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\author{Shelbi (kfisher17)}
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  /Title (pharmacology-of-antipsychotic-agents.pdf)
  /Creator (Cheatography)
  /Author (Shelbi (kfisher17))
  /Subject (Pharmacology of Antipsychotic Agents Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Pharmacology of Antipsychotic Agents Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Shelbi (kfisher17)} via \textcolor{DarkBackground}{\uline{cheatography.com/79317/cs/21869/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Shelbi (kfisher17) \\
  \uline{cheatography.com/kfisher17} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 24th February, 2020.\\
   Updated 24th February, 2020.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Antipsychotic Drugs}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Used for tx of SZ and for the tx of psychotic sx in manic states, major depression, dementia, delirium, and drug-induced psychoses} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Antipsychotic Drug Groups:}}} \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{➤ 1st generation antipsychotic agents (Typical)} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{➤ 2nd generation (Atypical)} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\emph{Can treat both organic and drug-induced}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.08 cm} x{5.92 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Prototypical 1st Generation (Typical)}}  \tn
% Row 0
\SetRowColor{LightBackground}
Low Potency & {\bf{Chlorpromazine}} (1st antipsychotic discovered) \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & Thioridazine \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Medium Potency & Loxapine \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
 & Perphenazine \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
High Potency & {\bf{Haloperidol}} \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
 & Droperidol \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & Fluphenazine \tn 
% Row Count 10 (+ 1)
% Row 7
\SetRowColor{white}
 & Pimozide \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Chlorpromazine}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Very 1st antipsychotic drug discovered} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Prototypic, low-potency drug ({\emph{now, rarely used as an antipsychotic agent}})} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Has {\bf{Low}} affinity for D2 receptors} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Main Side Effects: orthostatic hypotension (alpha 1 receptor blockade), sedation (H1), and weight gain (H1 and 5-HT-2A)} \tn 
% Row Count 7 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\bf{LOW}} incidence of EPS ({\emph{low affinity for D2}})} \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Dermatological reactions (urticaria and photosensitivity resembling sunburn) and LFT abnormalities} \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Questions}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{What is a measure of a drug's affinity for a receptor?} \tn 
\mymulticolumn{1}{x{8.4cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Ki - determined experimentally and is a measure of the affinity for a drug for a receptor (a measure of strength of the drug-receptor interaction)} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{The lower the Ki value, the \_\_\_\_\_\_\_\_ ({\emph{lower or higher}}) the affinity of the antagonist for the receptor.} \tn 
\mymulticolumn{1}{x{8.4cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Higher - On Exam: Ki values will be provided and we'll need to be able to determine the affinity of the antagonist for the receptor} \tn 
% Row Count 12 (+ 6)
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\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Haloperidol}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Prototypic high-potency antipsychotic agent} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{High affinity for D2 receptors} \tn 
% Row Count 2 (+ 1)
% Row 2
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\mymulticolumn{1}{x{8.4cm}}{Side Effects: EPS and hyperprolactinemia} \tn 
% Row Count 3 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{1st Gen (Typical) Antipsychotics}}  \tn
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{30 to 50\% of SZ pt's do {\bf{NOT}} respond to these drugs} \tn 
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% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Typical antipsychotic drugs improve positive sx, but only marginally improve negative sx and cognitive impairments of Sz} \tn 
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% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{High incidence of ADRs} \tn 
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% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{2nd gen (atypical) antipsychotics have been increasingly replacing them as the 1st-line tx of SZ} \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{2nd Gen (Atypical) Antipsychotics}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Clozapine, Olanzapine, Risperidone, Paliperidone, Ziprasidone, Quetiapine, Iloperidone, Asenapine, Lurasidone} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Aripiprazole, Braxpiprazole, Cariprazine ({\emph{Considered 3rd gen}})} \tn 
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% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{More effective than 1st gens in treating negative symptoms and improving cognitive functioning} \tn 
% Row Count 7 (+ 2)
% Row 3
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\mymulticolumn{1}{x{8.4cm}}{Currently 1st line (except clozapine) due to fewer side effects than typical agents} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Atypicals have also been associated with a reduction in the incidence of {\bf{suicide}} in SZ} \tn 
% Row Count 11 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{There is no uniform definition of the term "{\emph{atypical}}" antipsychotic. They are a group of drugs that have at least equal antipsychotic efficacy compared to 1st gen {\emph{without}} producing EPS and increased prolactin levels}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{MOA of 2nd Gens (Atypical)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Block 5-HT 2A receptors ({\emph{functionally, they are 5-HT-2A antagonists}})} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Also block D2 receptors ⇨ D2 antagonism is still required to achieve antipsychotic effects} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Also block other receptors (*H1, M1, alpha-1) ⇨ Side effects} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\emph{Ziprasidone}} also inhibits 5-HT and NE uptake} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{1st Generation (Typical) Antipsychotic Drugs}}  \tn
% Row 0
\SetRowColor{LightBackground}
Chemistry & Structure-Fxn relationships that were relied upon in the past have become less important \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
 & Instead, receptor-fxn relationships and functional assays are more clinically relevant \tn 
% Row Count 10 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{✽ Classification According to Potency ✽}}} \tn 
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% Row 3
\SetRowColor{white}
Low Potency & Chlorpromazine \tn 
% Row Count 12 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Thioridazine \tn 
% Row Count 13 (+ 1)
% Row 5
\SetRowColor{white}
Medium Potency & Loxapine \tn 
% Row Count 14 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & Perphenazine \tn 
% Row Count 15 (+ 1)
% Row 7
\SetRowColor{white}
High Potency & {\bf{Haloperidol}} \tn 
% Row Count 16 (+ 1)
% Row 8
\SetRowColor{LightBackground}
 & Droperidol \tn 
% Row Count 17 (+ 1)
% Row 9
\SetRowColor{white}
 & Fluphenazine \tn 
% Row Count 18 (+ 1)
% Row 10
\SetRowColor{LightBackground}
 & Pimozide \tn 
% Row Count 19 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{✽ MOA ✽}}} \tn 
% Row Count 20 (+ 1)
% Row 12
\SetRowColor{LightBackground}
Block dopamine D2 receptors & D2 receptor binding affinity (but not D1) strongly correlates with clinical potency of typical antipsychotic agents \tn 
% Row Count 26 (+ 6)
% Row 13
\SetRowColor{white}
Blockade of postsynaptic D2 receptors & ⇨ Reduction of dopaminergic neurotransmission \tn 
% Row Count 29 (+ 3)
% Row 14
\SetRowColor{LightBackground}
D2 receptor blockade in ALL dopaminergic pathways & ⇨ beneficial in the mesolimbic pathway \tn 
% Row Count 32 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{1st Generation (Typical) Antipsychotic Drugs (cont)}}  \tn
% Row 15
\SetRowColor{LightBackground}
 & ⇨ alleviates positive sx of SZ \tn 
% Row Count 2 (+ 2)
% Row 16
\SetRowColor{white}
 & ⇨ It doesn't do really anything for the negative or cognitive sx \tn 
% Row Count 6 (+ 4)
% Row 17
\SetRowColor{LightBackground}
 & {\bf{Side Effects:}} \tn 
% Row Count 7 (+ 1)
% Row 18
\SetRowColor{white}
 & • D2 receptor blockade in nigrostriatal pathway ⇨ {\bf{extrapyramidal sx (EPS)}} \tn 
% Row Count 12 (+ 5)
% Row 19
\SetRowColor{LightBackground}
 & • D2 receptor blockade in the tuberoinfundibular pathway ⇨ {\bf{increased prolactin release}} from the {\bf{anterior pituitary}} \tn 
% Row Count 19 (+ 7)
% Row 20
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Blocks other receptors:} \tn 
% Row Count 20 (+ 1)
% Row 21
\SetRowColor{LightBackground}
5-HT2A blockade & Contributes to antipsychotic effects \tn 
% Row Count 22 (+ 2)
% Row 22
\SetRowColor{white}
Other receptor blockade & Numerous additional side effect \tn 
% Row Count 24 (+ 2)
% Row 23
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{✽ SIDE EFFECTS ✽}}} \tn 
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% Row 24
\SetRowColor{white}
EPS & Various movement disorders associated with antipsychotic therapy (occurs mostly with 1st gen) \tn 
% Row Count 30 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{1st Generation (Typical) Antipsychotic Drugs (cont)}}  \tn
% Row 25
\SetRowColor{LightBackground}
 & Occurs due to D2 receptor blockade in the nigrostriatal pathway \tn 
% Row Count 4 (+ 4)
% Row 26
\SetRowColor{white}
 & • Akathisia: uncontrollable motor restlessness \tn 
% Row Count 7 (+ 3)
% Row 27
\SetRowColor{LightBackground}
 & • Dystonias: muscular spasms of the neck, eyes, and tongue \tn 
% Row Count 10 (+ 3)
% Row 28
\SetRowColor{white}
 & • Drug-Induced Parkinson's Syndrome: Resembles Parkinson's Syndrome \tn 
% Row Count 14 (+ 4)
% Row 29
\SetRowColor{LightBackground}
 & • Tardive Dyskinesia (TD): occurs after months or years of tx; may become {\bf{irreversible}}; repetitive, involuntary, purposeless movements (typically facial muscles are involved); {\bf{mechanism}}: up-regulation and supersensitivity of D2 receptors (that can become permanent) \tn 
% Row Count 28 (+ 14)
% Row 30
\SetRowColor{white}
Hyperprolactinemia & D2 receptor blockade in the tuberoinfundibular pathway causes increased plasma prolactin levels ({\emph{Hyperprolactinemia}}) \tn 
% Row Count 34 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

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\columnbreak
\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{1st Generation (Typical) Antipsychotic Drugs (cont)}}  \tn
% Row 31
\SetRowColor{LightBackground}
 & Manifested as: \seqsplit{Amenorrhea-galactorrhea} in women, gynecomastia in men, Infertility in both men and women \tn 
% Row Count 6 (+ 6)
% Row 32
\SetRowColor{white}
ADRs caused by Blockade of Non-Dopamine Receptors & 1st generation antipsychotic drugs also block 5-HT-2, alpha 1 adrenergic, muscarinic, and histamine H-1 receptors ⇨ More Side Effects \tn 
% Row Count 13 (+ 7)
% Row 33
\SetRowColor{LightBackground}
Blockade of H1 Receptors & Sedation \tn 
% Row Count 15 (+ 2)
% Row 34
\SetRowColor{white}
Blockade of alpha 1 adrenergic receptors & Orthostatic hypotension (could result in falls and injuries) \tn 
% Row Count 18 (+ 3)
% Row 35
\SetRowColor{LightBackground}
Blockade of muscarinic receptors & dry mouth, urinary retention, blurred vision, tachycardia, constipation, toxic-confusional state \tn 
% Row Count 23 (+ 5)
% Row 36
\SetRowColor{white}
Blockade of both H1 and 5-HT-2A receptors & Weight gain \tn 
% Row Count 26 (+ 3)
% Row 37
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{ADDITIONAL SIDE EFFECTS}}} \tn 
% Row Count 27 (+ 1)
% Row 38
\SetRowColor{white}
Typical antipsychotic agents affect hypothalamic function & impaired ability to regulate body temperature \tn 
% Row Count 30 (+ 3)
\end{tabularx}
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\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{1st Generation (Typical) Antipsychotic Drugs (cont)}}  \tn
% Row 39
\SetRowColor{LightBackground}
 & Hypo or Hyperthermia may result, depending on the ambient temperature \tn 
% Row Count 4 (+ 4)
% Row 40
\SetRowColor{white}
Thioridazine & Cardiac toxicity: reflected in prolongation of QTc interval and abnormal configuration of ST segment and T wave (correlates to increased risk of ventricular arrhythmias) \tn 
% Row Count 13 (+ 9)
% Row 41
\SetRowColor{LightBackground}
 & Retinal Tox: (pigmentary retinopathy): decreased vision and "browining" of vision \tn 
% Row Count 18 (+ 5)
% Row 42
\SetRowColor{white}
Neuroleptic Malignant Syndrome (NMS) & Rare, but life-threatening reaction to antipsychotic drugs \tn 
% Row Count 21 (+ 3)
% Row 43
\SetRowColor{LightBackground}
 & Symptoms: extreme muscle rigidity (lead pipe), hyperreflecia, fever, unstable BP, tachycardia, sweating, rapid changes in mental status, confusion, and coma \tn 
% Row Count 29 (+ 8)
% Row 44
\SetRowColor{white}
 & Lab: myoglobinemia and metabolic acidosis \tn 
% Row Count 32 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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% That's all folks
\end{multicols*}

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