Drugs schizophrenia

7/28/2019 Drugs schizophrenia

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Pharmacology


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Antipsychotics

1. Typical Antipsychotics

Dopamine antagonists

2. Atypical Antipsychotics

5-hydroxytryptamine effect, also effect

dopamine

3. Combination Drugs


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Typical Antipsychotics

Tend to produce Extrapyramidal side effects:

Parkinsonism tremors, rigidity, slowness of

movement, temporary paralysis

Dystonia involuntary muscle contractions

Akathisia inability to resist urge to move

Tardive dyskinesia involuntary movements of the

mouth, lips, and tongue Chewing, puckering, grimacing, etc


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Common Typical:

Haloperidol

Fluphenazine

Chlorpromazine

Common Atypical:

Clozapine

Risperidone

Olanzapine

Ziprasidone


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Typical - Phenothiazines

Dopamine D2 receptor antagonists

Chlorpromazine- first developed from

promethazine, first tricyclic antihistamine


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Typical- Haloperidol

Butyrophenone class

Used in 1970s almost exclusively

Treatment of acute psychotic states More active against positive psychotic

symptoms (delusions, hallucinations, etc)

No anticholinergic effects therefore used inpatients with delirium


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Atypical Antipsychotics

Atypicals do not induce EPSE

Block D2 receptors and seratonin receptors

(decreases EPSE)

As opposed to typicals, these are more loosely

bound to D2 receptors

Easier dissociation

Shown that higher occupation of D2 receptors by

drug, higher incidence of EPSE


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Improve the negative symptoms and

disorganization

Fewer EPS side effects

But can cause agranulocytosis so blood

monitoring is required


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Clozapine

First atypical (1990)

Most dangerous atypical: risk ofagranulocytosis (severe decrease in WBC

count) Most effective in reducing EPSE, also in

reducing negative symptoms

Increases Fos-positive neurons in the prefrontalcortex (shown to affect negative symptoms)


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Risperidone

blocks several of the receptors on nerves

including dopamine type 2, serotonin type 2,

and alpha 2 adrenergic receptors.

It is believed that many psychotic illnesses are

caused by abnormal communication among

nerves in the brain and that by altering

communication through neurotransmitters,risperidone can alter the psychotic state.


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Antipsychotics Side Effects

Extrapyramidal symptoms

NMS

Tarditive dyskinesia- irreversible

Anti-cholinergic effects (dry mouth, blurredvision, photophobia, tachycardia, constipation)

Orthohypertension

Sedation

Sexual dysfunction Weight gain

agranulocytosis


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Side Effects

Typical Antipsychotics

drowsiness,

shaking,

trembling,

muscle twitches, and

spasms.

Typical and Atypical

Antipsychotics

weight gain, blurred vision,

constipation,

lack of sex drive, and

dry mouth.


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EPS Treatment

Likely caused by blocking the central D2

receptors responsible for movement

Anticholinergic therapy

- Dipenhydramine (Benadryl)


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THERAPIES


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Documents

Drugs schizophrenia