[ Music] antipsychotic therapy and pharmacology is an essential topic let’s go over the highlights here so antipsychotics are drugs also known as neuroleptics and they are categorized in terms of conventional and atypical they act by obstruct dopamine receptors and thereby reduce psychotic symptoms these are used to treat psychotic illness and too psychosis that starts along with other ailments so throughout the lecture serial you’ve learned that psychosis can actually appear as a evidence of severe depression it can also come up during times of dementia so there are a lot of uses for antipsychotics and they can occur in other patients who don’t merely have a primary psyche insane illnes as well so let’s go through the two types usual and atypical well a few examples of ordinary neuroleptics include chlorpromazine thyroid is een haloperidol a typical examples are things like risperidone and ziprasidone so the normal neuroleptics these are d2 dopamine antagonists they have a quite high authority now a normal neuroleptics do annoy dopamine however their lower authority for that and we are really too will target serotonin and histamine receptors as well the typical neuroleptics tend to be really good at analyse positive evidences but the atypicals are actually better at considering the negative evidences which we think of as the merits of the psychotic manifestations ordinary neuroleptics because of their dopamine siege they can really justification a great deal of extrapyramidal side effects that doesn’t happen just as much with the atypical neuroleptics nonetheless these are more likely to cause side effects like sedation and also weight gain or metabolic questions when it comes to the conventional neuroleptics there are again two subtypes there’s the high capacity normal neuroleptics and too low-toned capacity conventional neuroleptics so we’ll talk a little more about those last-minute and for the atypical Nora as I said before these tend to not only block dopamine but they likewise have a strong affinity for serotonin alpha receptors histamine receptors as well in serotonin so the antipsychotics basically again these target dopaminergic neurons that’s really the key and there are a few different dopamine pathways that you should be familiar with the nigrostriatal the Me’s a limbic and the tubero infundibular now neuroleptics are highly overweight soluble and therefore there are a lot of options for returning these intramuscularly or through an dose we’re gonna review that later but as a teaser it’s important to know that when it comes to taking an antipsychotic medication sometimes patients are very fomented in the hospital setting and it’s really nice to have the option to do an insertion of remedy likewise some people don’t like taking a pill every day and the longacting injectable antipsychotics actually allows users by monthly or monthly dosing which can be a nice option for cases so there are a lot of different squanders for antipsychotic prescriptions some are of course the primary psychotic diseases too mood conditions like mania and depression and Tourette’s disorder they can also be helpful there so let’s talk a little more about the conventional antipsychotics and let’s start with the low-pitched effectivenes wands so these have a little bit of a lower affinity for the dopamine receptor and patterns include cor promazine and thioridazine now there’s a higher incidence of anticholinergic influences with these remedies and a lower incidence of the extrapyramidal side effects that can be very upsetting to patients also a little of a lower incidence of neuroleptic malevolent syndrome which can be a deadly side effect of antipsychotic prescription the high capacity conventional antipsychotics have a very high affinity for dopamine siege and these include haloperidol flu phenazine and some other examples listed here there’s a very high incidence of EPS or extrapyramidal indications with these medications and also neuroleptic malignant illnes lower incidence of anticholinergic and antihistamine troubles so what are extrapyramidal side effects you might be wondering so it’s very important to know for your cards so extrapyramidal side effects come from dopamine blockade often through that nigrostriatal pathway and a very early ratifies of this can be acute dystonia now this might attest in your case as something like an oculogyric crisis where their seeings kind of roll up in their honcho it can also be seen as torticollis or next stiffness and acute dystonia can be very distressing to a patient and it can occur immediately or within hours next another eps evidences is brady kinesia or parkinsonian indications so this can look like masked facies where person doesn’t have a lot of expression it can also look like cogwheel rigidity which you might test for when you’re doing your physical exam on a patient some patients have this brady kinesia or hindered changes and they also can have a gate where they do something which is called turning on block meaning that they will make a sudden stop and then turn their entire body so it’s not very easy for them to shift and maneuver as it is for the rest of us they may also get a tremor which can be a cardinal peculiarity of a parkinsonian side effects from this prescription another difficulty that can occur within months of starting an antipsychotic medication is akathisia this is highly distressing to patients so what akathisia is is it’s an internal feel of restlessness it will often evident as a patient pacing perhap sounding their foot or their hand on their leg they’ll often describe to their doctor that they just feel like they want to crawl out of their surface so that’s a sign of a Cathie’s which again is very distressing and then a really important side effect of antipsychotics to be informed about is tardive dyskinesia now it can take times and even decades for a patient to develop tardive dyskinesia a little pearl for your quiz is that elderly Caucasian ladies her hat highest risk for developing tardive dyskinesia when they’re is dealing with an antipsychotic so what this actually looks like is abnormal shifts for example of somebody’s face you may see someone fastening their tongue out frequently or smacking their cheeks together this can also occur less frequently in boundaries or truncal areas and the really unfortunate thing about tardive dyskinesia is that in most cases it’s actually not reversible so it can be very permanent and a disfiguring side effects both traditional and atypical neuroleptics have similar efficacies in terms of treating positive indications of psychosis now you might remember the positive indications of psychosis or things like hallucinations hallucinations bizarre actions however when it comes to treating the negative symptoms of psychosis things like having a flat influence little motive good vigour speech alodia that’s better treated with one of the newer antipsychotics or atypical antipsychotics so the traditional antipsychotic side effects to review them are anti dopaminergic anti ham which we’ll go over that in more detail in a minute of course tardive dyskinesia and dystonia or in other words the EPS symptoms including brady kinesia and akathisia neuroleptic malignant illnes which we’ll talk about in more details too a serious side effect so in terms of tardive dyskinesia we spoke it before but another little pearl to know this is riding movements of the mouth and tongue when your patient is described as having that judge tardive dyskinesia the anti dopaminergic sideeffects is certainly the extrapyramidal symptoms too hyperprolactinemia and this is due to interference of dopamine in the tubero infundibular pathway so cases have been able to end up with so much dopamine blockade that they get a surge in prolactin and this can manifest is actually lactation from the breast and it can occur in women but also in men and then neuroleptic malevolent disorder is another extremely noteworthy sideeffect to look out for so I mention anti ham side effects before well let’s talk about that aims so that H is antihistamine where patients can become very sedated the a is anti alpha adrenergic side effects this can look like worth a static hypotension cardiac arrhythmias and sex dysfunction the anti muscarinic side effects include baked lip tachycardia urinary retention misty vision and constipation all things that are of course undesirable to your case they may also get force income promoted liver enzymes they may have eye difficulties or off the malla reasoning problems dermatological problems and seizures and because tardive dyskinesia is so incredibly important in a potentially irreversible and deforming side effects we’re mentioning it a good deal here it’s really important to be informed about for your quiz and it’s really important to note that it can lead to that permanent disfiguration if you have a patient showing signs of tardive dyskinesia you really want to consider lowering their dose of antipsychotic giving them a drug holiday from their antipsychotic or switching them to another worker preferably an atypical antipsychotic[ Music]
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