chapter 13 - antipsychotic and antianxiety drugs

What is the mechanism of action for the typical antipsychotics drug class?

primarily block dopamine (D2) receptors

What are the drug indications for the typical antipsychotics drugs class?

• Schizophrenia

• psychotic conditions

What are the contraindications for the typical antipsychotics drug class?

• pregnancy (avoid if possible)

What are the adverse effects for the typical antipsychotics drug class?

• extrapyramidal syndrome (movement disorders)

• dystonic reactions

• akathisia

• parkinsonism

• tardive dyskinesia

• neuroleptic malignant syndrome (potentially fatal)

• dry mouth

• sedation

• constipation

• visual disturbances

What are the drug interactions for the typical antipsychotics drug class?

• CNS depressants and alcohol

• anticholinergic drugs

• alpha-blocking drugs

• glaucoma, prostate hypertrophy, urinary and intestinal obstruction (use with caution due to anticholinergic properties)

What are the drug subclasses under the typical antipsychotics drug class?

• phenothiazines

• butyrophenones

• thioxanthenes

What are the drugs in the phenothiazines drug subclass?

• chlorpromazine

• fluphenazine

• thioridazine

• trifluoperazine

What are the details for the drugs in the phenothiazines drug subclass? (chlorpromazine, fluphenazine, thioridazine, trifluoperazine)

• drug indication: nausea, vomiting, pruritus, certain allergic reactions

• adverse affects: postural hypotension

• unique features: also have anticholinergic, antihistaminic, alpha-adrenergic-blocking and antiemetic effects, strength of peripheral effects vary based on drug

• ROA: PO, IM, IV, SC (drug dependent)

What are the drugs in the butyrophenones drug subclass?

• haloperidol (Haldol)

What are the details for the drugs in the butyrophenones drug subclass? (haloperidol (Haldol))

• drug indications: highly agitated and manic patients Tourette’s syndrome (suppress tics and vocalizations)

• adverse effects: ***highest incidence of EPS

• unique features: high potency, lower incidence of peripheral effects

• ROA: PO, IM

What are the drugs in the thioxanthenes drug subclass?

• thiothixene

What are the details for the drugs in the thioxanthenes drug subclass? (thiothixene)

• adverse effects: postural hypotension, drowsiness, ***higher incidence of EPS

• unique features: high potency, less sedation, anticholinergic, and alpha-blocking effects than chlorpromazine

• ROA: PO, IM

What is the mechanism of action for the atypical antipsychotics drug class?

affect and reduce activity of serotonin (5HT2A) receptors (more than D2 receptors)

What are the drug indications for the atypical antipsychotics drug class?

• schizophrenia

• psychotic conditions

What are the contraindications for the atypical antipsychotics drug class?

• pregnancy (avoid if possible)

• glaucoma

• prostate hypertrophy

• urinary and intestinal obstruction (use with caution due to anticholinergic properties)

What are the adverse effects for the atypical antipsychotics drug class?

• weight gain

• elevated triglycerides

• development of diabetes mellitus

• ***less incidence compared to typical antipsychotics but still possible

  • extrapyramidal syndrome (movement disorders)

    • dystonic reactions

    • akathisia

    • parkinsonism

  • tardive dyskinesia

  • neuroleptic malignant syndrome

What are the drug interactions for the atypical antipsychotics drug class?

• CNS depressants and alcohol

• anticholinergic drugs

• alpha-blocking drugs

What are the drugs in the atypical antipsychotics drug class?

• aripiprazole (Abilify)

• clozapine

• risperidone

• olanzapine

What are the details for aripiprazole (Abilify)?

• adverse effects: dizziness, headache, constipation, anxiety, sleep disturbances, decreased sweating, increased body temperature and fever

• unique features: affects many DA and 5HT receptors, high potency, low incidence of EPS, sedation, autonomic and metabolic disturbances

• ROA: PO, IM

What are the details for clozapine?

• adverse effects: sedation, seizures, weight gain, agranuolcytosis (increased infections), anticholinergic effects, postural hypotension

• unique features: high incidence of adverse effects makes other atypical drugs preferred

• ROA: PO

What are the details for risperidone?

• adverse effects: mild sedation

• unique features: high potency, low incidence of EPS, but risk increases with dose

• ROA: PO, IM, SC

What are the details for olanzapine?

• drug indication: acute mania and bipolar disorder

• adverse effects: dizziness, sedation, weight gain, postural hypotension

• ROA: PO, IM

What are the drug subclasses for the antianxiety (anxiolytics) drug class?

• benzodiazepines

• miscellaneous

What is the mechanism of action for the benzodiazepines drug subclass?

bind to receptor on chloride channel and increase GABA activity by increasing frequency of channel opening, this results in hyperpolarization and reduced neuronal activity

What are the drug indications for the benzodiazepines drug subclass?

• anxiety

What are the contraindications for the benzodiazepines drug subclass?

• pregnancy (avoid benzodiazepines for anxiety)

What are the drugs in the benzodiazepines drug subclass of antianxiety drugs?

• lorazepam (Ativan)

• diazepam (Valium)

• alprazolam (Xanax)

• clonazepam (Klonopin)

What are the details for lorazepam (Ativan)?

• drug indications: sedation, anticonvulsant

• unique features: short-acting

• schedule IV

• ROA: PO, IV, IM

What are the details for diazepam (Valium)?

• drug indications: pre-op medication, alcohol withdrawal, anticonvulsant, muscle relaxant

• unique features: long-acting

• schedule IV

• ROA: PO, IV, IM

What are the details for alprazolam (Xanax)?

• drug indications: panic disorder, sedation

• unique features: short-acting

• schedule IV

• ROA: PO

What are the details for clonazepam (Klonopin)?

• drug indications: anticonvulsant

• unique features: long-acting

• schedule IV

• ROA: PO, IV, IM

What is the mechanism of action for the miscellaneous drug subclass of the antianxiety drugs (anxiolytics) drug class?

unknown: thought to act on serotonin receptors

What are the drug indications for the miscellaneous drug subclass of the antianxiety drugs (anxiolytics) drug class?

• generalized anxiety disorder

What are the adverse affects for the miscellaneous drug subclass of the antianxiety drugs (anxiolytics) drug class?

• dizziness

• lightheadedness

• rash

• tiredness

What are the drugs in the miscellaneous drug subclass of the antianxiety drugs (anxiolytics) drug class?

• buspirone (BuSpar)

What are the details for the drug buspirone (BuSpar)?

• unique features: often administered 2-3 times a day

• ROA: PO