1. Sympathetic and Parasympathetic mimic one or the other or block one or the other?
Made up of two major neurotransmitters
Norepinephrine (sympathetic NS)
Acetylcholine (parasympathetic NS)
● Cholinergic drugs: effects similar to acetylcholine (activates parasympathetic NS)
● Adrenergic drugs: effects similar to Norepinephrine and Epinephrine (activates sympathetic NS)
● Anticholinergic agents block or inhibit cholinergic activity (parasympathetic NS)
● Adrenergic blocking agents inhibit the adrenergic system (sympathetic NS)
2. Antidepressants and Anticonvulsants Black- Warning
● Antidepressants-WARNING: ALL ANTIDEPRESSANTS INCREASE RISK OF SUICIDE IN
CHILDREN AND YOUNG ADULTS!!!
o MOA-Inhibitors- SAR: HTN crisis!
● Anticonvulsants- WARNING: INCREASED RISK OF SUICIDE FOR 1ST 6 MONTHS OF THERAPY
3. Adverse Effects 1st Generation & 2nd Generation Psychotic Medications
, Antipsychotics: First Generation (Typical/Conventional)
Common adverse effects (~80% of patients experience EPS)
o Extrapyramidal Side Effects (EPS)
▪ Acute Dystonia this is a crisis situation and requires RAPID treatment
https://youtu.be/76yyO9G9oZQ
● Give anticholinergic agent
▪ Parkinsonism/pseudoparkinsonism
● Give anticholinergic agent or amantadine and discontinue drug
▪ Akathisia https://youtu.be/wSx21Ml8a7o
● Give beta blocker, benzo or anticholinergic medication
▪ Tardive dyskinesia (TD) Late EPS & Typically permanent!
● https://youtu.be/n5DUWM39ekQ
● AIMS test Abnormal Involuntary Measure Scale –
(Does not work with anticholinergic agent)
Common adverse effects-continued
• Sedation-NO DRIVING
• Sexual dysfunction
• Anticholinergic effects
• Neuroendocrine effects
• Photosensitivity – wear sunscreen
Adverse Effects
• Neuroleptic malignant syndrome- LIFE THREATENING EMERGENCY
• Sudden high fever, blood pressure fluctuations,
dysrhythmias, muscle rigidity, diaphoresis, drooling, and
change in consciousness developing into coma
• Treatment= STOP medication, dantrolene, bromocriptine
(for muscle rigidity) + aspirin /acetaminophen
(antipyretics) + hydration
Antipsychotics: Second and Third Generation (Atypical)
Made up of two major neurotransmitters
Norepinephrine (sympathetic NS)
Acetylcholine (parasympathetic NS)
● Cholinergic drugs: effects similar to acetylcholine (activates parasympathetic NS)
● Adrenergic drugs: effects similar to Norepinephrine and Epinephrine (activates sympathetic NS)
● Anticholinergic agents block or inhibit cholinergic activity (parasympathetic NS)
● Adrenergic blocking agents inhibit the adrenergic system (sympathetic NS)
2. Antidepressants and Anticonvulsants Black- Warning
● Antidepressants-WARNING: ALL ANTIDEPRESSANTS INCREASE RISK OF SUICIDE IN
CHILDREN AND YOUNG ADULTS!!!
o MOA-Inhibitors- SAR: HTN crisis!
● Anticonvulsants- WARNING: INCREASED RISK OF SUICIDE FOR 1ST 6 MONTHS OF THERAPY
3. Adverse Effects 1st Generation & 2nd Generation Psychotic Medications
, Antipsychotics: First Generation (Typical/Conventional)
Common adverse effects (~80% of patients experience EPS)
o Extrapyramidal Side Effects (EPS)
▪ Acute Dystonia this is a crisis situation and requires RAPID treatment
https://youtu.be/76yyO9G9oZQ
● Give anticholinergic agent
▪ Parkinsonism/pseudoparkinsonism
● Give anticholinergic agent or amantadine and discontinue drug
▪ Akathisia https://youtu.be/wSx21Ml8a7o
● Give beta blocker, benzo or anticholinergic medication
▪ Tardive dyskinesia (TD) Late EPS & Typically permanent!
● https://youtu.be/n5DUWM39ekQ
● AIMS test Abnormal Involuntary Measure Scale –
(Does not work with anticholinergic agent)
Common adverse effects-continued
• Sedation-NO DRIVING
• Sexual dysfunction
• Anticholinergic effects
• Neuroendocrine effects
• Photosensitivity – wear sunscreen
Adverse Effects
• Neuroleptic malignant syndrome- LIFE THREATENING EMERGENCY
• Sudden high fever, blood pressure fluctuations,
dysrhythmias, muscle rigidity, diaphoresis, drooling, and
change in consciousness developing into coma
• Treatment= STOP medication, dantrolene, bromocriptine
(for muscle rigidity) + aspirin /acetaminophen
(antipyretics) + hydration
Antipsychotics: Second and Third Generation (Atypical)
