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TERMS TO LEARN

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Akathisia An inner sense of restlessness.
Delirium Tremens (DTs) Autonomic instability, hallucinations, tremor, hypertension, tachycardia, and risk of seizures associated with cessation of alcohol ingestion.
Dyskinesias Abnormal involuntary movement.
Dystonia Muscle spasm, stiffness.
Extrapyramidal Syndrome (EPS)

Parkinson-like syndrome, akathisias, and dystonias.

Evolution appears as follows:

  • Acute dystonia develops over hours

  • Akinesia develops over days

  • Akathisia develops over weeks

  • Tardive dyskinesia develops over months

Neuroleptic Malignant Syndrome (NMS) Characterized by muscular rigidity, fever, and autonomic instability; associated with the use of neuroleptic medications (eg, haloperidol).
Obsessive Compulsive Disorder (OCD) Anxiety disorder that is characterized by recurrent, unwanted, intrusive thoughts and/or behaviors.
Posttraumatic Stress Disorder (PTSD) Anxiety disorder that develops after exposure to one or more traumatic events. Symptoms include flashbacks, nightmares, hypervigilence.
Premenstrual Dysphoric Disorder (PMDD) Severe form of premenstrual syndrome characterized by depression symptoms, irritability, and tension before menstruation. Occurs in 3–8% of women.
Seasonal Affective Disorder (SAD) Type of depression that seems to affect a person at a certain time of the year. It is more common in the late fall and winter months but can be at other times of the year.
Serotonin Syndrome Caused by overactivation of central 5-HT receptors; symptoms include abdominal pain, diarrhea, sweating, fever, tachycardia, hypertension, delirium, myoclonus; can induce cardiovascular shock and death.
Tardive Dyskinesia (TD) Irreversible syndrome of involuntary choreoathetoid movements associated with chronic use of neuroleptic medications; typically involves mouth, face, limbs, and trunk.
Toxic Epidermal Necrolysis (TENS) Potentially life threatening rare dermatologic reaction, widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes. Usually a drug reaction however, can have other etiologies such as infection or malignancy.
Trigeminal Neuralgia Sharp, stabbing pain that occurs in one or more divisions of the trigeminal nerve.
Wernicke-Korsakoff Syndrome Neurologic disorder caused by thiamine deficiency; often seen in chronic alcoholic patients; symptoms include confusion, ataxia, and memory impairment.

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I. ANTIPSYCHOTICS

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CLASSIFICATION OF ANTIPSYCHOTICS

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TYPICAL ANTIPSYCHOTICS

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Drug Pharmacokinetics Mechanism of Action Clinical Uses Drawbacks and Side Effects
Phenothiazines
Chlorpromazine (Thorazine) A: IM, IV, PO

D: Widely distributed, crosses BBB

M: Hepatic (P450)

E: Parent drugs and metabolites excreted in urine > feces

  • Blocks dopamine D2 post synaptic receptor

Low
  • Intractable hiccups

  • Nausea and vomiting

  • Schizophrenia/psychotic features associated with mental illnesses

  • QT prolongation (esp Thioridazine)

  • NMS

  • TD

  • EPS

  • Increased risk of death in elderly patients with dementia-related psychosis with all typical antipsychotics

  • Inhibits P450 enzymes (except Trifluoperazine and Loxapine)

Thioridazine (Mellaril) A: PO Low
  • Schizophrenia/psychotic features associated with mental illnesses

Fluphenazine (Prolixin, Permitil) A: IM, PO, SC High
  • Schizophrenia/psychotic features associated with mental illnesses

Trifluoperazine (Stelazine) A: PO High
  • Schizophrenia/psychotic features associated with mental illnesses

  • Nonpsychotic anxiety

Perphenazine A: PO High
  • Schizophrenia

  • Nausea ...

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