T45 antipsychotics & mood stabilizers

schizophrenia - symptoms

positive symptoms (delusion, hallucination),

negative symptoms (withdrawal, loss of motiation),

cognitive deficits

positive symptoms of schizophrenia - caused by

increased DA in mesolimbic

first generation antipsychotics - mechanism

lower DA in all pathways

first gen antipsychotics - effect on symptoms

decrease positive symptoms, worsen all other pathways

inhibit D2 at nigrostriatal pathway - causes…

parkinsonism (EPS)

inhibit D2 at tuberoinfundibular pathway - causes…

hyperprolactinemia

haloperidol - drug class

1st gen antipsychotic

haloperidol - benefits

less side effects compared to other 1st gen antipsychotics, high affinity to D2 receptor

haloperidol - ADRs

EPS, hyperprolactinemia

second gen antipsychotics - mechanism

inhibit D2, inhibit 5-HT_2A → increase DA

second gen antipscyhotics - effect on symptoms

decrease positive symptoms, decrease negative symptoms, decrease EPS, decrease prolactin

risperidone - drug class

second gen antipsychotics

risperidone - benefits

higher affinity to D2 than other 2nd gen antipsychotics

risperidone - ADRs

EPS & hyperprolactinemia (but less severe than 1st gen)

quetiapine - drug class

2nd gen antipsychotics

quetiapine - contraindication

CVS disease

quetiapine - ADRs

QT prolongation, arrhythmia

clozapine - drug class

2nd gen antipsychotics

clozapine - benefits

effective in refractory psychosis (anti-psychotic resistance)

clozapine - ADRs

agranulocytosis (very low WBC)

what should be the side effect of concern for 2nd gen antipsychotics

metabolic syndrome

SSRIs - examples

fluoxetine, sertraline

SSRIs - used for what

depression, anxiety

SSRIs - side effect

diarrhea, erectile dysfunction, headache (most common)

amitriptyline - drug class

tricyclic antidepressants (TCAs)

TCAs - contraindication

CVS disease

TCAs - ADRs

anticholinergic side effects, orthostatic hypotension, sedation, weight gain

TCA overdose - use what to treat

sodium bicarbonate

TCAs - fatal side effect

epilepsy (seizure)

lithium - clinical use

bipolar disorder

lithium - advantage

effective against manic & depressive symptoms

lithium - limitation

narrow therapeutic range (easily get lithium toxicity)

lithium - ADRs

teratogenic, tremor, weight gain

valproate - clinical uses

epilepsy, neuropathic pain, migraine

valproate - ADRs

liver toxicity, teratogenic, weight gain