Flashcards in Anti-Psychotics -- Segars Deck (31):
Recurrent suicidal behavior -- treatment
Schizophrenia - positive vs. negative symptoms
Positive = hallucinations, delusions, disorganized speech, agitation, behavioral dyscontrol
Negative = Apathy, avolition, alogia, cognitive deficits
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
Typical antipsychotic agents (3)
Atypical antipsychotic agents (8)
***Major SE difference between the typicals and atypicals
TYPICALS have movement-disorder side effects (extrapyramidal symptoms)
MoA of antipsychotics (in general)
Block D2 post-synaptic receptors
**Partial agonists at D2/3 and 5HT-1A receptors
**Blocker of NE reuptake transporter (NERT)
NorquetiAPINE (metabolite of QuetiAPINE)
Which agents are more likely to block D1 and D4 receptors also?
Which agents are more likely to block 5-HT receptors also?
**Typical agent(s) -- sedation, hypotension, seizures
Low potency blocker of D2
**Typical agent(s) -- dystonia, akathisia, dyskinesia, parkinson-like symptoms
High potency blockers of D2
***Extrapyramidal symptoms (EPS) -- treatments?
- Diphenhydramine (Benadryl)
Propranolol/Clonazepam (for akathisia)
**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)
**Non-behavioral side effect related to dopamine inhibition
Hyperprolactinemia -- amenorrhea, erectile dysfunction, infertility, decreased libido, galactorrhea)
***Agranulocytosis - drug cause?
Must do what?
Autonomic instability, stupor, hyperpyrexia, muscle rigidity, altered mental status
Neuroleptic malignant syndrome (NMS)
Injectable, high-potency typical agents
ALL patients taking antipsychotics should FIRST have what things measured/recorded?
Glucose, lipids, weight, BP, waist size, FHx, etc.
Some (atypicals especially) may cause: weight gain, hyperlipidemia/hyperglycemia, QT prolongation
**Highest risk of mortality from taking anti-psychotics
STROKE -- in elderly w/ dementia
Aripiprazole, Olanzapine, Paliperidone, Risperidone
Sedation (anti-histamine effect) -- drugs? (3)
Anti-muscarinic effects -- drugs? (3)
Orthostatic hypotension (anti-alpha effect) -- drugs? (2)
QT prolongation/ECG changes -- drugs? (4)
EPS -- drugs? (3)
Weight gain -- drugs? (2)
Hyperglycemia, Hyperlipidemia - drugs? (2)
Seizures - drugs (3)
Hyperprolactinemia - drugs? (2)
Haloperidol (other 2 are less)
2 things to think about when choosing a drug
Previous dosing history (efficacy vs. SEs)
Tolerance to SEs
**Patient w/ non-compliance can be treated w/ what?
Long-acting injectable agents
Typicals = Haloperidol, Fluphenazine
Atypicals = Risperidone, Olanzapine, Aripiprazole, Paliperidone