antipsychotic. what do antipsychotics treat? psychotic disorders (psychosis) abnormal thinking and...
TRANSCRIPT
ANTIPSYCHOTIC ANTIPSYCHOTIC
What do antipsychotics treat?
Psychotic Disorders (Psychosis) Abnormal Thinking and Perceptions Loss of Contact with Reality Delusions (false beliefs) Hallucinations
ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGS
CLINICAL USE1. Treatment of schizophrenia Reduce some of the positive symptoms
Hyperactivity Bizarre behavior Hallucinations and delusions
Facilitate functioning in both out andinpatient environments
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
CLINICAL USE1. Treatment of schizophrenia Beneficial effects may take several
weeks to develop Individual patients may respond best
to specific drugs
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
CLINICAL USE1. Treatment of schizophrenia Negative symptoms
Older drugs do not have much effect Newer atypical drugs improve some
Emotional blunting Social withdrawal
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
CLINICAL USE2. Other psychiatric and neurologic
indications Psychotic symptoms of other psychotic
disorders Tourette’s syndrome and other tic
disorders
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
CLINICAL USE2. Other psychiatric and neurologic
indications Toxic psychoses caused by overdosage
of certain CNS stimulants Alzheimer’s and Parkinsonism
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
CLINICAL USE2. Nonpsychiatric indications Antiemetic action
Phenothiazines except thioridazine Antipruritics
9
Extra Pyramidal Symptoms
EPS
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
1. Reversible neurologic effects Occurs most frequently
Haloperidol Fluphenazine Trifluoperazine
Less frequent with clozapine Less common with the newer drugs
EPS (Extra Pyramidal Symptoms)
EPS include: Acute Dystonias: happens within hours Parkinsonism: develops gradually (Days –
Weeks) Tardive Dyskinesia: chronic development Tardive Dystonia: chronic development Akathisia
Parkinsonian Syndrome Parkinsonian Syndrome
Tremors Rigidity Cogwheeling Bradykinesia
May resemble Depression: Slowing in thinking Decreased initiative Masked face
Treatment of EPS
BRAND NAME GENERIC NAME
Akineton BiperidenArtane Trihexyphenidyl
Symmetrel Amantadine1
Akathisia
Restless Pacing
Akathisia
Akathisia: Inability to sit still
A feeling of restlessness, A need to keep moving,
Difficult to differentiate from illness-related behaviors
Akathisia
Appear Anxious: May misidentify akathisia as anxiety Anxiety can aggravate akathisia
Treatment: Lowering the dosage of the medication Anticholinergics: not always effective Propranolol: 10 to 80 mg/d Clonidine: 0.1 to 0.8 mg/d
BDZ
Tardive Dyskinesia
T D
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
2. Tardive dyskinesia Choreoathetoid movements of the
muscle of the lips and buccal cavity Maybe irreversible Tend to develop after years of therapy May appear as early as 6 months
ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGS
2. Tardive dyskinesia Antimuscarinic drugs that improve
extrapyramidal effects increase theseverity of symptoms
No effective drug for treatment Switching to clozapine does not
exacerbate the condition
Neuroleptic Malignant SyndromeNMS
NMS(Neuroleptic Malignant Syndrome)
A rare but potentially fatal complication
Main clinical findings: Hyperthermia Severe muscular rigidity Autonomic instability:
Pulse/ BP/ Breathing/ Sweating Changing levels of consciousness Unstable vital signs
NMS(Neuroleptic Malignant Syndrome)
Lab tests: Creatine Phosphokinase (CPK)
Leukocytosis (increased WBC) Increased Myoglobin and Myoglobinuria
Mortality: 20 – 30 % May be higher when depot forms are
used
NMS(Neuroleptic Malignant Syndrome)
Treatments Stop the antipsychotics Supportive and symptomatic TX Medications:
Dantrolene
Bromocriptine
Amantadine
Metabolic Syndrome
Monitoring and Management
Equipment
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
3. Autonomic effects Result from blockade of peripheral
muscarinic receptors and alphaadrenoceptors
Strongest autonomic effects Thioridazine
Weakest Haloperidol
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
3. Autonomic effects Intermediate autonomic effects
Clozapine and most atypicalantipyschotics
ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGS
Autonomic effects Atropine-like effects
Dry mouth Constipation Urinary retention Visual problems Not with ziprasidone and aripiprazole
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
3. Autonomic effects Alpha receptor blockade
Postural hypotension All atypical drugs
Failure to ejaculate Phenothiazines
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
4. Endocrine Dopamine D2 receptor blockade in
the pituitary Hyperprolactinemia Gynecomastia
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
6. Sedation More marked sedation
Chlorpromazine-Clozapine-Olanzapine-Thioridazine
Less sedating among the older drugs Fluphenazine and haloperidol
Least sedating among newer drugs Aripiprazole
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
7. Miscellaneous toxicities Visual impairment due to retinal
deposits Thioridazine
At high doses, fatal ventricular arrhythmias
Thioridazine
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
TOXICITY7. Miscellaneous toxicities Arrhythmias
Ziprasidone Agranulocytosis, seizure at high doses
Clozapine
ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS
TOXICITY8. Overdosage toxicity Usually fatal Hypotension
Fluid replacement Seizures
Diazepam or phenytoin Cardiotoxicity is difficult to treat