Antipsychotic Drugs Flashcards by Andrew Fournet

Name the typical antipscyhcotics

Chlorpromazine
Fluphenazine
Perphenazine
Thiothixene
Haloperidol

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Name the atypical antipsychotics

Clozapine
Risperidone
Olanzapine
Quetiapine
Ziprasidone
Aripiprazole
Paliperidone
Lurasidone
Asenapine

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What is alogia?

Lack of speech

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What is avolition?

Lack of initiative (motivation)

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Which Dopamine receptors inhibit Adenylate Cyclase?

D2, D3, D4

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Which Dopamine receptors activate Adenylate Cyclase?

D1 and D5

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What does Adenylate Cyclase do?

converts ATP to cAMP

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What is the MoA of typical antipsychotics?

Dopamine D2 blockers

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What type of symptoms are typicals good for treating?

Postive Symptoms

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Which Dopamine receptors inhibit Adenylate Cyclase?

D2, D3, D4

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Which Dopamine receptors activate Adenylate Cyclase?

D1 and D5

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What is the relevance of high potency typicals? Why do they do this?

High potency have higher chance of EPS, and they offer less sedation. This is due to weak anticholinergic effect and autonomic SAs.

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What is the MoA of typical antipsychotics?

Dopamine D2 blockers

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What type of symptoms are typicals good for treating?

Postive Symptoms

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What is the rank of potency of typicals?

Haloperidol>Fluphenazine=Perphenazine>Thiothixene>Chlorpromazine

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What is the relevance of low potency typical? Why do they do this?

Low potency typicals have lower incidence of Extra Pyramidal Symptoms (EPS). This is because of their antimuscarinic effects

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What is the relevance of high potency typicals? Why do they do this?

High potency have higher chance of EPS, and they offer less sedation. This is due to weak anticholinergic effect and autonomic SAs.

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What type of symptoms are atypicals good for treating?

Negative Symptoms

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What is the potency of Clozapine?

Low potency

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What is the MoA of Risperidone?

5-HT2/D2 agonist

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What is the only approved antipsychotic for children and teens?

Risperidone

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What is the primary active metabolite of Risperidone?

Paliperidone

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What is the MoA of Aripiprazole?

D2 partial agonist

5-HT2A antagonist, 5-HT1A partial agonist

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What is the MoA of Ziprasidone?

5-HT2A, 5-HT1A, 5-HT2C/D2 antagonist

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Which atypical antipsychotic acts as a D1, D2, 5-HT1, 5-HT2, alpha adrenergic and histamine receptor antagonist. With low affinity for muscarinic receptors?

Asenapine

What is the MoA of Lurasidone?

D2 and 5-HT2A antagonist | Partial agonist of 5-HT1A

Which atypical antipsychotic has the highest incidence of EPS?

Lurasidone

What effects do antipsychotics have in the Cerebral Cortex?

They can lower the threshold for seizures. This most often occurs with low potency drugs like the phenothiazines (Chlorpromazine, Fluphenazine, and Perphenazine)

What effects do antipsychotics have in the Basal Ganglia?

Decrease dopamine activity. This causes EPS. | Initially, they increase dopamine metabolism, synthesis, and firing rate, but this diminishes over time.

At what site in the brain do antipsychotics have their antipsychotic effect?

Limbic System

Which antipsychotic is an antidiuretic?

Chlorpromazine

Which antipsychotics have the most increase in prolactin secretion?

All Typicals and Risperidone

Which antipsychotics have no increase or decrease Prolactin secretion?

Quetiapine | Aripiprazole (may decrease secretion)

What effects do antipsychotics have in the brain stem at low doses?

Decreased vasomotor reflexes

What effects do antipsychotics have in the chemoreceptor trigger zone in low doses?

anti-nausea and vomiting elicited by activation of dopamine receptors

Which antipsychotic is an antidiuretic?

Chlorpromazine

What are the SAs of Chlorpromazine?

``` antidiuretic lowers glucose tolerance lowers insulin release orthostatic hypotension causes jaundice Urticaria in 5% of patients ```

Which atypical antipsychotics increase the risk of DM2?

Atypicals: Clozapine and Olanzepine have highest risk

Which atypical antipsychotics have the least risk of DM2

Aripiprazole and Ziprasidone

Which EPS symptoms have the latest onset?

Perioral Tremor | Tardative Dyskinesia

Which atypical antipsychotics have the least incidence of weight gain?

Ziprasidone (+/-) and Aripiprazole (+)

Which atypical antipsychotic has the highest risk of causing EPS?

Risperidone

Which atypical antipsychotics have the highest potential for CYP interactions?

Aripiprazole Quietipine Respiridone Ziprasidone

In a patient who develops Parkinsonian syndrome due to antipsychotic Rx, which two medications are contraindicated to treat this new problem? Why?

L-DOPA and Bromocriptine are contraindicated because they can induce agitation and enhance the psychosis

Which EPS symptoms have a delayed onset?

Perioral Tremor | Tardative Dyskinesia

Which EPS symptom can appear within the first 5 days of therapy?

Acute Dystonia

Which EPS symptom can develop within 5-60 days of therapy?

Akathesia (There's ants in my pants!!!)

Which EPS symptom can develop within 5-30 days of therapy?

Parkinsonian syndrome

In a patient who develops Parkinsonian syndrome due to antipsychotic Rx, which two medications are contraindicated to treat this new problem? Why?

L-DOPA and Bromocriptine are contraindicated because they can induce agitation and enhance the psychosis

What are the symptoms of Neuroleptic Malignant Syndrome?

``` Fever Severe Parkinsonism with catatonia Fluctuations in coarse tremor intensity Autonomic instability high creatine kinase Myoglobinemia ```

What is the mortality rate in NMS?

High (10%)

How do you treat NMS?

STOP the antipsychotic | Dantrolene (muscle relaxant) or bromocriptine

Which drug will require weekly white blood cell counts? Why?

Clozapine | Because this can cause agranulocytosis (can see leukopenia before onset)

Which atypical antipsychotics have the highest incidence of metabolic syndrome?

Olanzapine

Which atypical antipsychotics have the lowest risk of metabolic syndrome?

Zisprasidone and Aripiprazole

Which side effect is caused seretonergic, muscarinic, noradrenergic, and D2 blockade?

Sexual side effects

What type of tissues do antipsychotics accumulate in?

High blood supply tissues

Should a pregnant woman take antipsychotics? Why?

Probably not. | Crosses placental barrier and enters beast milk.

Which antipsychotics have active metabolites?

Chlorpromazine Phenothiazines (chlorpromazine, Fluphenazine, Perphenazine) Respiridone (*Paliperidone) Aripiprazole

Name the long acting depot antipsychotics

Prolixin Decanoate Haldol Decanoate Risperidal Consta

What are some miscellaneous uses of antipsychotics?

Nausea and Vomiting (low dose) Alcoholic hallucinosis Neuropsychiatric disease with movement disorders: Tourette's , Huntington's, Intractable Hiccup

Antipsychotic Drugs Flashcards

(61 cards)