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Flashcards in Antipsychotic Deck (83)
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1

What are the two classes of antipsychotics?

First generation = "conventional" or "typical"
Second generation = "atypical"

2

What are the pathways associated with antipsychotic efficacy?

Hyperactivity of DA neurons in the mesolimbic pathway
Deficiency of DA in the mesocortical pathway

3

Which Da pathway are positive and negative sx?

Mesolimbic = positive
Mesocortical = negative

4

What receptors do most antipsychotic medications target?

D2 blocker

5

What receptors do antipsychotics block?

Histamine-1
Alpha-1
Muscarinic cholinergic

6

What motor SE are produced from antipsychotics?

TD
EPS

7

What happens if we block the mesolimbic pathway?

Improve positive sx of schizophrenia

8

What happens if we block the mesocortical pathway?

Worsening of negative sx (cognitive slowing/blunting)

9

What happens if we block the nigrostriatal pathway?

EPS

10

What happens if we block the tuberoinfundibular pathway?

Increase in prolactin/ hyperprolactinemia

11

What does EPS include?

Dystonia
Akathisia
Pseudoparkinsonism
TD

12

When is EPS more common?

FGA

13

What is acute dystonia?

Muscular rigidity and cramping often involving the neck, tongue, and face

14

What is the treatment of acute dystonia?

Removal of offending agent
Anticholinergics/benzo

15

What is akathisia?

Subjective feeling of intense restlessness (shaking/twitching/fidgeting)

16

What is the treatment of akathisia?

Removal of offending agent
Anticholinergic/propranolol

17

What is pseudoparkinsonism?

Bradykinesia
Ridigity
Cogwheeling
Tremor

18

What is the treatment of pseudoparkinsonism?

Removal of offending agent
Anticholinergics
Amantadine (DA)

19

What is tardive dyskinesia?

Long-standing or permanent abnormal involuntary movements

20

What is the treatment of TD?

Removal of offending agent
VMAT-2 inhibitors

21

What is neuroleptic malignant syndrome (NMS)?

"lead pipe" rigidity
Fever
Autonomic instability
Elevated WBCs

22

What is the treatment of NMS?

Removal of offending agent
Supportive care

23

What drug causes QTc prolongation?

Haloperidol

24

How are antipsychotics connected to mortality?

Increased mortality in elderly patients treated for dementia-related psychosis

25

How long should antipsychotics be used?

Shortest duration possible

26

What is the MOA of second generation antipsychotics?

D2 antagonism plus "selectively modifying" effects of serotonin antagonism

27

What SE are reduced in second from first generation antipsychotics?

Reduced risk of causing EPS and TD
Do not raise prolactin levels
Improve negative symptoms more than conventional antipsychotics

28

What are the SE of SGA?

Wt gain
Diabetes
Dyslipidemia

29

What is the most efficacious antipsychotic?

Clozapine

30

What are the CIs for clozapine?

H/o:
Seizures
Agranulocytosis