predisposition, involvement of multiple genes
  9. Therapeutic goals of antipsychotic drugs
    prevention of self-inflicted harm or harm to others, provide the pt's basic needs, improve quality of life
  10. Drugs to tx schizophrenia
    • primarily block the response to inc/abnormal NT levels
    • does not cure and/or eliminate disorder but dec the intesity of hallucinations and delusions
    • control + symptoms; no direct control of - symptoms
    • Non-compliance major reason for therapeutic failure
  11. Dopamine hypothesis for schizophrenia
    Drugs that are efficacious in tx of schizophrenia block DA recand drug efficacy correlates best to D2 rec binding
  12. Antipsychotics: Efficacy and Metabolism
    • provide symptomatic relief in 70% of pt
    • sig dely of 4-8 weeks in onset of action
    • met by liver
    • Fluphenazine, haloperidol, resperidone: slow release formula - give IM for noncompliant pt
    • Some tolerance, little dependence
  13. Antipsychotics: side effects
    • Cholinergic Muscarinic Rec Block (chlorpromazine, thioridazine) = dry mouth, urinary retention, memory impairment, blurred vision, constipation and confusion
    • Alpha-Adrenorec Block (chlorpromazine) - orthostatic hypotension & light headedness, reflex tachycardia, sexual dysfunction
    • Pituitary D2 Rec Block (All, mostly haloperidol) = inc in prolactin release --infertility and impotence
    • H1-his Rec Block (chlorpromazine and clozapine) = sedation and weight gain
    • Neuroleptic Malignant syndrom = collapse of ANS, fever, diaphoresis, CV instability -*immediate tx:bromocriptine (DA ag)
    • Emetic Effects: nausea and vomiting
  14. Antipsychotics: Central side effects
    • Striatal DA rec block: Parkinsonian effects (bradykinesia, tremor, m. rigidity), dystonias (neck and facial spasms)
    • DA rec upreg/supersensitivity: occurs after sev mo to yrs, tardive dyskinesias (invol oral-facial movements) which are irrev or slowly rev
  15. Antipsychotics: interactions and adverse effects
    • Induction of sev hepatic drug met enzymes: inc drug met
    • Potentiation of CNS dep effects: analgesics, gen anesthetics and CNS dep
    • Blockage of the therapeutic efficacy of L-DOPA: used to tx parkinson's disease
    • Acute adverse effects only see @ very high doses: hypotension, hyper/hypo-thermia, seizures, coma, ventricular tachycardia
  16. Typical vs. Atypical
    • Typical (older): Fluphenazine, thioridazine, haloperidol = rel more selective for D2 rec + high potential for extrapyramidal effects (parkinsonism)
    • Atypical (newer): Clozapine, olanzapine, risperidone = as/more selective for 5HT than D2 rec, some are effective @ low doses, low incidence of extrapyramidal effects, no inc prolactin, high risk agranulocytosis, inc weight gain
  17. Implications to Dentistry
    • Can add to CNS dep effects of antianxiety/sedative/hypnotic drugs, anesthetics, opiod analgesics
    • secondary inf: oral candidiasis, agranulocytosis->susceptibility to infection
    • Antipsychotics: dec salivary flow, inc caries
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