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Flashcards in Anti-Psychotics -- Segars Deck (31):
1

Recurrent suicidal behavior -- treatment

Clozapine

2

Schizophrenia - positive vs. negative symptoms

Positive = hallucinations, delusions, disorganized speech, agitation, behavioral dyscontrol

Negative = Apathy, avolition, alogia, cognitive deficits

3

Schizophrenia - cause of positive vs. negative symptoms



Name of this theory?

Positive = increased post-synaptic D2 receptor activity in mesolimbic system
Negative = decreased D1 activity in pre-frontal cortex

Dopamine hypothesis

4

Typical antipsychotic agents (3)

Haloperidol
ChlorpromAZINE
FluphenAZINE

5

Atypical antipsychotic agents (8)

AriPIPRAZOLE
BrexPIPRAZOLE

ClozAPINE
OlanzAPINE
QuetiAPINE

PaliperIDONE
RisperIDONE
ZiprasIDONE

6

***Major SE difference between the typicals and atypicals

TYPICALS have movement-disorder side effects (extrapyramidal symptoms)

7

MoA of antipsychotics (in general)

Block D2 post-synaptic receptors

8

**Partial agonists at D2/3 and 5HT-1A receptors

AriPIPRAZOLE
BrexPIPRAZOLE

9

**Blocker of NE reuptake transporter (NERT)

NorquetiAPINE (metabolite of QuetiAPINE)

10

Which agents are more likely to block D1 and D4 receptors also?

Which agents are more likely to block 5-HT receptors also?

ATYPICALS

ATYPICALS

11

**Typical agent(s) -- sedation, hypotension, seizures

Why?

Chlorpromazine

Low potency blocker of D2

12

**Typical agent(s) -- dystonia, akathisia, dyskinesia, parkinson-like symptoms


Why?

Fluphenazine
**HALOPERIDOL

High potency blockers of D2

13

***Extrapyramidal symptoms (EPS) -- treatments?

***Anticholinergics
- Diphenhydramine (Benadryl)
- Benztropine
- Trihexyphenidyl
Amantadine
Propranolol/Clonazepam (for akathisia)

14

**3 other receptors that can be blocked by antipsychotics and cause symptoms (w/ symptoms)

Muscarinic (dry mouth, constipation, blurred vision, etc.)

Alpha-adrenergic (orthostatic hypotension, impotence)

Histamine (SEDATION)

15

**Non-behavioral side effect related to dopamine inhibition

Hyperprolactinemia -- amenorrhea, erectile dysfunction, infertility, decreased libido, galactorrhea)

16

***Agranulocytosis - drug cause?

Must do what?

Clozapine

Monitor WBCs

17

Autonomic instability, stupor, hyperpyrexia, muscle rigidity, altered mental status

Cause?

Neuroleptic malignant syndrome (NMS)

Injectable, high-potency typical agents

18

ALL patients taking antipsychotics should FIRST have what things measured/recorded?

***Why?

Glucose, lipids, weight, BP, waist size, FHx, etc.

Some (atypicals especially) may cause: weight gain, hyperlipidemia/hyperglycemia, QT prolongation

19

**Highest risk of mortality from taking anti-psychotics

**Drugs? (4)

STROKE -- in elderly w/ dementia

Aripiprazole, Olanzapine, Paliperidone, Risperidone

20

Sedation (anti-histamine effect) -- drugs? (3)

Chlorpromazine

Olanzapine
Quetiapine

21

Anti-muscarinic effects -- drugs? (3)

Chlorpromazine

**Clozapine
Olanzapine

22

Orthostatic hypotension (anti-alpha effect) -- drugs? (2)

Chlorpromazine

Clozapine

23

QT prolongation/ECG changes -- drugs? (4)

Chlorpromazine
Fluphenazine

Paliperidone
**ZIPRASIDONE

24

EPS -- drugs? (3)

***Haloperidol
Fluphenazine
Chlorpromazine

25

Weight gain -- drugs? (2)

***Clozapine
***Olanzapine

26

Hyperglycemia, Hyperlipidemia - drugs? (2)

***Clozapine
***Olanzapine

27

Seizures - drugs (3)

Chlorpromazine

Clozapine
Olanzapine

28

Hyperprolactinemia - drugs? (2)

Haloperidol (other 2 are less)

Risperidone

29

2 things to think about when choosing a drug

Previous dosing history (efficacy vs. SEs)

Tolerance to SEs

30

**Patient w/ non-compliance can be treated w/ what?

**Drugs? (6)

Long-acting injectable agents

Typicals = Haloperidol, Fluphenazine

Atypicals = Risperidone, Olanzapine, Aripiprazole, Paliperidone

31

Anti-psychotics in pregnancy?

ALL but 2 are Category C -- can use if truly needed