Behavioral Medicine Pharmacology
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| TYPICAL antipsychotics | Haloperidol (Haldol); Fluphenazine (Prolixin); Perphenazine (Trilafon); Thioridazine (Mellaril); Chlorpromazine (Thorazine
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| ATYPICAL antipsychotics | Clozapine (Clozaril); Olanzapine (Zyprexa); Risperidone (Risperdal); Quetiapine (Seroquel); Ziprasidone (Geodon); Aripiprazole (Abilify)
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| Choice of antipsychotic for: First episode | Atypicals
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| Choice of antipsychotic for: Noncompliance | Long-acting medications
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| Choice of antipsychotic for: Aggression | Clozapine; High potency typical; Olanzapine and quetiapine
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| Choice of antipsychotic for: Insomnia | Olanzapine, quetiapine; Low potency typicals
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| Choice of antipsychotic for: Dysphoria | Atypicals
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| Choice of antipsychotic for: Suicidal Behavior | Atypicals
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| Choice of antipsychotic for: Substance Abuse | Aypticals
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| Choice of antipsychotic for: Cognitive problems | Aypticals
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| Choice of antipsychotic for: Compulsive water drinking | Clozapine
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| Sufficient trial w/typical / atypical antipsychotics = | 4-6 weeks
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| Antipsychotics: tx length: first episode | 12 months following sx remission
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| Antipsychotics: tx length: multiple episodes | 5 yrs following sx remission
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| Antipsychotics: relapse prevention | slow taper (3-9 mo); 20% relapse rate after 1 yr of tx; 50% rate within 6 mo post-d/c of tx
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| Antipsychotic tx resistance = | 3 different antipsychotic meds from 2 different classes; hx of poor social functioning
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| Only antipsychotic to show improvement in well defined treatment resistance: | clozapine
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| Monitoring for clozapine | Due to risk of low WBCs; monitor qwk for 6 mo, q2wks for 6 mo, q4wk for life; greatest risk first 6 mo
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| Only true atypical antipsychotic: | clozapine
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| Akathisia is an AE of all antipsychotics except: | clozapine
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| Cardinal sx of pseudoparkinsonism | Akinesia, bradykinesia; Pill rolling tremor; Cogwheel rigidity; Shuffling gait; Masked facies
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| Dystonia risk factors | Young males; High potency agents; High doses; Previous dystonia
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| Definition of dystonia | Mx spasms (jaw, tongue, neck)
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| Definition of neuroleptic malignant syndrome (NMS) | Autonomic instability; Mx rigidity; Altered consciousness; High temp; Myoglobinuria
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| Definition of akathisia | Subjective restlessness; Objective inability to be still
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| Definition of tardive dyskinesia | Buccolingual movements (Fly catchers tongue; Puckering); facial movements (grimacing, chewing); Truncal movements (rocking, gyrating); upper / lower extremities (irregular purposeless movements, foot tapping)
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| Tx for tardive dyskinesia | switch to atypical
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| Treatment for akathisia | Start at low dose; Decrease dose; Switch to an atypical; anticholinergics are ineffective
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| Main feature of atypicals is: | diminished EPS and prolactin levels
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| Treatment for pseudoparkinsonism | anticholinergics
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| Risk factors for tardive dyskinesia | High doses; Long length of tx; Cumulative tx; Increased age; Organic mental disorder; DM; Mood disorder; Female
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| NMS mortality = | 10-20%
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| Antipsychotic tx algorithm | Trial of SGA; trial of other SGA; [trial of single agent (FGA or new SGA) OR clozapine]; clozapine plus (FGA, SGA, or ECT); trial of single agent (FGA or new SGA); combo tx
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| Antipsychotic AE | #Dystonia; akathisia; pseudoparkinsonism; tardive dyskinesia; NMS; CV (ortho hypotension, tachycardia, EKG: prolonged QT / torsades); wt gain; diabetes; hyperlipidemia; anticholinergic; sedation; seizure; GU; thermoregulation / fever; agranulocytosis
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| Phenothiazine MOA | inhibition of dopamine receptors.
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| Phenothiazine meds | Chlorpromazine (Thorazine). Fluphenazine (Prolixin). Proclorperazine (Compazine). Trifluoperazine (Stelazine). Thioridazine (Mellaril)
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| Dibenzapine meds | Clozapine. Olanzapine (Zyprexa). Quetiapine (Seroquel).
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| Lithium MOA | increased NE reuptake and serotonin receptor senstivity
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Created by:
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