too little dopamine results in extrapramidal side effects. drug induced imbalance between ACh and dopamine. balance of aCh and dopamine is required for normal functioning of the extrapyramidal system. they are caused by the blockaged of dopamine receptors in the basal ganglia and the end of the dopamine tracts.
treated with Anticholinergic drug such as Benztropine (cogentin); Biperden (akineton); and Trihexyphenidyl (Artane).
Dystonia - Muscular spasm of the face, eye, neck, and tongue, laryngeospasm, can be life threatening
Pseudo-Parkinsonism - Stiff and stooped posture, shaking, drooling, hand tremors, shuffling gait
Akathesia - unable to sit still, very restless, may rock or tap feet
Tardive Dyskinesia - Protruding and rolling tongue, smacking and licking, spastic facial distortion
Muscular spasm of the face, eye, neck, and tongue, laryngeospasm, can be life threatening. abnormal postures (muscle freezing). sustained, twisted and contracted positioning of limbs, trunk, eyes, neck, or mouth. happend within the first 3 days of treatment and responds to anticholinergic drugs. Eskalith, Lithonate
A positive charged ion
Lithium must be maintained within a narrow therapeutic blood level or 0.6 to 1.2 mEq/L.
Optimal maintenance level is 0.8.
Above 1.5 Lithium can cause toxicity which will result in:
Ataxia, tremors, EEG changes, extreme thirst, confusion, muscle weakness, diarrhea (possibly severe), seizures, hypotension, coma, and death.
Salt and water intake can alter the Lithium level so as the fluid volume decreases the Lithium level rises.
Patients on Lithium need to be taught about this so that if they have the flu, diarrhea episodes, or any situation that changes their fluid volume they are aware of the danger.
Increases levels of Serotonin, Norepinephrine, Dopamine, and Tyramine
Cannot eat any foods containing Tyramine which includes wine and chianti, cheese, figs,
beer and ale, sour cream, yougurt, avocados, bananas, fava beans,bolobna, chicken liver, fish, liver, meat tenderizer, pickled herring, salami, sausage, caffeine, chocolate, licorice, sauerkraut, soy sauce, yeast.
Monoamine Oxidase Inhibitors
-First generation antipsychotics - These are the standard or older drugs, they are also termed neuroleptics, traditonal, typical drugs.
-These drugs block dopamine and thereby reduce the positive symptoms of Schizophrenia - such as delusions, hallucinations, paranoia.
Phenothiazines such as Thorazine
Haldol (very common in hospital not only in psy), Prolixin, Navane, Mellaril
Second generation antipsychotics - These are the Atypical drugs - they have fewer side effects than the First generation drugs.
These drugs block dopamine and block serotonin as well.
They target both the positive symptoms of Schizophrenia (halluciantion/ etc/ mania) and the negative symptoms of Schizophrenia (social withdrawal, attention deficiet, cognitive dysfunction, blunt affect).
Clozaril, Risperdal, Zyprexa, Seroquel, Geodon, Abilify.