- Schizophrenia: 3 drug classes: -zine, haloperidol & -apine -done (1st 2 typical drug classes, the phenothiazine -ZINE and the non-phenothiazine (haloperidol), both treated just the positive symptoms. -ZINE drugs cause more sedating efects. non -Zine cause more EPS motion side effects. The last 3rd drug -APINE & -DONE drugs treated both positive and negative with less DA motion side effects but more metabolic such as weight gain, diabetes side effects.)
- EPS (DYScO atTHIS PARK): dean DA thrown off from top of pyramid
blurb:
- Remember that the schizophrenia typical meds work more on the DA (trying to get the dean DA away from the library), therefore lots of their effects would be about the motions (sedating vs EPS which is a motion disorder). Also, they work on positive symptoms such as hallucinations, delusions, paranoia
- Remember that the schizophrenia atypical meds work more on the serotonin receptors, therefore not much if any motion side effects, more on the metabolic side effects. Also, they also work on negative symptoms such as low motivation and other emo.
- TYPICAL 1st generation -ZINE:
- more sedating (no motions)
- less than extrapyramidal (motions) --- too sedated to move
- work on positive symptoms only
- TYPICAL 1st generation non-phenothiazine (no -zine) (ex. haldol):
- more extrapyramidal EPS (motion)
- less sedating than the -zine family --- no more sedated, so moving
- work on positive symptoms only.
- ATYPICAL (ex. Risperidone) -APINE, -DONE (peri-DONE & si-DONE) :
- less EPS, more metabolic effects such as diabetes, weight gain, hyperlipidemia
- (but over all still fewer side effects than the typical ones--- newer better)
- also work on the negative + positive symptoms.
Diagnosis:
- Schizophreania = a type of psychosis
- Radical changes in personality
- Impaired function
- Distorted sense of objective reality
Symptoms:
- Delusion-------false beliefs or ideas strongly held in spite of invalidating evidence
- Hallucinations ---hearing, seeing or feeling things that are not actually there
- Illusions---------- erroneous, false perception of reality
- Paranoia ----------unfounded or exaggerated distrust of others
Pathophysiology:
- Genetics --- positive family history
- DA overactivity @ basal nuclei (motor)
- DA2-receptors symptoms (postsynaptic receptor)
Drug therapy principles:
- Antipsychotic agents
- Drugs compete w/ DA
- Blocks DA-2receptors => reduce schizophrenia symptoms
- No cure, just symptom management
- 1st line drug does not mean best
- drug prescribed based on adverse effects
- if d/c drugs => high rates of relapse
Drug classes:
1 - Phenothiazines (Conventional Typical Anti-Psychotic drugs)
2 - Non-phenothiazines (Conventional Typical Anti-Psychotic drugs)
3 - Atypical Anti-psychotic
Anti-psychotic side effects:
1 - EPS
2 - Tardive dyskinesia
3 - Anticholinergic effects
4 - Orthostatic hypotension
5 - EKG changes
6 - Sedation & Cognition
7 - Sexual dysfunction
8 - NMS --- usu. w/ dehydration, exhaustion & parenteral agents & organic mental disorders
9 - Agranulocytosis- Clozapine: weekly WBC monitoring
for the first 6 months of therapy is
mandated
Mnemonics: DEPTH => they can get into deep trouble if they are too rough with the dean
Dermatologic (D)
EPS (pseudo-Parkinsonism) & EKG (check baseline ekg)
Photosensitivity
Tardive dyskenisa (uncontrolled bizarre movements of face due to hypersensitivity of DA receptors)
Hypotension
Sexual dysfunction & Sedation, cognition
Their
Drug names:
1 - Phenothiazines (Conventional Typical Anti-Psychotic drugs)
- chlorpromaZINE----- Chlor-pro-ma-zine --Chlor the cyclops promising to throw the dean DA out
- trifluoperaZINE-----tri-flu-opera-zine---A terrible musician tries to play the flute and sing opera and it causes the dean to perish.
- fluphenaZINE--flu-phena-zine---Flute player made the dean DA leave the scene with his music
- thioridaZINE--Theo-rid-zine--Theo rids the scene of the dean DA
- mesoridaZINE
- perphenaZINE
-AZINE ===> Pheno-thi-AZINE => AZINE = A scene = making a scene = crazy = psychotic = schizophrenia => all of these drugs end at the scene at the library
Toxicity: sedation ----(tooo much DA thrown out)
Mnemonics: the ppl in the library get tired after too much of them spent throwing out the dean => sedation
2 - Non-phenothiazines (Conventional Typical Anti-Psychotic drugs)
- haloperidol (an angel wearing her halo & a parasol)
- thiothixene (Thighs of the thick librarian kick the dean out)
- pimozide (the Pimp kicks the dean DA out)
- loxapine (lo-xa-keeps the Dean DA far from the library)
Tox.: EPS
3 - Atypical Anti-psychotic
- clozapine---- (a clothespin that pins the dean down outside of hte library, so she can't go in and stir things up). Need weekly wbc monitoring during first 6mo.
- asenapine ---APINE (a pin such as clothespin)-Aspen-a-pin
- cariprazine---APINE (a pin such as clothespin)-Caricature-a-pin
- olanzapine ---APINE (a pin such as clothespin)-Olando-bloom-a-pin
- quetiapine---APINE (a pin such as clothespin) --Quentin-a-pin
- risperidone---(a wrestlers spears the dean and throws him out of the library)
- iloperidone---
- paliperidone
- ziprasidone
- lurasidone
- brexipiprazole----Prazole
- aripiprazole-------prazole
Improves both positive & negative ---- atypical (pin, spears) => everything improved
Less EPS than typical antipsychotics
