PHARMACOLOGY 05/14/2023

UNIT VI (MENTAL AND BEHAVIORAL HEALTH DRUGS) Atypical (second-generation antipsychotics)

- treatment for both positive and negative symptoms

OUTLINE: - Make up the second category of antipsychotics
- Effective for treating schizophrenia and other psychotic
Antipsychotics and Anxiolytics disorders in patients who do not respond to or are intolerant of
Antidepressants and Mood stabilizers typical antipsychotics
- Two advantages:
1. Effective in treating negative symptoms
2. Unlikely to cause symptoms of EPS, including tardive
From moods and emotions flow the various thoughts and actions of individuals, which are dyskinesia
communicated throughout the central nervous system (CNS) by chemical - Clozapine
neurotransmitters. - Risperidone
- Olanzapine
ANTIPSYCHOTICS AND ANXIOLYTICS - Aripiprazole
Pharmacophysiologic mechanisms of action
OUTLINE:
● Antipsychotics block the actions of dopamine = dopaminergic antagonists
Psychosis ● There are 5 subtypes of dopamine receptors numbered D1 - D5
Antipsychotic Agents ● All antipsychotics block D2 (Dopaminergic) receptors which promotes the
Anxiolytics presence of EPS, resulting in drug-induced pseudoparkinsonism in varying
degrees.
PSYCHOSIS ● Atypical antipsychotics - weak affinity to D2 receptors and Stronger affinity to D4
receptors, they block the serotonin receptor
- Loss of contact with reality, is manifested in a variety of mental or ● Atypical = cause fewer EPS than the typical (Phenothiazine) antipsychotic agents
psychiatric disorders

SYMPTOMS INCLUDES: usually characterized by more than one symptom, such as

Adverse reaction
difficulty in processing information, disorganized thoughts, distortion of reality, delusions,
hallucinations, incoherence, catatonia, and aggressive or violent behavior. Extrapyramidal Syndrome
SCHIZOPHRENIA 1. Pseudoparkinsonism (Major Side effect)
- Resembles symptoms of parkinsonism
- Chronic Psychotic disorder, and the major category of psychosis in which - Patients that take high potency typical antipsychotics (chlorpromazine)
many of these symptoms are seen.
- Major category of psychosis Symptoms are usually develop in adolescence or = Not likely to have symptoms
early childhood
SYMPTOMS:

3 GROUPS OF SYMPTOMS IN SCHIZOPRENIA ● Shuffling gait

● Pill Rolling Motions of the hands
 COGNITIVE SYMTOMS - characterized by disorganized thinking, ● Bradykinesia
memory difficulty, and decreased ability to focus attention ● Stooped posture
 POSITIVE SYMPTOMS - exaggeration of normal function (e.g., ● Masklike facies
agitation), incoherent speech, hallucinations, delusions, and paranoia. ● Rigidity
 NEGATIVE SYMPTOMS - a decrease or loss in function and ● Tremors at rest
motivation. Chronic and persistent
Treatment
Traditional group of antipsychotics (First-generation antipsychotics) for positive treatment
● Anticholinergic drugs
Atypical (second-generation anti[psychotics) For treatment of both negative and positive

ANTIPSYCHOTICS / DOPAMINE ANTAGONISTS

2. Acute Dystonia
- Compose the largest group of drugs used to treat mental illness. Specifically, these - Occur in 5% of patients within days of taking typical antipsychotics
drugs improve the thought processes and behavior of patients with psychotic Symptoms
symptoms, especially those with schizophrenia and other psychotic disorders.
● Muscle spasms of the face, tongue, neck, and back
ANTIPSYCHOTICS- Also known as neuroleptics or psychotropics-, Antipsychotics ● Facial grimacing
or neuroleptics are preferred names ● Abnormal or involuntary upward movement
NEUROLEPTIC - any drug that modifies psychotic behavior and exerts an antipsychotic ● Laryngeal spasms (Can impair respiration)
effect
Treatment
Anxiolytics
Anticholinergic antiparkinson drugs
- Also called as antianxiety drugs or sedative-hypnotics
● Benztropine
The fundamental symptoms, which are virtually present through all the course of the ● Benzodiazepine
disorder, are also known as the famous Bleuler's four A's: ● Lorazepam (may also be prescribed)
Akathisia
Alogia, Autism, Ambivalence, and Affect blunting.
- Occurs in approximately 20% of patients who take antipsychotic drug
Antipsychotics - These drugs improve the thought process and behavior of patients with
psychotic symptoms, especially those with schizophrenia and other psychotic disordersTwo Symptoms
categories:
● Trouble standing still
· Typical (first-generation antipsychotics) ● Restless
● Paces the floor
- conventional, or traditional group of antipsychotics ● In constant motion (feet rocking back and forth)
- helpful for managing positive symptoms Treatment
- Phenothiazines
Nonphenothiazines ● Benzodiazepine (lorazepam or beta blocker such as propranolol)

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 PHARMACOLOGY 05/14/2023

Tardive Dyskinesia Withdrawal Symptoms (due to abrupt DC): agitation, nervousness, insomnia, tremor

- Serious adverse reaction that occurs in approximately 20%-30% of Treatment for Benzodiazepines Overdose
patients who have taken a typical antipsychotic drug for more than 1 year
1. Emetic and follow with activated charcoal (if conscious)
2. gastric lavage if unconscious.
3. Benzodiazepine antagonist flumazenil IV
Symptoms
4. Airway, Oxygen, RR
● Protrusion and rolling of the tongue 5. IV vasopressors - severe hypotension
● Sucking and smacking movements of the lips 6. Mental health consultation for the patient
● Chewing motion Avoid:
● Involuntary movement of the body and extremities
● Facial dyskinesia ● Alcohol/CNS depressants - respiratory depression
- Reactions are more frequent and severe in older adults and high ● Tobacco, caffeine, sympathomimetics - decreased effectiveness
prevalence in cigarette smokers
Treatment
● Benzodiazepines, calcium channel blockers, and beta blockers are
sometimes helpful, although no agent is effective for all patients
● High doses of vitamin E
● Clozapine
Phenothiazines

● acid (GABA), an inhibitory neurotransmitter within the CNS, fewer side effects
and may be less dangerous in overdosing
● Long- term use of barbiturates = drug tolerance and dependence, respiratory
distress

Anxiety

There are two types of anxiety—primary and secondary.

• Primary anxiety is not caused by a medical condition or by drug use;

• Secondary anxiety is related to selected drug use or medical or psychiatric disorders.

● Anxiolytics are not usually given for secondary anxiety unless the medical
problem is untreatable, severe, and causes disability.
● Anxiolytic could be given for a short period to alleviate any acute anxiety attacks.
● Chlorpromazine hydrochloride was the first phenothiazine introduced for
treating psychotic behavior in patients in psychiatric hospitals.
Example: Chlorpromazine hydrochloride, Fluphenazine, Thioridazine

Non-phenothiazine

● Butyrophenone - haloperidol
○ Haloperidol’s behavior is similar to that of phenothiazines.
○ Potent antipsychotic drug in which the equivalent prescribed dose is
smaller than that of drugs of lower potency, Chlorpromazine.
○ Drug dose of Haloperidol is 0.5-5 mg; drug dose of chlorpromazine is
10-25 mg.
○ Administration for haloperidol is slow release via injection every 2-4
weeks.
○ Administration precautions should be taken to prevent soreness and
inflammation at the injection site.
○ Injection site should not be massaged, and sites should be rotated.
Drug interactions

● Atropine counteracts EPS and potentiates antipsychotic effects.

Antipsychotic Dosage for Older Adults

● Older adults usually require smaller doses of antipsychotics - from 25% to 50%
less than young and middle age.
Anxiolytics

● Also known as antianxiety drugs, primarily used to treat anxiety and insomnia.
● Benzodiazepines is the major anxiolytic group, considered more effective than
barbiturates, because they enhance the action of gamma-aminobutyric
Miscellaneous Anxiolytics
● The anxiolytic buspirone hydrochloride binds to serotonin and dopamine
receptors.
● Effective until 1 to 2 weeks after continuous use.
● NOTE: Buspirone has an interaction with grapefruit juice that may lead to
toxicity.
● To avoid this interaction = Limit intake of grapefruit juice

Drug tapering - avoid unwanted withdrawal symptoms

Examples: Chlordiazepoxide, Diazepam, clorazepate dipotassium, lorazepam

Alprazolam.

Side EFFECTS; sedation, dizziness, incontinence, constipation

Adverse Reaction: leukopenia, drug tolerance dependence

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