13.01 Atypical Antipsychotics
- Two classes of Anti-psychotic medications
- Conventional (sometimes called First Generation)
- Older drugs
- Treat “positive” symptoms of schizophrenia
- Positive symptoms- Hallucinations, delusions, disorganized speech, movements disorder
- Examples- Phenothiazines and Nonpheothiazines
- Atypical (sometimes called Second Generation)
- Newer drugs
- Treat “positive” and “negative” symptoms of schizophrenia
- Negative symptoms- apathy, blunted emotional response, impaired attention
- Examples- Risperidone, Quetiapine, Olanzapine, Clozapine, Aripiprazole, Ziprasidone, Paliperidone
- Conventional (sometimes called First Generation)
- How they work…
- Mechanism not completely understood
- They block dopamine, serotonin and adrenergic receptors in the brain
- Atypical or Second Generation Antipsychotics have decreased risk for extrapyramidal side effects than the convential antipsychotics.
- Generally, better tolerated than conventional antisychotic medications.
- Side Effects
- Weight gain
- Increased Triglycerides (type of fat found in the body)
- Increased risk of CVA (cerebrovascular accident)
- Decreased sexual drive
- Anticholinergic effects
- Dry mouth
- Blurred vision
- Urinary retention
- Extrapyramidal Side Effects (caused by blocked dopamine receptors)
- Less common than with conventional antipsychotics
- Acute dystonia
- Spasms of back, tongue and facial muscles
- Tardive Akathisia
- Inability of muscles to relax
- Repetitive movements with hands and feet
- Shuffling gait
- Muscle Rigidity
- Tardive dyskinesia
- Lip smacking
- Puffing of cheeks
- Chewing repetitively
- Neuroleptic Malignant Syndrome (less common than with conventional antipsychotics)
- Muscle rigidity
- Increased HR
- Increased BP
- Elevated serum creatinine levels (this could be fatal)
- Monitor patient for compliance.
- Monitor patient’s weight
- Monitor for signs of Neuroleptic Malignant Syndrome
- Medications should be used in conjunction with other treatment options like therapy and counseling.
- Mood Affect
- Neuroleptic Malignant Syndrome can be life threatening. Make sure patients are aware of what signs and symptoms to be on the look out for and that they should contact their provider immediately.
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So, in this video, we gonna talk about the antipsychotic medications. Specifically, we gonna talk about the atypical antipsychotic. But, let’s take a look at like how many classes do we have for Anti-psychotic medications. Conventional and atypical antipsychotic. Coventional antipsychotics are old drugs, they were researched and invented about like quite a few years ago while the atypical antipsychotics are newer drug to treat the psychosis. And psychosis means, these drugs are mostly used to treat schizophrenia. And, there are two different parts in the conventional antipsychotic as well, which is the Phenothiazines and Nonphenothiazines. Let’s take a look at about the atypical antipsychotic medications.
So, mechanism of action of these drugs is really unclear. There are multiple neurotransmitter this medication works on. One of them is dopamine, second is serotonin and adrenergic receptors in the brain. So, this medication will block dopamine, serotonin and adrenergic receptors in the brain. And, these drugs help in treating both positive and negative symptoms of schizophrenia. While we looked at the different types of antipsychotic medications like conventional and atypical antipsychotic. Conventional antipsychotic are mostly used to treat positive symptoms of the schizophrenia. While, these medications are used for positive and negative, both. Now, one of the things to remember when we take a look at the side effects of this psychotic medication is dopamine. Dopamine is a neurotransmitter in the brain that works with the balance, muscle movements, and muscle coordination. Dopamine in the brain will coordinate all these muscle movements in our body. If there is a deficit of dopamine in our body, excuse me, in our brain, then it will cause the incoordination. The brain will not be able to think and coordinate all the muscle movements if there is a deficiency of dopamine. Now, this drug will block the dopamine, so you will see some side effects like for the muscle coordination problems, gait problems, etc. We’ll talk about them in the next slide. But, just a main thing to remember, dopamine, it helps in muscle coordination and movements.
So, side effects of this medication is tachycardia. Now, this medication also blocks the adrenergic, so will produce the effects like cholinergic, etc, etc. And it will also block some of the cholinergic receptors. It will cause the antocholinergic side effects as well. But tachycardia is the main one, sedation, dizziness. We’ll talk about this neuroleptic malignant syndrome and extrapyramidal side effects in the next slides. It will increase the risk of CVA. It can cause the weight gain and obesity. It can cause diabetes and increase the triglyceride. It can cause the osteoporosis. And one of the main side effect that people usually stop using this medication is decreased libido and menstrual disorders due to the increased prolactin level. So, this is the side effect, unwanted side effects and many people, young people, will stop using this medication due to this one of the main side effects. It can cause Diabetes Mellitus 2 since this medication increases the resistance of insulin and medication of extra glucose metabolism.
Now, there are main 2 side effects we really need to know about this medication is neuroleptic malignant syndrome and extrapyramidal side effects. And these are the side effects are often often often tested on the NCLEX as well. Let’s take a look. Neuroleptic malignant syndrome which is really rare in this particular class of drugs, in atypical antipsychotic, this is very common, you will see in conventional antipsychotic. But still, we need to know. These are really serious side effects, severe side effects. Neuroleptic malignant syndromes signs and symtoms are confusion, fever, muscle rigidity, high serum creatinine level, and this one could be really fatal. So, you need to teach patient who are in this medication, if they see these side effects, call their doctor immediately.
There are some extrapyramidal symptoms as well. Now, extrapyramidal symptoms are caused by block, due to the blockage of dopamine receptors or dopamine neurotransmitters in the brain. As we talked like dopamine is really important in the coordination and muscle movements. So, these extrapyramidal symptoms are caused by blockage of dopamine neurotransmitter in the brain. The first one includes acute dystonia which is spasms of back muscles, tongue and facial muscle. Akathisia which is inability to rest or relax, they’ll be doing repetitively movements like with the hands, their feet, or some kind of movements, they cannot rest or relax. This is Parkinsonium, includes tremor, shuffling gate and muscle rigidity which is same as the Parkinson disease. Because, if you remember, the pathophysiology of Parkinson, Parkinson is caused by decreased level of dopamine. Now, this medication blocks the dopamine neurotransmitter in our brain. So, basically, makes more prone to cause Parkinson symptoms which is tremor, shuffling gait and muscle rigidity, these three. Last one is tardive dyskinesia, which is unusual tongue or facial movements such as lip smacking, puffing of cheeks, chewing repetitively. So, some kind of tongue and facial movements they’ll be doing repetitively. And I usually hard to distinguish between this tardive dyskinesia and akathisia. Because, akathisia is also inability to rest or relax which could be lip smacking, could be tardive dyskinesia. So, this is really hard to differentiate and really often exam-ed on NCLEX, unfortunately. But, you really need to remember, if it is lip or facial due to tardive dyskinesia, and rest of them is, if they’re doing repetitive movement with hand, legs, something like that, then go with the akathisia.
Okay. Some of the examples of this medication is Risperidone, Quetiapine, Olanzapine, Clozapine, Aripiprazole, Ziprasidone and Paliperidone.
So, this is about the atypical antipsychotic medication. If you have any questions, feel free to ask us and thanks for watching.