Antipsychotics

Description

Psicología Flowchart on Antipsychotics, created by J.J. Lopez on 27/02/2022.
J.J. Lopez
Flowchart by J.J. Lopez, updated more than 1 year ago
J.J. Lopez
Created by J.J. Lopez over 2 years ago
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Resource summary

Flowchart nodes

  • Antipsychotics
  • First Generation
  • Second Generation
  • General Information
  • Also known as Typical: Mostly blocks Dopamine Receptors (D2)
  • Also known as Atypicals
  • Blocks Dopamine and Seretonin Receptors (D2 and 5HT2A)
  • Reudce halucinations and delusions associated with Schizofrenia
  • Neurological Side Effects
  • Most 2nd Gen Meds can help with negative symtpoms (Ex. Clozapina)
  • D2 Blockers are not seletive, therefore they generate side effects
  • Mesocortical Pathway
  • Nigrostriatal Pathway
  • Tuberoinfundibular Pathway
  • Achieved by blocking D2 in the Mesolimbic Pathway
  • Negative Symptoms & Executive Functioning Deficits
  • Extrapyrimidal side effects
  • Increased Prolactin
  • Metabolic Side Effects
  • Major Adverse Effects of receptor blockades
  • D2 dopamine: Extrapyramidal Symptoms; Prolactin Increase
  • Alfa 1 norepinephrine: Postural Hypotension
  • H1 histamine: Sedation/drowsiness; weight gain
  • M1 muscarinic ACh: Memory deficits; 
  • 5HT(1B;2C) serotonin: weight gain
  • Similar Efficacy Difference in Potency
  • Pharmacokinetics 
  • Lipid soluble
  • 20-40 hour half life
  • Some metabolites can persist for months of stopping Rx
  • High Potency
  • Low Potency
  • Low or High Potency: This refers to a Rx affinity for D2 receptors. Influences adverse efects
  • Haloperidol-Haldol
  • Thiordazine
  • Chlopromazine
  • Perphenazine-Trilafon
  • Pimozide-ORAP
  • Fluphenazine
  • Loxapine
  • Prochlorperazine-COMPRO/PROCOMP
  • Will cause sedation More Anticolinergic, antiadrenergic and antihistaminic 
  • Less extrapyramidal effects​​​​
  • Less Anticolinergic, antiadrenergic and antihistaminic 
  • Less affinity for D2
  • More affinity for D2
  • More extrapyramidal effects​​​​
  • Antipsychotic Overdose: Neuroleptic Malignant Syndrome
  • -High Fever (102 to 104 F) -Muscle stiffness -Sweating a lot -Anxiety or other changes in mental state -Fast or abnormal heartbeat -Quick breathing NMS can damage muscles and cause very high or low blood pressure. If you’re not treated, you can get serious problems, like: -Kidney failure -Heart and lung failure -Lack of oxygen in the body -Infection in the lungs caused by breathing in fluid (aspiration pneumonia) More acid in the body
  • Pine
  • Done
  • Pip
  • Clozapine
  • Olanzapine-Zyprexa
  • Quetiapine-Seroquell
  • Palipiperidone-Invega
  • Ziprasidone-Geodon
  • Risperidone-Risperdal
  • Lurasidone-Latuda
  • Aripiprazole-Abilify
  • Increases flow of DA in the nigrostriatal pathway
  • Diabetes, Hypercholesterolemia, weight gain and cardiac effects
  • Less likely extrapyramidal effects​​​​
  • This is done by allowing more DA in the PFC
  • Tx: Aggression and Violence
  • Tx at different dosages using XR: (High), antidepressant (medium), hypnotic (low)
  • D2, 5HT2C, Alpha-1, H1
  • Sedation: High; Weight Gain: High; EPS: Low
  • Warning: Can supress bone marrow, cause convulsions and orthostatic hypotension
  • Tx: Psychosis from 13 y/o and up
  • High Dosage XR: Antipsychotic H1, 5HT2A, D2
  • Medium Dosage XR: Antidepressant Agonist: 5HT1A; Antagonist: 5HT7, Alpha-2, 5HT!B
  • Sedaion: Very High; Weight Gain: High: EPS: Low
  • Warning: orthostatic hypotension, increase in triglycerides and resistance to insuline
  • D2, 5HT2A, 5HT2C, H1, M3
  • Sedation: High; Weight Gain: Very High; EPS: High
  • Warning: increase in triglycerides and resistance to insuline
  • Tx: Irritability and agression in autism (5-16); psychosis
  • D2, 5HT2A, Alpha-1
  • High Dosage: Works like Tipical Antipsychotic; High EPS
  • Medium Dosage: Psychosis, Maniac Bipolar and can be used in children and adolecents
  • Sedation: medium; Weight Gain: High; EPS: Very High
  • Tx: Psychosis and Mania (13+); Irritability in autism (6-17)
  • Warning: Even in low dosages it can inhibit prolactin and make kids fat
  • D2,5HT2A, 5HT7, 5HT1A
  • Sedation: Very Low; Weight Gain: Very Low; EPS: Low
  • Tx: Psychosis patients that gained weight are out on this Rx
  • D2, 5HT2A, 5HT2C, 5HT1A, 5HT7, Alpha-2
  • Has to be taken with food
  • Can be used as tranquilizers for agitated and disruptive behavior
  • Withdrawl of Antipsychotics
  • -Vomiting -Nausea -Diarrhea -Insomnia -Restlessness -Anxiety -Agitation -Dizziness -Loss of motor control
  • Will usually show up in the first few days after abstiaining or reducing dosage
  • NOT ADDICTIVE!
  • AVOID ANFETAMINES, COCAIN AND L-DOPA!
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