what are the low potency antipsychotics? side effects?
chloropromazine, thioridazine -cheating thieves are low…..non neurologic side effects (anticholinergic, antihistamine and alpha 1 blockade effects)
what is the toxicity of antipsychotics?
highly lipid soluble, and stored in body fat; thus very slow to be removed from the body, extrapyramidal system side effects: dyskinesias, endocrine side effects: dopamine receptor antagonism—hyperprolactinemia: galactorrhea, side effects from blocking muscarinic receptors; hypotension, and dry mouth, and sedation.
NMS, tardive dyskinesia
evolution of EPS side effects:
4 hr of acute dystonia (muscle spasm, stiffness, oculogyric crisis) 4 day akathisia (restlessness) 4 wk bradykinesia (parkinsonism) 4 mo tardive dyskinesia
what is neuroleptic malignant syndrome-and what drug is this associated with? Treatment:
it’s ATYPICAL for OLd CLOSets to QUIETly RISPER from A to Z
mechanism of atypical antipsychotics…
not understood…varied effects on 5ht2, dopamine and alpha and H1 receptors
clinical use of atypical antipsychotics
schizophrenia-both positive and negative symptoms: also used for bipolar disorder, ocd, anxiety disorder, depression, mania, tourette’s syndrome
what are the toxicities for atypical antipsychotics?
fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics…..olazapine, clozapoine may cause significant eight gain…clozapine may cause agranulocytosis…requires weekly wbc monitoring and sezure ziprasidone may prolong the QT interval
olanzapine/clozapine may cause significant:
clozapine may cause
agranulocytosis -rqrs weekly wbc monitoring and seizure
may prolong the QT interval
not established, possibly related to inhibition of phosphoinositol cascade
clinical use of lithium
mood stabilizer for bipolar disorder-blocks relapse and acute manic events…also for SIADH
Toxicity of Lithium-what do teratogenic effects include:and mnemonic:
tremor, sedation, edema, heart block, polyuria…ADH antagonist-causing nephrogenic diabetes insipidus, TERATOGENIC…cardiac defects-ebstein anomaly and malformaltion of the great vessels… LMNOP-lithium side effects: movement (tremor), nephrogenic diabetes insipid us, hypothyroidism, pregnancy problems.
what rqrs close monitoring of serum levels of lithium…
narrow therapeutic window.
lithium is almost exclusively excreted by:___ where?
the kidneys-most is reabsorbed at the proximal convoluted tubule following Na reabsorption
buspirone: used in:
used in generalized anxiety disorder….
buspirone MOA: mnemonic
stimulates 5HT1a receptors: I’m always anxious if the BUS will be ON time, so I take BUSpirONe
how long does it take for buspirone to take effect? doesn’t cause what? takes ____ weeks to take effeect? does it interact w/alcohol compared to __
1-2 weeks for it to take effect…does not cause sedation, addiction, or tolerance. does not interact with alcohol-vs barbiturates and benzodiazepines
Fewer than TCAs-Gi distress, SEXUAL DYSFUNCTION-anorgasmia and decreased libido. Serotonin synddrome: with any drug that increases serotonin (MAOIs, SNRIs, TCAs): hyperthermia, confusion, myoclonus, cardiovascular collapse..flushing, diarrhea, seizures….tx of it: 5HT2 receptor antagonist: (octreotide)
So generalized anxiety disorder can be tx w/
Busiprone and SSRIs, SNRIs
inhibit serotoinin and NE uptake
Clinical use of SNRIs…duloxetine is also indicated for. which SNRI has a greater effect on NE
Depression….Venlafax-also used in generalized anxiety disorder and panic disorders….Duloxetine=also indicated for diabetic peripheral neuropathy…Duloxetine=greater effect on NE
all end in -iptyline and -ipramine except doxepin and amoxapine
Block reuptake of NE and serotonin
clinical use of tCAs…bedwetting, OCD drugs
Major depression, bedwetting (imipramine), OCD (clomipramine) fibromyalgia
Toxicity of TCAs…which ones to use in elderly, which one for ppl with seizures…how to tx some of the tox?
alpha 1 blocking effects like hypotension, and dry mouth, urinary retention…amitryp(3rd degree) have more anticholin effects than 2ndary-nortriptyline…despiramine=less sedating-and higher sezure threshold…TRI-C’s=convulsions, coma, cardiotoxicity….also resp depression and hyperpyrexia…confusion and hallucinations in elderly due to tricyclic effecs-use nortryptyline in elderly. use NaHCO3 for cardio tx
MAO Inhibitors (MAOIs)
MAO Takes Pride In Shanghai Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline(selective MAO B inhibitor)
MAOI-selective MAOB inhibitor
MOA of MAOIs
nonselective MAO inhibition increases levelsof amine neurotransmitters-NE, serotonin, dopoamine
Clicical use of MAOIs
atypical depression, anxiety, hypochondriasis..
Toxicity of MAOIs–a lot due to ingestion of:
Hyperensive crisis-MOST NOTABLY WITH ingestion of TYRAMINE-which is found in many foods such as wine and cheese….CNS stimulation, contraindicated with SSRIs, TCAs, St. John’s Wort, Meperidine, and dextromethophan-(to prevent serotonin syndrome)
buproprion, Mirtazapine, Maprotilline, Trazadone
Buproprion: MOA, type of drug, side effects…be careful w/giving to which type of ppl
Used for smoking cessation…increases Norepinephrine and dopamine via unknown mechanism..atypical antidepressant…tox=stimulant effects=tachycardia, insomnia) also headache, seizure in Bulimic pts…no sexual side effects.
Mirtazapine. Type of drug, moa, toxicity
alpha 2 antagonist (increases the release of NE and serotonin), and potent 5Ht2 and 5HT3 receptor antagonist. this drug is an atypical antidepressant, and it’s toxic effects: sedation (may be desired in depressed pts w/insomnia), increased appetite and weight gain-may be good in elderly or anorexic, and dry mouth
Maprotilline: type of drug and MOA, tox
Blocks NE reuptake. Toxicity : sedation, orthostatic hypotension. This drug is an atypical antidepressant
Trazodone-type of drug, Moa, used mostly for___ toxicity….male side effects:
atypical antidepressant. Primarily inhibits serotonin reuptake. used primarily for insomnia, as high doses are nedded for antidepressant effects…toxicity: sedation, nausea, priapism, postural hypotension…called trazoBONE to ue to male specific side effects 🙂