Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 7310 > Pharmacology of antipsychotic agents > Flashcards

Pharmacology of antipsychotic agents Flashcards

1
Q

All antipsychotics have some propensity to lengthen

A

QTc intervals but these vary widely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the four pathways for the dopaminergic system in the brain?

A

Nigrostriatal pathway, mesolimbic pathway, mesocortical pathway, tuberinfundibular pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the hypothetical function of the Nigrostriatal pathway?

A

Neurons start in the substantia nigra and project to to the striatum for control of motor function. The death of neurons in this pathway can result in Parkinson’s disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the hypothetical function of the Mesolimbic pathway?

A

Neurons project from the ventral tegmental area to the nucleus accumbens, amygdala, and hippocampus. They play a role in reward and desire, addiction, motivation, and emotional response. If not functioning properly they can cause hallucinations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the hypothetical function of Mesocortical Pathway?

A

Neurons project from the ventral tegmental area to the prefrontal cortex. They are involved in memory and creation of memories. Amnesia and memory issues are a result of inappropriate functioning of this pathways.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the hypothetical function of Tuberinfundibular pathway?

A

Neurons start in the hypothalamus and project to the pituitary gland. They play a role in hormonal regulation, maternal behavior and nurturing, pregnancy, and sensory processes. malfunctioning of these pathways can cause hallucinations and interpersonal issues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CAΨs

A

Conventional antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What receptors do conventional antipsychotics affect?

A

non-elective dopamine receptor antagonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the three categories of conventional antipsychotics?

A

phenothiazines, butyrophenones, and thioxanthines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Neuroleptic agents that affect a variety of receptors including dopaminergic receptor sites.

A

What are phenothiazines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Phenothiazides are used to treat…

A

psychosis including schizophrenia; violent agitated, disturbed behavior, and mania secondary to bipolar disorder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Phenothiazides work by binding to

A

dopamine (D1 and D2), muscarinic, histamine H1, and serotonergic 5HT2 receptors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Phenothiazides also possess peripheral

A

adrenergic receptor blockage and quinidine-like cardiac effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Phenothiazides may do what to seizure thresholds?

A

lower them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the signs of clinical toxicity in someone taking phenothiazides?

A

sedation, coma, hypotension, EPS, and cardiac arrythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What type of side effects can be seen with phenothiazides?

A

Anticholinergic effects including blurred vision, decreased GI motility, delirium, agitation, hallucination, hyperthermia, tachycardia, and seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name 9 types of phenothiazides?

A

Chlorpromazine, fluphenazine, mesoridazine, perphenazine, prochlorperazine, promazine, thiridazine, Trifluoperazine and triflupromazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

This conventional antipsychotic group is similar to phenothiazides, though probably with less antiadrenergic, anti-histaminic and anticholinergic, and more anti-dopaminergic effects.

A

Butyrophenones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the nine types of Butyrophenones?

A

Haloperidol, Droperidol, Bromperidol, Benperidol, Tifluperidol, Melperone, Piamperone, Moperone, Fluanisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

This conventional antipsychotic is more selective D2 agonists and are used most often in children and adolescents. Their side effect profile is like other conventional antipsychotics but also includes restless leg syndrome.

A

Thioxanthenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the seven types of thioxanthenes?

A

Flupentixol, thiotixene, zuclopenthixol, chlorprothixene, lucanthone, clopenthixol, hycanthone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a causative factor in the undesirable side effects in conventional antibiotics?

A

to block adequate numbers of D2 receptors in the mesolimbic dopamine pathway to quell positive symptoms, one must simultaneously block the same number of D2 receptors throughout the brain, and this causes undesirable side effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When dopamine D2 receptors in the tuberoinfundibular DA pathway are also blocked by conventional antipsychotics it can cause…

A

sedation, motor issues, increased plasma prolactin concentrations (hyperprolactinemia).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hyperprolactinemia can cause conditions such as

A

galactorrhea (breast secretions), amenorrhea, and may interfere with fertility, demineralization of bones, gynecomastia, sexual dysfunction and weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When dopamine D2 receptors in the nigrostriatal DA pathway are also blocked by conventional antipsychotics this causes

A

EPS such as akathisia, tremors, dystonia, parkinsonism, tardive dyskinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

The blockade of histamine H1 receptors in conventional antipsychotic drugs causes

A

weight gain and drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

The blockade of a1-adrenergic receptors in conventional antispsychotic drugs causes

A

cardiovascular side effects such as orthostatic hypotension and drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Low potency conventional antipsychotics require higher doses but

A

in addition low potency agents tend to have more of the unwanted side effects and are more sedating in general then high potency ones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

AAΨ

A

Atypical Antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What differentiates AAΨ from CAΨ in terms of effectiveness and side effects.

A

AAΨ have a clinical profile of equal positive symptom antipsychotic actions, but lo EPS and hyperprolactinemia compared to conventional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

The current atypical antipsychotics as a class are defined as

A

serotonin-dopamine antagonists with simultaneous serotonin 5HT2A receptor antagonism that accompanies D2 agonism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

AAΨ have additional properties that are important such AS

A

antidepressant actions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

All antipsychotics are effective for psychotic mania but atypical antipsychotics appear to have greater efficacy for

A

nonpsychotic mania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which AAΨ has the best anecdotal and clinical evidence for utility in various anxiety disorders

A

quetiapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the three receptors that are blocked by AAΨ that theoretically are responsible for causing sedation?

A

M1 Muscarinic cholinergic receptors, H1 Histamine receptors, and a1 adrenergic receptors.

36
Q

Clozapine, quetiapine, olanzapine, and iloperidone are all more potent

A

H1 antagonists than D2 antagonists

37
Q

Only the pines clozapine, quetiapine, and olanzapine have high potency for

A

muscarinic receptors

38
Q

All AAΨ have at least moderate binding potency to this receptor, but the most potent are clozapine, quetiapine, risperidone, and iloperidone

A

a1 adrenergic antagonism

39
Q

Which two AAΨ have a high metabolic risk?

A

Clozapine and olanzapine

40
Q

Which four AAΨ have a medium metabolic risk?

A

risperidone, paliperidone, quetiapine, iloperidone (weight only)

41
Q

Which four AAΨ have a low metabolic risk?

A

ziprasidone, aripiprazole, lurasidone, iloperidone (low for dyslipidemia)

42
Q

What are the four parameters that should be tracked when prescribing AAΨ?

A

weight (BMI), fasting triglycerides, fasting glucose, and blood pressure

43
Q

What are the major factors that determine whether a patient progresses along the metabolic highway to premature death?

A

unmanageable factors: genetic makeup and age
Manageable factors: change in lifestyle
Most manageable factors: selection of the antipsychotic

44
Q

How to remember the AAΨ

A

The pine (peenz), the dones (dohnz), two pips, and a rip, and the others

45
Q

Identify the three pertinent “Pines”

A

Clozapine (clozaril), Olanzepine (Zyprexa), Quietiepine (Seroquel)

46
Q

The presence of what in Clozapine is linked to its lack of EPS, tardive dyskinesia and hyperprolactinemia?

A

The presence of serotonin 5HT2A antagonism

47
Q

The gold standard for efficacy in schizophrenia

A

Clozapine

48
Q

Clozapine may have a particular niche in treating

A

aggression and violence in psychotic patients

49
Q

Clozapine is the only antipsychotic documented to reduce the risk of this in schizophrenia

A

suicide in schizophrenia

50
Q

Clozapine may reduce this in some patients with this problem, especially over long treatment intervals.

A

tardive dyskinesia

51
Q

What is the most important thing to monitor with Clozapine?

A

Absolute neutrophil count for as long as they are treated with clozapine due to its occasionally fatal complication of agranulocytosis

52
Q

Clozapine may have the greatest efficacy but also the most side effects among the AAΨ. Side effects include:

A

seizures, sedation, excessive salivation, myocarditis, and the greatest degree of weight gain and cardiometabolic risk

53
Q

Due to its side effects and risks clozapine is considered

A

NOT first line, but is used when other antipsychotics fail

54
Q

Olanzipine is BLANK potent than clozapine

A

more

55
Q

Olazipine has LESS

A

EPS, sedation, prolactinemia

56
Q

Olazipine has significant side effects such as

A

weight gain, cardiometabolic risks, dyslipidemia (elevating triglycerides) or diabetes,

57
Q

As far as when to prescribe Olanzipine it is considered

A

second line

58
Q

Quetiapine has a different formation that includes an active metabolite

A

norquetiapine

59
Q

Quetiapine is BLANK potent than clozapine

A

MORE

60
Q

Quetiapine has a robust

A

antidepressant effects

61
Q

Quetiapine should be taken

A

at night because it is most sedating at its peak delivery shortly after taking it

62
Q

The antipsychotic quetiapine is

A

an 800 mg ideally XR formulation

63
Q

The antidepressant quetiapine is

A

300 mg ideally XR formulation

64
Q

The sedative hypnotic quetiapine is

A

50 mg in the IR formulation

65
Q

Quetiapine is the preferred atypical antipsychotic for patients with

A

Parkinson’s disease who require treatment for psychosis (as is clozapine)

66
Q

Quetiapine has many side effects such as

A

weight gain, increase in fasting triglycerides, and insulin resistance

67
Q

Name the four “dones” (dohnz)

A

Risperidone, Paliperidone (invega), ziprasidone (geodon), lurasidone (latuda)

68
Q

This medication is available in a long term depot injectable formulation lasting for 2 weeks, an oral disintegrating tablet, and liquid formaluation

A

risperidone

69
Q

What side effects are serious concern for risperidone?

A

it raises prolactin levels even at low doses, weight gain (especially in children), and dyslipidemia

70
Q

This is the active metabolite of risperidone

A

Paliperidone

71
Q

A big difference between paliperidone and risperidone IS

A

that paliperidone is eliminated upon urinary excretion and SO has few pharmacokinetic drug interactions and it comes in a sustained-release formulation

72
Q

This AAΨ has a formulation for a depot long term administration of every 4 weeks and is currently the preferred depot AAΨ.

A

Paliperidone

73
Q

What makes Ziprasidone unique?

A

It has little or no propensity for weight gain and little issue with dyslipidemia, elevation of fasting triglycerides, or insulin resistance

74
Q

How should ziprasidone be taken?

A

Twice a day and with food (at least 500 calorie meal)

75
Q

This AAΨ has an intramuscular dosage formulation for rapid use in urgent circumstances

A

ziprasidone

76
Q

What cardiac complication can be caused by ziprasidone?

A

QTc prolongation

77
Q

Lurasidone has a high affinity for

A

5HT7 and 5HT2A

78
Q

What are the benefits of Lurasidone?

A

little sedation if dosed at night and little weight gain or dyslipidemia (may reverse previous weight gain or dyslipidemia associated with a different AAΨ). It has both antipsychotic and some antidepressant effects.

79
Q

What are the two pips and a rip?

A

Aripiprazole (abilify), Brexipiprazole (Rexulti), Cariprazine (Vraylar)

80
Q

Aripiprazole is a

A

D2 partial agonist and 5HT1A partial agonist

81
Q

Aripiprazole is effective in treating

A

schizophrenia ages 13 and up, mania/mixed mania age 10 and older, and autism related irritability in children ages 6-17

82
Q

Benefits of Aripiprazole include

A

little or no propensity for weight gain, dyslipidemia, elevation of fasting triglycerides or insulin resistance

83
Q

Brexpiprazole is used to treat

A

schizophrenia, mania, agitation and psychosis in dementia

84
Q

This AAΨ is still under investigation, but has the interesting potential for development as a weekly, biweekly, or even monthly oral depot

A

Cariprazine

85
Q

What are the three “other” AAΨ

A

sulpiride, amisulpride, Sertindole

86
Q

Conventional antipsychotics have lots of side effects due to

A

dopamine D2 antagonism

87
Q

Atypical antipsychotics have decreased side effects because

A

D2 antagonism, D2 partial antagonism, 5HT2 antagonism and 5HT1A partial agonism

NURS 7310 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions