Antipsychotic Rx + Antidepressants

Antipsychotic Rx + Antidepressants - ANTIPSYCHOTIC AGENTS...

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Unformatted text preview: ANTIPSYCHOTIC AGENTS DRUG MOA USE ABSORPTION/ROA EFFECTS CONTRA/ RX INTERACTIONS All older antipsychotic Rx Blocks mainly D 2 R +  1R + histamine + muscarinic + serotonin 1. Schizophrenia (major use) 2. Tx of mania 3. psychotic syndromes of schizoaffective disorder 4. Tourette’s syndrome 5. Toxic psychosis due to OD w/ CNS stimulants 6. Agitation & psychosis in Alz. Pts Use minimal effective dose and titrate up Orally admin; lipid soluble, metabolized by liver enzymes, excreted in kidneys 1. Antipsychotic effects: mesocorticol- limibic system 2. Extrapyramidal side effects: basal ganglia 3. Enhances release or prolactin: tuberoinfundibular path of hypothalamus & post. pituitary 4. Anti-emetic: CTZ ADVERSE: 1. Behavioral: sedation, somnolence, lethargy due to 5-HT blockage; confusion due to antimuscunaric effect 2. EPS (parkinsonism, akathisia, acute dystonia) TX EPS effects: anticoholinergic/anti- parkinson Rx (i.e. benztropine, diphenhydramine) 3. TARDIVE DYSKINESIA: IRREVERSIBLE (no Tx) 4. NEUROLEPTIC MALIGNANT SYNDROME: MM rigidity, akinesia, hyperthermia, hypotension, tachycardia TX: MM relaxant (i.e. Diazepam & Dantrolene, Bromocriptine) 5. Antimuscunaric: dry mouth, blurred vision, urinary retention, constipation (IN LOW POTENCY RX) 6. Weight gain 7. Hyperprolactinemia – galactorrhea- amenorrhea 8. Loss of libido, impotence, infertility OD TX: gastric lavage, symptomatic & supportive tx CONTRA/CAUTIONS: 1. Rx hypersensitivity 2. Coma/CNS depressants 3. Parkinsonism 4. Liver/kidney disease 5. Epilepsy 6. Elderly 7. Pregnancy RX INTERACTIONS: 1. Sedative-Hypnotics 2. Opioids 3. Anticholinergic Rx 4. Antihypertensive 5. Antiarrhythmics DRUG MOA USE ABSORPTION/ROA EFFECTS CONTRA/ RX INTERACTIONS 9. Allergic rxns Phenothiazines Chloropromazine (aliphatic SC) Blocks D2R + Antiemetic for postoperative N/v or cancer chemotherapy PROTOYPE; parental admin available 1. + Sympathoplegic effects: orthostatic hypotension, inhibition of ejaculation 2. OCULAR PIGMENTATION + Contraindicated in pts w/ bone marrow depression & blood dyscrasias Thioridazine (Piperidine SC) Potent muscarnic blocking effect 1. + CV effect: causes cardiac arrhythmias 2. ↓ EPS effects, but ↑ sedation & hypotension 3. PIGMENTARY RETINOPATHY 4. VENTRICULAR ARRHYTHMIA sudden death w/ OD Fluphenazine (Piperaqzine SC) High potency; parental admin available 1. ↑ EPS effects, but ↓ sedation & hypotension 2. Neuroleptic malignant syndrome 2....
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Antipsychotic Rx + Antidepressants - ANTIPSYCHOTIC AGENTS...

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