antipsychotic medications
Prescription drugs that are used to reduce psychotic symptoms; frequently used in the treatment of schizophrenia; also called
... [Show More] neuroleptics.
Block dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery. Acute and chronic psychosis, schizophrenia, manic phase of bipolar disorders, Tourette's syndrome, delusional and schizoaffective disorders, dementia. Conventional (typical) or atypical.
Patient education: s/s of orthostatic hypotension - move slowly when standing up. Sedation - avoid hazardous activities such as driving until sedation wears off.
Impaires libido and erection / ejaculation
*avoid anticholinergic drugs, barbiturates, benzos and alcohol.
first generation antipsychotics
a group of medications originally developed to combat psychotic symptoms by reducing dopamine levels in the brain; also called conventional or typical antipsychotics
block receptors for dopamine, acetylcholine, histamine, and norepinephrine
Ex.
(low potency): Chlorpromazine, Thioridazine
s/e orthostatic hyposension, long Q-T syndrome, high sedation
(medium potency): loxapine, perhenazine,
s/e moderate sedation
(high potency):fluphenazine, haloperidol, pimozide, thiothoxene, frifluoperizine
s/e movement problems
second generation antipsychotics
drugs that alleviate schizophrenia with less likelihood of movement problems
S/E: are associated with metabolic adverse effects (eg. weight gain, dyslipidemia, hyperglycemia, and increased risk of diabetes). As such they should be monitored for changes. Olanzapine and clozapine carry the greatest risk.
Ex. apripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine (Zyprexa), Quetiapine (Seroquel), Risperidone,
Potency
the size of the dose needed to elicit a given response
Neuroleptic Malignant Syndrome (NMS)
A rare and sometimes fatal reaction to high-potency neuroleptic drugs. Symptoms include muscle rigidity, fever, and elevated white blood cell count. It is thought to result from dopamine blockage at the basal ganglia and hypothalamus.
Treatment: support body through withdrawal.
Chlorpromazine (Thorazine)
- Chlorpromazine is used to treat psychotic disorders such as schizophrenia or manic-depression, and severe behavioral problems in children ages 1 through 12. Chlorpromazine is also used to treat nausea and vomiting, anxiety before surgery, chronic hiccups, acute intermittent porphyria, and symptoms of tetanus.
S/E:
- This medication can cause photophobic skin reactions and damage to the retina of the eye if exposed to direct sunlight. PTs taking this should be reminded to wear protective clothing, apply sunscreen and wear sunglasses when they are outside.
sedation, orthostatic hypotension, anticholinergic effects.
Clozapine (Clozaril)
Second Generation (Atypical) Antipsychotic
low affinity to D2 dopamine receptors
treats schizophrenia and suicidal behavior. Not many EPSs.
S/E weight gain, orthostatic hypotension, sedation, cholinergic, urinary retention, constipation, tachycardia.
extrapyramidal symptoms
side effects of antipsychotic medications that affect a person's gait, movement, or posture
Usually caused by high potency first gen. antipsychotics
Also referred to as EPS
Acute Dystonia: occurs within first few days of therapy. Severe spasm of the muscles of tongue, face, neck and back.
Parkinsonism: bradykinesia, mask-like facies, drooling, tremor, rigidity, shuffling gait, stooped posture.
Akathisia: pacing and squirming, need to move uncontrollably. develops in first 2 months of treatment.
Tardive Dyskinesia: occurs with long-term therapy. Involuntary choreoathetoid movements of the tongue and face.
Haloperidol (Haldol)
An antipsychotic drug thought to block receptor sites for dopamine, making it effective in treating the delusional thinking, hallucinations and agitation commonly associated with schizophrenia.
-Preferred treatment for Tourette syndrome.
-Hepatic metabolism, excreted in urine.
-early extrapyramidal reactions occur frequently. Long Q-T .
Risperidone (Risperdal)
Antipsychotic (Atypical)
rapid-acting used for schizophrenia and acute bipolar mania.
Absorbed rapidly, not effected by food, peaks 1 hour after dosing. Excreted through urine.
S/E: increases prolactin levels but symptoms uncommon. Metabolic effects. Sedation in large doses.
Olanzapine (Zyprexa)
antipsychotic (atypical), mood stabilizer, thienobenzodiazepine
antagonizes dopamine and seratonin type 2 in the CNSalso has antocholinergic, antihistiminic, and anti alpha1 adernergic effects
decreases manifestations of psychoses
Metabolized by the liver.
Peaks in 6 hours
21-54 hour half-life
contraindicated in lactation
S/D metabolic. can cause leukopenia and neutropenia increasing risk for infection. Somnolence.
Quetiapine (Seroquel)
Antipsychotic (Atypical).
Treats: Schizophrenia, major depression, bipolar
Improves positive symptoms and lowers negative symptoms by blocking 5-HT2 receptors and D2 receptors.
CYP3A4 - hepatic metabolism and excreted in urine and feces.
S/E: metabolic effect, cataracts, long Q-T
CYP3A4
most common metabolic enzyme involved in drug interactions
Inducers: phenytoin, rifampin, barbituates, carbamazepine
Inhibitors: ketoconazole, itraconazole, fluconazole, erythromycin. if using these and taking drugs metabolized by this enzyme, levels will increase which may cause toxicity.
Aripiprazole (Abilify)
atypical antipsychotic
dopamine system stabilizers.
Treats schizophrenia, acute bipolar mania, major depressive disorder, agitation associated with psychosis and irritability associated with autism spectrum disorder.
Does not have metabolic s/e or EPSs.
Food does not effect, protein bound, metabolized by liver, long elimination.
S/E headache, agitation, nervousness, anxiety, insomnia, nausea, vomiting, dizziness, somnolence.
High suicidality
Cariprazine (Vraylar)
atypical antipsychotic
Mechanism unknown.
Similar to aripiprazole.
SSRIs (selective serotonin reuptake inhibitors)
selectively inhibits serotonin reuptake from synaptic gap and results in potentiation of serotonergic neurotransmissions.
Examples: Luvox, Paxil, Prozac, Zoloft
end in [pram], [ine]
citalopram [Celexa];
escitalopram [Lexapro];
fluoxetine [Prozac];
paroxetine [Paxil]
initial responses are seen approx. 1-3 weeks. Max responses can take up to 12 weeks. Take for at least 1 month before changing or increasing dose.
Do NOT use with MAOIs
Fluoxetine (Prozac)
Antidepressant, SSRI
Treats: Depression
(also bipolar, ocd, panic disorder, bulimia, pmdd).
S/E: sexual dysfunction in 70% of adults. Treatment for this would involve decreasing dose, drug holiday on weekends, add a drug to treat this such as bupropion, nefazodone, mirtazapine.
Weight gain and serotonin syndrome can be other side effects.
Abrupt withdrawal can cause dizziness, headaches, nauea, sensory issues, tremors, anxiety and dysphoria - should be tapered down.
Do not use in 3rd trimester
Serotonin Syndrome
With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).
Can resolve on it's own by discontinuing the drug.
SSNRIs (selective serotonin and norepinephrine reuptake inhibitors)
Block 5-HT reuptake and thereby increase 5-HT in the synapse.
Examples: Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Venlafaxine (Effexor XR), LEvomilnacipran (Fetzima).
TCAs (tricyclic antidepressants)
Inhibit serotonin and NE re-uptake (Amitrptyline, Desipramine, exepin, imipramine, and Clomipramine-OCD)
MAOIs (monoamine oxidase inhibitors)
-antidepressants that inhibit the action of an enzyme (monoamine oxidase) that is responsible for breakdown of NE and 5-HT
Ex: isocarboxizid (marplan), phenelzine (nardil), selegiline (emsam).
-can have fatal side effects (hypertensive crisis) if foods rich in amino acid TYRAMINE are consumed
-thus, not used unless other classes of medication have failed
-Depression with ATYPICAL features respond well to MAOIs
Aripiprazole (Abilify)
Antipsychotic
Aripiprazole is used to treat certain mental/mood disorders. It may also be used in combination with other medication to treat depression.
Dizziness, Lightheadedness, Drowsiness, Nausea, Vomiting, Tiredness, Excess saliva/drooling, Blurred, vision, Weight gain [Show Less]