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Anti-psychotics Flashcards

(129 cards)

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1
Q

syndrome of chronic disordered thinking and disturbed behavior

A

psychoses

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2
Q

deficits in integrating ______ and ______ with ________

A

thoughts and perception with emotions

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3
Q

schizophrenia primarily develops between the ages of ______. cases are rare before age ____ and after age ______

A

16-30. rare before 12 and after 40

males: 16-25, females: 25-30

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4
Q

schizophrenia is a _________ group of _______ disorders

A

heterogeneous group of heritable disorders

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5
Q

3 classes of schizophrenia symptoms

A

positive symptoms, negative mood, negative cognition

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6
Q

positive symptoms

A

delusions, hallucinations, disorganized speech, disorganized behavior

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7
Q

negative mood symptoms

A

dysphoria, suicidality, anxiety, hopelessness, anxiety, hostility

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8
Q

negative cognition symptoms

A

attention deficit, memory deficit, abstract thought deficit

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9
Q

pharmacological agents address the _______ of psychosis

A

symptoms

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10
Q

Dopamine Hypothesis: _________ dopaminergic activity in schizophrenia

A

excessive

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11
Q

antipsychotics strongly block postsynaptic ____ receptors

A

D2

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12
Q

Serotonin Hypothesis: psychosis may result from _______ of 5HT2A receptors

A

hyperactivation

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13
Q

Atypical antipsychotics are _______ ________ of the 5HT2A receptor; they _______ the level of constitutive activity of these receptors

A

inverse agonists, decrease

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14
Q

excess glutamate release may ________ the mesolimbic pathway, causing _______ dopamine in ventral striatum

A

activate, excess

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15
Q

Glutamate hypothesis: psychosis may result from _______ NMDA receptors on GABA neurons

A

hypofunctional

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16
Q

decreased GABAergic activity causes _______ of glutamatergic signaling, which can cause ________ dopamine release

A

dis-inhibition, excess

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17
Q

2 NDMA receptor antagonists

A

Phencyclidine, Ketamine

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18
Q

The NMDA receptor is an ________ ________, it requires _________ as a co-agonist for full activation. in schizophrenics this site may not be fully _______

A

ion channel, glycine, saturated

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19
Q

________ muscarinic antagonism in CNS leads to delusional behavior

A

Excessive

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20
Q

________ of H1 receptors was once thought to be important in anti-psych activity

A

blockade

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21
Q

Typical or Atypical: Chlorpromazine

A

Typical

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22
Q

Typical or Atypical: Perphenazine

A

Typical

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23
Q

Typical or Atypical: Trifluoperazine

A

typical

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24
Q

Typical or Atypical: Thioridazine

A

typical

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25
Typical or Atypical: Fluphenazine
typical
26
Typical or Atypical: Haloperidol
Typical
27
Typical or Atypical: Thiothixene
Typical
28
Typical or Atypical: Mesoridazine
Typical
29
Typical or Atypical: Loxapine
Typical
30
Typical or Atypical: Molindone
Typical
31
Typical or Atypical: Pimozide
Typical
32
Typical or Atypical: Clozapine
Atypical
33
Typical or Atypical: Risperidone
Atypical
34
Typical or Atypical: Olanzapine
Atypical
35
Typical or Atypical: Quetiapine
Atypical
36
Typical or Atypical: Ziprasidone
Atypical
37
Typical or Atypical: Aripiprazole
Atypical
38
Typical or Atypical: Paliperidone
Atypical
39
Typical or Atypical: Iloperidone
Atypical
40
Typical or Atypical: Asenapine
Atypical
41
Typical or Atypical: Lurasidone
Atypical
42
Typical or Atypical: Brexipiprazole
Atypical
43
Typical or Atypical: Cariprazine
Atypical
44
_________ antipsychotics primarily block D2 receptors
Typical
45
_________ antipsychotics block D2 and 5HT2A receptors (some have higher affinity for 5HT2A)
Atypical
46
_________ antipsychotics are associated with Extrapyramidal Side Effects
Typical
47
_________ antipsychotics are associated with Metabolic Side Effects
Atypical
48
Typical antipsychotics primarily block _______ receptors
D2
49
Atypical antipsychotics block ______ and ______ receptors
D2 and 5HT2A
50
typical antipsychotics are more associated with which type of side effects
Extrapyramidal
51
Atypical antipsychotics are more associated with which type of side effect
Metabolic
52
what symptoms do antipsychotics improve
hallucinations, delusions, combativeness, anorexia, self care, withdrawal
53
the potency of typical antipsychotics correlates ________ with their affinity for the ______ receptor
linearly, D2
54
typical antipsychotics generally have a higher affinity for the _____ receptor
D2
55
atypical antipsychotics generally have a higher affinity for the _____ receptor
5HT2A
56
which TYPICAL antipsychotic has the most side effects
Chlorpromazine
57
which ATYPICAL antipsychotic has the most side effects
Clozapine
58
D2 receptors in the ________ and _______ areas control psychoses
Cortex and Limbic
59
D2 receptors in the _________ and _________ areas are more associated with adverse effects
Basal Ganglia and Hypothalamus/Pit
60
Adverse effects can occur because of the ________ of the D2 receptors
location
61
which Typical antipsychotic has metabolic side effects
Chlorpromazine
62
what are metabolic side effects
weight gain, lipids, glucose
63
which typical antipsychotics are NOT phenothiazine derivatives
Loxapine, Haloperidol, Molindone
64
MOST typical antipsychotics are ____________ derivatives
phenothiazine
65
which 3 Atypical antipsychotics are NOT associated with metabolic side effects
Aripiprazole, Asenapine, Ziprasidone
66
Extrapyramidal side effects are due to _____ receptor antagonism in the ________
D2, Basal ganglia
67
what are Extrapyramidal side effects
Parkinsonism, Restlessness, Dystonia, Tardive Dyskinesia
68
what are Extrapyramidal side effects
Parkinsonism, Restlessness, Dystonia, Tardive Dyskinesia
69
How do you treat Parkinsonism
anticholinergics
70
How do you treat Dystonia
IM or IV diphenhydramine or benztropine (anticholinergics)
71
How do you manage akathisia
lower dose, change drugs, adjunctive med (propranolol, benztropine, benzodiazepines)
72
adjunctive medications for akathisia
propranolol, benztropine, benzodiazepines
73
what is akathisia
restlessness, pacing, fidgeting
74
how to PREVENT tardive dyskinesia
use minimum effective dose, use atypical
75
how to TREAT tardive dyskinesia
lower dose, switch to atypical, Valbenazine
76
can you use anti-muscarinic drugs to treat tardive dyskinesia
NO, they will not improve
77
what is tardive dyskinesia
involuntary movements, often choreoathetoid
78
are men or women more likely to get tardive dyskinesia
women
79
what drug is used to treat tardive dyskinesia
Valbenazine
80
MOA of Valbenazine
VMAT2 inhibitor, increases cytoplasmic DA
81
side effects of Valbenazine
sleepiness, QT prolongation
82
newer drug for tardive dyskinesia but has a boxed warning for depression
Deutetrabenazine
83
cause of Neuroleptic Malignant Syndrome
High parenteral doses of antipsychotics into skeletal muscle
84
what 3 antipsychotics cause NMS-atypical
Clozapine, Olanzapine, Risperidone
85
Treatment of Neuroleptic Malignant Syndrome
Dantrolene or Bromocriptine (D/C antipsych)
86
spasm of muscles of tongue, face, neck, back
acute dystonia
87
restlessness
akathisia
88
bradykinesia, rigidity, tremor, shuffling gait
Parkinsonism
89
extreme rigidity, fever, unstable BP, can be fatal
neuroleptic malignant syndrome
90
what drug has been used to treat/prevent metabolic syndrome
Metformin
91
``` Metabolic Syndrome: FBGL > _____, ________ BP, Triglycerides > ________, ________ Waist Circumference, ________ HDL, Weight _______ ```
``` FBGL > 100, INCREASED BP, Triglycerides > 150, INCREASED Waist Circumference, DECREASED HDL, Weight GAIN ```
92
what is monitored at baseline, 1 month, and 3 months
weight, BP, fasting glucose, fasting lipid panel
93
what is monitored yearly
weight, BP, fasting glucose
94
what is monitored every 3 years
fasting lipid panel
95
``` what changes are you looking for when monitoring for metabolic syndrome: ______% increase in weight, BMI > ______, Fasting glucose > _______, BP > _______ ```
5-7% increase in weight, BMI > 25, Fasting glucose > 126, BP > 140/90
96
_________ antipsychotics (other than _______) are first choice drugs
atypical, Clozapine
97
most metabolically neutral atypical antipsychotics
Ziprasidone, Aripiprazole, followed by Asenapine
98
what 4 antipsychotics come in long acting injectables
Haloperidol, Fluphenazine, Risperidone, Paliperidone
99
how often are Fluphenazine and Risperidone injections needed
every 2 weeks
100
how often are Haloperidol injections needed
every 4 weeks
101
How often are Paliperidone injections needed
every 3 months
102
which antipsychotic can cause Agranulocytosis
Clozapine
103
fall in granulocytes
Agranulocytosis
104
Clozapine and prominent anti ____ and _____ receptor effects, which cause ______ and _______
M and H1, constipation, Sedation
105
what is the most effective antipsychotic (but is limited by side effects)
Clozapine
106
which antipsychotic is used for Autism
Risperidone
107
what is the most effect antipsych after Clozapine (but is also limited by side effects)
Olanzapine
108
which antipsych can be used for depression monotherapy
quetiapine
109
which antipsych has increased absorption when taken with food
Ziprasidone
110
what is the active metabolite of Risperidone
Paliperidone
111
which antipsych is used for anxiety and depression
Iloperidone
112
which antipsych is an add on agent for MDD
Brexpiprazole
113
which antipsych is used for Bipolar Type 1
Cariprazine
114
which antipysch is only a partial agonist at D2 (decrease EPS, positive side effect profile)
Aripiprazole
115
Bipolar 1
depression and mania
116
Bipolar 2
major depression and hypomania
117
Cyclothymia
hypomania and less severe depression
118
elevated, expansive mood with increased energy and goal directed behavior. associated with functional impairment requiring hospitalization
Mania
119
what is the difference is mania and hypomania
hypomania doesn't require hospitalization
120
PREVENT bipolar episodes with
mood stablizers (lithium, valproate, carbamazepine, lamotrigine)
121
TREAT bipolar episodes with
atypical antipysch and/or benzodiazepine
122
2 common features between bipolar disorder and epilepsy
episodic nature and kindling
123
Lithium inhibits __________, which decreases levels of ________ and ________. This pathway is normally ________ during mania
IMPase, Inositol and PIP2, increased
124
Lithium inhibits _______ by enhancing ______ activity, which increases ________ levels in the hippocampus
GSK3, Akt, beta-catenin
125
elevated dopamine normally _______ GSK3
activates
126
therapeutic levels of Lithium
0.75-1.25 mEq/L
127
lithium has a _____ therapeutic index
low
128
how is lithium excreted
renally
129
lithium treatment may cause ________ and __________ due to inhibition of ________
polyuria and polydipsia, Anti-Diuretic Hormone

Pharmacology (5 decks)

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