Transcript Medical Care

Medical Care
Antipsychotic medications
• mainstay of treatment for schizophrenia
2 Types of Antipsychotics
• Conventional or 1st generation
– Dopamine 2 receptor antagonists
• Atypical or second generation
– Serotonin dopamine antagonists
– Block other dopamine receptors (D1 & D5) and
serotonin receptors
Conventional antipsychotics
Butyrophenones
• Haloperidol (Haldol, Serenace)
• Droperidol (Droleptan)
Thioxanthenes
• Chlorprothixene
• Flupenthixol (Depixol, Fluanxol)
• Thiothixene (Navane)
• Zuclopenthixol (Clopixol, Acuphase)
Conventional Antipsychotics
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Phenothiazines
Chlorpromazine (Thorazine, Largactil)
Fluphenazine (Prolixin)
Perphenazine (Trilafon)
Prochlorperazine (Compazine)
Thioridazine (Mellaril, Melleril)
Trifluoperazine (Stelazine)
Mesoridazine
Periciazine
Promazine
Triflupromazine (Vesprin)
Levomepromazine (Nozinan)
Promethazine (Phenergan)
Pimozide (Orap)
Conventional Antipsychotics according
to Potency
Low potency
• Chlorpromazine (Largactil, Thorazine)
• Thioridazine (Mellaril)
• Mesoridazine
Medium potency
• Loxapine (Loxapac, Loxitane)
• Molindone (Moban)
• Perphenazine (Trilifon)
• Thiothixene (Navane)
• Trifluoperazine (Stelazine)
High potency
• Haloperidol (Haldol, Serenace)
• Fluphenazine (Prolixin)
• Droperidol
• Zuclopenthixol (Clopixol)
Atypical Antipsychotics
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Clozapine
Olanzapine
Risperidone
Quetiapine
Ziprasidone
Amisulpride
Asenapine
Paliperidone
Iloperidone
Zotepine
Sertindole
Aripiprazole
Non-Neurologic Adverse Effects
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Sedation
Orthostatic Hypotension
Anticholinergic response
Endocrine effects (hyperprolactinemia)
Dermatologic effects (atopic dermatititis,
photosensitivity)
Opthalmologic effects (retinal pigmentation)
Cardiac effects (QT interval prolongation)
Weight gain
Hematologic effects (leukopenia, agranulocytosis)
Jaundice
Neurologic Adverse Effects
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Epileptogenic effects
Dystonia
Parkinsonian effects
Akathisia
Tardive dyskinesia
Neuroleptic malignant syndrome
Anticholinergic agents
• often used in conjunction with the conventional
antipsychotic agents to prevent dystonic
movements or to treat extrapyramidal symptoms
• Ex. benztropine, procyclidine, trihexyphenidyl,
diphenhydramine or amantadine
Choice of drug
• Current clinical practice favors the use of high potency
antipsychotics due to the unfavorable adverse effects
associated with low potency antipsychotics
• Combination therapy
– non-sedating high potency during daytime
– Sedating low potency at bedtime
• Extremely non-compliant patients : long-acting depot
preparations
• Emergency management of extremely agitated patient:
Haloperidol 5-10mg + Lorazepam 2 mg IM
Therapeutic drug monitoring
• Patients may not always take their medications; checking the level
can be a clue to this.
• Patients often have other medical illnesses; medicines used in these
illnesses can interact with psychotropic medications.
• Patients may not always be the best reporters of their symptoms,
and medication levels can occasionally detect clinically silent
toxicity.
• Smoking tobacco products induces the liver enzyme CYP1A2, which
metabolizes clozapine. Patients who stop smoking while being
treated with clozapine often experience an increase in their
clozapine levels. (Nicotine patches and nicotine inhalers and
chewing tobacco do not induce this enzyme.)