Unit 1 Psychotropic and antipsychotic drugs 05 February 2024.pdf

Interpret the classification of psychotropic drugs. [SAQA ELO 2,7,8]
1.1.1 Explain the classification of psychotropic drugs.

Summarise the guidelines for the use of antipsychotic medication. [SAQA ELO 2,7,8]
1.2.1 Discuss the guidelines for the use of antipsychotic medication with reference to different lines of treatments, dosages, side effects and management of relapse.

1. Unit 1:
Psychotropic drugs
Pharmacology 3

2. Objectives
•Interpret the classification of psychotropic drugs. [SAQA
ELO 2,7,8]
•1.1.1 Explain the classification of psychotropic drugs.
•Summarisethe guidelines for the use of antipsychotic
medication. [SAQA ELO 2,7,8]
•1.2.1 Discuss the guidelines for the use of antipsychotic
medication with reference to different lines of treatments,
dosages, side effects and management of relapse.

3. What are psychotropic drugs?
•Psychotropic drugs, also known as psychoactive or psycho-
pharmaceutical drugs, are substances that affect the mind, behavior,
or perception.
•They are commonly used in the treatment of various mental health
conditions.

4. What are psychotropic drugs?
•Psychotropic drugs exert their actions by either mimicking the
effects, blocking the activity, or altering the storage, release, or
uptake of neurotransmitters (signaling molecules in the brain that
relay information between neurons and between neurons and other
types of cells).
•Some psychotropic drugs restore the balance of neurotransmitters
by preventing their breakdown once released from neurons.
•Examples of neurotransmitters that can be affected by psychotropic
drugs include dopamine, gamma-aminobutyric acid (GABA),
norepinephrine, and serotonin.

5. REVIEW OF THE CENTRAL NERVOUS SYSTEM
•The peripheral nervous system consists of sensory neurons and
motor neurons.
•Sensory neurons sense the environment and conduct signals to the
brain that become a person’s conscious perception of that stimulus.
•This conscious perception may lead to a motor response that is
conducted from the brain to the peripheral nervous system via
motor neurons.
•Motor neurons are part of the somatic nervous system that
stimulates voluntary movement of muscles and the autonomic
nervous system that controls involuntary responses.

6. The Central and Peripheral Nervous Systems

8. The five main classes of psychotropic drugs are distinguished
primarily by the effects that result from their actions on
neurotransmitters.

9. Neurotransmitters
•There are several types of neurotransmitters associated with mental health disorders and
psychoactive medications, including acetylcholine, glutamate, GABA, glycine, dopamine,
serotonin, norepinephrine, and histamine.
•Acetylcholine:Acetylcholine stimulates nicotinic and muscarinic receptors in the
parasympathetic nervous system. Other substances also bind to these receptors. For
instance, nicotine (in tobacco products) binds to nicotinic receptors, and muscarine
(products of specific mushrooms used as a hallucinogenic) binds to muscarinic receptors.
•Glutamate:Glutamate is an excitatory neurotransmitter. Elevated levels of glutamate are
associated with psychosis symptoms that can occur with schizophrenia, as well as with
illicit drug use such as methamphetamines. Conversely, lamotrigine, a medication used
to treat bipolar disorder, inhibits glutamate.
•Gamma-Aminobutyric Acid and Glycine:Gamma-aminobutyric acid (GABA) and glycine
are inhibitory neurotransmitters that act like brakes in a car by slowing down overexcited
nerve cells. Low levels of GABA are associated with seizures, anxiety, mania, and impulse
control. Pregabalinis an anticonvulsant that mimics the effects of GABA and is used to
treat generalized anxiety disorder.

10. Neurotransmitters
•Dopamine:Dopamine plays an essential role in several brain functions, including
learning, motor control, reward, emotion, and executive functions. It is associated
with several mental health disorders and is targeted by many psychotropic
medications. For example, bupropion is an antidepressant that inhibits dopamine
reuptake, leading to increased dopamine levels in the synapse and relieving the
symptoms of depression. Conversely, chlorpromazine blocks dopamine receptors
and is used to treat psychosis, but this blockade can cause extrapyramidal side
effects (involuntary and uncontrolled muscle movements).
•Serotonin:Serotonin modulates multiple neuropsychological processes such as
mood, sleep, libido, and temperature regulation. Abnormal levels of serotonin
have been linked to many mental health disorders such as depression, bipolar
disorder, and anxiety. Many psychotropic medications target serotonin. For
example, fluoxetine belongs to a class of antidepressants called selective
serotonin reuptake inhibitors (SSRIs). SSRIs prevent the reuptake of serotonin at
the synapse, making more of the chemical available in the brain and relieving
depression.

11. Neurotransmitters
•Norepinephrine and Epinephrine:Norepinephrine and epinephrine
stimulate alpha-and beta-receptors in the sympathetic nervous system.
Their release exerts effects on a variety of body processes, including stress,
sleep, attention, and focus. Many psychotropic medications target these
neurotransmitters. For example, venlafaxine belongs to a class of
antidepressants called norepinephrine reuptake inhibitors (NRIs). NRIs are
prescribed to treat depression by preventing the reuptake of
norepinephrine at the synapse and boosting levels of norepinephrine in the
brain.
•Histamine:Histamine mediates homeostatic functions in the body,
promotes wakefulness, modulates feeding behavior, and controls
motivational behavior. For example, diphenhydramine, a histamine
antagonist, causes drowsiness and is also used to treat extrapyramidal
symptoms.

13. Antidepressants
•Antidepressants are commonly used to treat depression but are also
used to treat other conditions, such as anxiety, chronic pain, and
insomnia.
•Some people respond better to certain antidepressant medications
than to others, so an individual may have to try different types of
antidepressants before finding one that effectively treats their
symptoms.
•Additionally, it may take antidepressants two or more weeks to
achieve peak effect.

15. Mood stabilisers
•Mood stabilizers are used primarily to treat bipolar disorder.
•They are also used to treat depression (usually in combination with
an antidepressant), schizoaffective disorder, and disorders of
impulse control.
•Lithium is an example of a mood stabilizer.
•Anticonvulsant medications are also used as mood stabilizers.
•Antipsychotics, antianxiety, and antidepressants may also be used
to treat bipolar disorders.

16. Anti anxiety medications
•Antianxiety medications help reduce the symptoms of anxiety, panic
attacks, or extreme fear and worry.
•The most common class of antianxiety medications is
benzodiazepines.
•Benzodiazepines are used to treat generalized anxiety disorder,
although SSRIs or other antidepressants are typically used to treat
panic disorder or social phobia (i.e., social anxiety disorder).
•Beta-blockers and buspironemay also be prescribed for anxiety.

18. Anti psychotics
•Antipsychotic medicines are primarily used to manage psychosis (i.e., a loss of contact with
reality that may include delusions or hallucinations).
•Psychosis can be a symptom of a physical condition (such as a high fever, head injury, or
substance intoxication) or a mental disorder (such as schizophrenia, bipolar disorder, or severe
depression).
•Antipsychotic medications may also be used in combination with other medications to treat the
symptoms of other mental health conditions, including attention deficit hyperactivity disorder
(ADHD), eating disorders, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder
(OCD), and generalized anxiety disorder.
•First-generation antipsychotics (also called typical antipsychotics) have several potential adverse
effects, and medication is prescribed based on the client’s ability to tolerate the adverse effects.
•Second-generation antipsychotics (also referred to as atypical antipsychotics) have fewer adverse
effects and are generally better tolerated. Clients respond differently to antipsychotic
medications, so it may take several trials of different medications to find the one that works best
for their syptoms.

19. Anti psychotic Medications
•Antipsychotic drugs treat psychosis, a collection of symptoms that affect
your ability to tell what’s real and what isn’t.
•These drugs are a critical part of treating conditions that involve psychosis.
•Without them, many of these conditions are so disruptive or severe that
they need 24/7 psychiatric care.
•Antipsychotic medications are drugs that mainly treat psychosis-related
conditions and symptoms.
•But taking an antipsychotic drug doesn’t always mean you have a symptom
or condition related to psychosis.
•That’s because these drugs are very important for treating other
conditions, too.

20. What is psychosis?

21. There are two main types of antipsychotic
medications:
•First-generation antipsychotics. Also known as “typical
antipsychotics,” these drugs were the first types of medications
developed for treating psychosis. Most aren’t commonly used for
treating psychosis now.
•Second-generation antipsychotics. Also known as “atypical
antipsychotics,” these are now the main drugs for treating psychosis.
That’s mostly because they have fewer side effects.

22. There are two main types of antipsychotic
medications:
•Typical (first-generation) and atypical (second-generation)
antipsychotics are two classes of medications used to treat psychotic
disorders, such as schizophrenia.
•While both types aim to alleviate symptoms, there are significant
differences between them in terms of their pharmacology, side effect
profiles, and mechanisms of action.

23. Here's a comparison of typical and atypical
antipsychotics:
•**1. ** Mechanism of Action:
•Typical Antipsychotics:
•Primarily block dopamine receptors, especially the D2 receptor, in the brain.
•High affinity for dopamine receptors in the mesolimbic pathway (associated
with positive symptoms of schizophrenia).
•Atypical Antipsychotics:
•Block dopamine receptors as well, but they also affect other
neurotransmitters, particularly serotonin.
•Have a higher affinity for serotonin receptors, especially the 5-HT2A receptor.

24. Here's a comparison of typical and atypical
antipsychotics:
•**2. ** Efficacy:
•Typical Antipsychotics:
•Generally effective in treating positive symptoms of schizophrenia, such as
hallucinations and delusions.
•Less consistent in addressing negative symptoms (e.g., social withdrawal, lack
of motivation).
•Atypical Antipsychotics:
•Effective in treating both positive and negative symptoms of schizophrenia.
•May have a more favorable impact on cognitive function.

25. Here's a comparison of typical and atypical
antipsychotics:
•**3. ** Extrapyramidal Symptoms (EPS):
•Typical Antipsychotics:
•Commonly associated with EPS, including parkinsonism, akathisia
(restlessness), dystonia (muscle spasms), and tardive dyskinesia (involuntary
movements).
•Atypical Antipsychotics:
•Generally have a lower risk of causing EPS compared to typical antipsychotics.

26. Here's a comparison of typical and atypical
antipsychotics:
•**4. ** Metabolic Side Effects:
•Typical Antipsychotics:
•Typically have a lower risk of causing metabolic side effects, such as weight
gain, dyslipidemia, and insulin resistance.
•Atypical Antipsychotics:
•Associated with a higher risk of metabolic side effects, including weight gain,
dyslipidemia, and an increased risk of diabetes.

27. Here's a comparison of typical and atypical
antipsychotics:
•**5. ** Prolactin Elevation:
•Typical Antipsychotics:
•Often associated with elevated levels of the hormone prolactin, leading to
side effects like gynecomastia (enlarged breasts) and menstrual irregularities.
•Atypical Antipsychotics:
•Can also cause prolactin elevation, but generally to a lesser extent than
typical antipsychotics.

28. Here's a comparison of typical and atypical
antipsychotics:
•**6. ** Risk of Tardive Dyskinesia:
•Typical Antipsychotics:
•Higher risk of causing tardive dyskinesia, which is characterized by
involuntary, repetitive movements of the face and body.
•Atypical Antipsychotics:
•Lower risk of tardive dyskinesia compared to typical antipsychotics.

29. Here's a comparison of typical and atypical
antipsychotics:
•**7. ** Anticholinergic Effects:
•Typical Antipsychotics:
•More likely to cause anticholinergic side effects, such as dry mouth, blurred
vision, and constipation.
•Atypical Antipsychotics:
•Tend to have fewer anticholinergic effects.

30. First-generation (typical) antipsychotics
•Chlorpromazine. The brand name of this medication (Thorazine) is no longer available in the U.S., but generic versions still are.
•Fluphenazine. The brand names of this medication (Prolixin, Permitil) are no longer available in the U.S., but generic versions still
are.
•Haloperidol(Haldol®).
•Loxapine(Adusuve®). One of the brand names of this medication (Loxitane) is no longer available in the U.S., but generic versions
still are.
•Molindone. The brand name of this medication (Moban) is no longer available in the U.S., but generic versions still are.
•Perphenazine. The brand name of this medication (Trilafon) is no longer available in the U.S., but generic versions still are.
•Pimozide(Orap*).
•Prochlorperazine(Compro®). One of the brand names of this medication (Compazine) is no longer available in the U.S., but generic
versions still are.
•Thiothixene. The brand name of this medication (Navane) is no longer available in the U.S., but generic versions still are.
•Thoridazine. The brand name of this medication (Mellaril) is no longer available in the U.S., but generic versions still are.
•Trifluoperazine. The brand name of this medication (Stelazine) is no longer available in the U.S., but generic versions still are.

31. Second-generation (atypical) antipsychotics
•Aripiprazole(Abilify®, Aristada®).
•Asenapine(Secuado®, Saphris®).
•Brexpiprazole(Rexulti®).
•Cariprazine(Vraylar®).
•Clozapine(Clozaril®, Versacloz®). One of the brand names of this medication (Fazaclo) is no longer available in the U.S., but generic
versions still are.
•Iloperidone(Fanapt®).
•Lumateperone(Caplyta®).
•Lurasidone(Latuda®).
•Olanzapine(Zyprexa®, Lybalvi®, Symbyax®).
•Quetiapine(Seroquel®).
•Paliperidone(Invega®).
•Pimavanserin(Nuplazid®).
•Risperidone(Perseris®, Risperdal®).
•Ziprasidone (Geodon®).

32. How do antipsychotics work?
•All antipsychotics work by changing how s known asneurotransmitters. Cells throughout your
nervous system have receptors, which are like locks, on their surfaces. Neurotransmitters are like
keys, and they have very specific shapes.
•If a neurotransmitter with the right shape attaches to a receptor, it can activate the cell and tell it
to do something. Some neurotransmitters have nearly the right shape, but they don’t activate the
cell. Instead, they block neurotransmitters that could activate the cell.
•Antipsychotics rely on the lock-and-key system for neurotransmitters and receptors in different
ways:
•First-generation antipsychotics: These block the way your brain uses several neurotransmitters,
especiallydopamine. They also blockacetylcholine(pronounced “Uh-SEE-till-CO-lean”), histamine
andnorepinephrinefrom latching onto various receptors.
•Second-generation antipsychotics: These block certain dopamine and serotonin receptors. But
unlike first-generation antipsychotics, these medications don’t just block receptors. They also
activate certain other dopamine and serotonin receptors. Blocking some receptors and activating
others is why these medications work differently.

33. What conditions do antipsychotics treat?
•Antipsychotics treat conditions that cause or
involve psychosis. Those include:
•Schizophrenia(and its related spectrum of
disorders, includingschizoaffective disorderand
schizophreniform disorder).
•Bipolar disorder
•Mania
•Major depressive disorderwith psychotic features.
•Delusional disorder
•Severe agitation.
•Borderline personality disorder
•Dementia
•Delirium
•Substance-induced psychotic disorder.
•Providers may treat other conditions with
antipsychotics, but those drugs aren’t their main
treatment. These conditions include:
•Tourette syndrome
•Huntington’s disease
•Parkinson’s disease
•Lesch-Nyhan syndrome
•Obsessive-compulsive disorder

34. What are the potential benefits of
antipsychotics?
•Range of conditions they treat. Antipsychotics can treat specific brain-related conditions. They
can also treat mental health conditions (many of which happen for brain-related reasons that
aren’t fully understood).
•Type of conditions they treat. Antipsychotics treat conditions that can be very complex,
disruptive and severe. Some of these conditions are very difficult (if not impossible) to treat with
other kinds of medications. Also, many people with these conditions would need long-term (or
even lifelong) care 24/7 without these drugs.
•History of research and use. First-generation antipsychotics came into use in the early 1950s. The
first second-generation antipsychotic came into use in the 1960s. That means these medications
have decades of research and study supporting them.
•Number of drugs available. There are many different types of antipsychotic drugs. That means
your healthcare provider can often offer options for you to choose from when recommending a
medication.
•Contributions to other treatment approaches. Antipsychotics can also make other types of
mental health treatments more effective. When used together, antipsychotics and mental health
therapy (the technical term is “psychotherapy”) usually have a much better chance of helping a
person.

35. What are the possible disadvantages, side
effects and complications of antipsychotics?
•Drug-induced movement disorders. First-generation and second-generation antipsychotics can cause aninability to hold still
(akathisia)oruncontrolled face muscle movements (tardive dyskinesia). Other symptoms include tremors orparkinsonism-like
symptoms. They can also causeneuroleptic malignant syndrome, a possibly deadly complication. Scientists developed second-
generation antipsychotics to avoid that side effect.
•Heart and circulatory problems. Antipsychotic drugs may alter your heart rhythm. They can also causeorthostatic hypotension,
which is a blood pressure drop when you stand or sit up quickly that can make you fall or pass out.
•Interactions. Antipsychotic medications can interact with several other types of medications. Be sure to tell your healthcare
provider about every medication, supplement, vitamin or herbal remedy you take. That can help them determine if there’s a risk
of interactions with an antipsychotic medication they prescribe for you.
•Metabolism effects. Antipsychotic drugs can cause high cholesterol (hyperlipidemia) and high blood sugar (hyperglycemia). They
can also increase your risk of developing Type 2 diabetes.
•Dizziness and sedation. All antipsychotics can have a sedative effect, meaning they make you tired. They can also cause dizziness,
increasing your risk of falls and injuries.
•High prolactin levels (hyperprolactinemia). Antipsychotics can affect your levels of the hormone prolactin. This can affect fertility
and causemissed periods (amenorrhea)andleaky discharge from your breasts when you aren’t breastfeeding/chestfeeding
(galactorrhea)in women andpeople assigned female at birth. It can cause infertility and sexual dysfunction in men and people
assigned male at birth.
•Immune disruption. Some antipsychotics can causeagranulocytosis, a dangerous condition that involves a weakening of your
immune system.
•Jaundice. This is when your skin and the whites of your eyes (sclera) turn yellow because of a problem in your liver.

36. Several conditions can get worse if you take
antipsychotics
•Liver damage or disease (cirrhosis)
•Heart disease
•A history ofstrokeorcirculatory problems in your brain (cerebrovascular disease).
•Parkinsonism (including Parkinson’s disease and many conditions that cause similar
symptoms).
•Bone marrow or immune problems.
•Blood pressure that’s severely high or low
•Type 2 diabetes.
•Glaucoma
•Enlarged prostate (benign prostatic hyperplasia)
•Stomach ulcers
•Chronic respiratory conditions.

37. Reference list
https://my.clevelandclinic.org/health/treatments/24692-antipsychotic-medications