2nd Generation Antipsychotics

Question 1

What are the 1st line choices for Antipsychotics?

Answer 1

2nd generations!

Question 2

What is the MOA for most of the 2nd Generation agents?

Answer 2

Block 5-HT AND D2

– more serotonin blocking than dopamine blocking

Question 3

What is good about the 2nd generation agents blocking 5-HT2 more so than blocking D2?

Answer 3

LESS extrapyramidal symptoms and tardive dyskinesia

Question 4

What 5 agents are 5-HT2/DA ANTAGONISTS?

Answer 4

-idones!
Iloperidone
Lurasidone
Paliperidone
Risperidone
Ziprasidone

Question 5

What 5 agents at 5-HT2/DA ANTAGONISTS?

Answer 5

Iloperidone
Lurasidone
Paliperidone
Risperidone
Ziprasidone

Question 6

If the 2nd generation agent ends in -idone, what is its MOA?

Answer 6

5-HT(2) and DA ANTAGONIST

Question 7

What is a side effect of Ziprasidone?

Answer 7

ECG changes

Question 8

Lurasidone is a 5HT2/DA ANTAGONIST. What is its extra MOA?

Answer 8

5-HT1 AGONIST

Question 9

What 3 agents are 5-HT2/DA ANTAGONISTS and partial D2/5-HT1 AGONISTS?

Answer 9

Aripiprazole
Brexpiprazole
Cariprazine

Question 10

What 3 agents are 5-HT2/DA ANTAGONISTS and partial 5-HT1/D2 AGONISTS?

Answer 10

Aripiprazole
Brexpiprazole
Cariprazine

Question 11

What is the MOA for Aripiprazole, Brexpiprazole and Cariprazine?

Answer 11

5-HT2/DA ANTAGONISTS

5-HT1/D2 AGONISTS

Question 12

What 5 agents are MULTI-acting?

Answer 12

Asenapine
Clozapine
Olanzapine
Quetiapine
Lumateperone

Question 13

What 5 agents are MULTI-acting?

Answer 13

Asenapine
Clozapine
Olanzapine
Quetiapine
Lumateperone

Question 14

If the 2nd generation agent ends in -apine, what is its MOA?

Answer 14

MULTI-acting

– also Lumateperone

Question 15

What general side effects ca be seen with the Multi-acting agents Clozapine and Olanzapine specifically?

Answer 15

Weight gain

Increased glucose and lipid levels

Question 16

What 2 Multi-acting agents can cause weight gain and elevated glucose/lipids?

Answer 16

Clozapine

Olanzapine

Question 17

What should you get on the patient before starting a 2nd generation agent?

Answer 17

BASELINE weight, BP, glucose and lipid levels

– check at 12 weeks after starting

Question 18

What specific (2) adverse effects can occur with Clozapine use?

Answer 18

Agranulocytosis

Seizures

Question 19

What specific (2) adverse effects can occur with Clozapine use?

Answer 19

Agranulocytosis

Seizures

Question 20

What specific (1) adverse effect can be seen with Olanzapine use?

Answer 20

Eosinophilia and systemic symptoms

Question 21

What is a Serotonin Inverse Agonist?

Answer 21

Pimavanserin

Question 22

What is a Serotonin Inverse Agonist?

Answer 22

Pimavanserin

Question 23

The 2nd generation agents have what risk with elderly dementia patients?

Answer 23

Stroke

Question 24

2nd generation agents can cause what syndrome?

Answer 24

Neuroleptic Malignant Syndrome

Question 25

Neuroleptic Malignant Syndrome

Answer 25

Parkinson like movements with muscle contractions

Question 26

What receptor opens with Neuroleptic Malignant Syndrome?

Answer 26

Ryanodine receptor opens -- Calcium efflux => parkinson like movements with wide spread muscle contractions

Question 27

What are the 2 antidote options for Neuroleptic Malignant Syndrome?

Answer 27

Dantrolene | Diazepam

Question 28

What are the 2 antidote options for Neuroleptic Malignant Syndrome and their MOA?

Answer 28

Dantrolene - closes ryanodine receptor | Diazepam - peripheral muscle relaxation

Question 29

What are 4 things you can use to monitor antipyschotic use?

Answer 29

GASS AIMS BARS ESRS

Question 30

GASS antipsychotic monitoring

Answer 30

Overall side effect scale

Question 31

AIMS antipsychotic monitoring

Answer 31

Abnormal Involuntary Movement Scale

Question 32

BARS antipsychotic monitoring

Answer 32

Akathisia scale

Question 33

ESRS antipsychotic monitoring

Answer 33

Extrapyramidal symptom scale

Question 34

What does Pimavanserin treat?

Answer 34

Parkinson disease Psychosis

Question 35

What treats Parkinson disease Psychosis?

Answer 35

Pimavanserin

Question 36

What drug can treat suicidal thoughts/behaviors?

Answer 36

Clozapine

Question 37

What drug can treat multi-drug resistant psychoses?

Answer 37

Clozapine

Question 38

There are 4 agents that can be given via injection for acute agitation. What are they?

Answer 38

Haloperidol Ziprasidone Olanzapine Aripiprazole

Question 39

There are 4 agents that can be given via injection for acute agitation. What are they?

Answer 39

Haloperidol Ziprasidone Olanzapine Aripiprazole

Question 40

How can you manage NON-adherence?

Answer 40

Long acting injectable agents

Question 41

What do long acting injectable agents manage?

Answer 41

Non-adherence

Question 42

What 1st generation agents (2) can be used as long acting injectable agents?

Answer 42

Haloperidol | Fluphenazine

Question 43

What 1st generation agents can be used as long acting injectable agents?

Answer 43

Haloperidol | Fluphenazine

Question 44

What 2nd generation agents (4) can be used as long acting injectable agents?

Answer 44

ROAP - Risperidone - Olanzapine - Aripiprazole - Paliperidone

Question 45

What 2nd generation agents can be used as long acting injectable agents?

Answer 45

ROAP - Risperidone - Olanzapine - Aripiprazole - Paliperidone