Flashcards in Antipsychotic drugs-Kirkpatrick Deck (62):
What are appropriate uses for antipsychotics?
Adjunct to antidepressants
What are other common uses for antipsychotics?
Behavioral problems in patients with dementia (2nd or 3rd line only)
Delirium ((2nd or 3rd line only)
What is the dopamine theory of schizophrenia?
Antipsychotic meds are all dopamine (blank) or (blank) and dopamine receptor binding has a strong correlation with (blank).
T or F
Patients’ responses to antipsychotics are highly variable; some don’t respond at all
Psychotic symptoms have a transient increase with infusion of low doses of what three things?
Ketamine (an NMDA antagonist)
MCPP (a sertonin agonist)
What are the 2 dopamine pathways?
When you give block dopamine receptors how does it effect these pathways?
nigrostrital- extrapyramidal side effects
what are the functions of the dopamine pathway?
-motor function (fine tuning)
What are the functions of the serotonin pathways?
What are the commonly use first generation drugs antipsychotics?
Which ones have a depot formulation?
Haloperidol and fluphenazine
What are the five most commonly used 2nd generation antipsychotics?
Which ones have a depot formulation?
-aripiprazole olanzapine, risperidone
What is the mechanism of action of all antispychotics except for one? Which one is the exception and how does it work?
They are all dopamine antagonists
Aripiprazole (abilify)-> partial dopamine agonist
Why dont you use the depot formulation of olanzapine?
Because it causes hypotension
Which 2 antipsychotics cause the most weight gain?
Clozapine and olanzapine
T or F
all of the 2nd generation drugs have superior efficacy, especially for negative symptoms
-improvement in neg sx is due to improvement in other psychiatric symptoms and/or motor side effects
T or F
2nd generation drugs have no risk of EPS
it varies by drug and is dose related
T or F
If a patient's psychotic symptoms havent responed you should raise the dose
T or F
if a patient has particularly severe psychotic symptoms, he or she needs a higher dose
T or F
If a patient has symptoms in the grey zone b/w odd experiences and clearcut psychosis, you should give a lower dose than usual
How do all antipsychotics look on a dose-response curve?
they have an exponential increase and then plateau (efficacy does not increase past this point, in fact it drops)
What antipsychotic is th e most effective but has the most side effects?
What is the class I antipsychotic?
What is the class II antipsychotic?
Risperidone and Olanzapine
What is the class III antipsychotic?
(zotepine, amisulpride, aripiprazole, sertindole, quietiapine, ziprasidone, remoxipride)
What is the major side effect of clozapine? Is this reversible? When will it most likely occur? How do you keep an eye out for it?
Agranulocytosis (bone marrow suppression)
in the first year (about 1%)
What are all the SEs of clozapine?
What are extrapyramidal side effects?
-Neuroleptic Malignant Syndrome
What is the treatment for EPS?
decrease dose, change medication
These will remedy everything except for akathisia
What is the only symptom of EPS that cannot be remedied by amantadine or anticholinergic drugs?
How do you treat akathisia?
-beta blockers (propranolol)
-maybe high doses of B6
A study was done comparing the rate of antipsychotic medication discontinuation with 1st generation vs 2nd generation antipsychotics, which class was discontinued more and why?
both were discontinued equally due to SEs
What is this:
syndrome of involuntary choreo-athethoid movements, not just the mouth and face
Tardive dyskinesia is a SE of (blank) generation antipsychotics and is (blank and blank)-related
dose and time
What ethinicity and gender is most susceptible to tardive dyskinesia?
Male gender, AA
If you stop the medication that is inducing tardive dyskinesia what will happen?
you will get transient worsening and then you may or may not get improvement
What movement disorder may be a risk factor for tardive dyskinesia?
Which is drug puts you at higher risk of developing tardive dyskinesia; haloperidol or olanzapine?
What is the only antipsychotic drug that caused weight loss?
Weight gain in schizophrenics is iatrogenic (caused by physicians) cuz that antipsychotics make you gain weight! How do we know this?
cuz schizophrenia is associated with smaller BMI, shorter and skinner people w/out tx
How do you treat weight gain?
If you block D2 receptors, what are the side effects?
EPS, prolactin elevation
If you block M1 receptors, what are the side effects?
Cognitive deficits, dry mouth, constipation, increased heart rate urinary retention, blurred vision
If you block H1 receptors what are the side effects?
sedation, weight gain, dizziness
If you block the alpha 1 receptors what are the side effects?
If you block the 5-HT2A receptors what are the side effects?
If you block the 5-HT2c receptors what are the side effects?
Why are secondary generation drugs considered better than first generation drugss?
cuz they block the 5-HT2A receptor thus inducing ANTI-EPS side effects YAY
What is the QT interval?
What happens if the interval is increased?
measure of the time between the start of the Q wave and the end of the T wave in EKG
-the electrical depolarization and repolarization of the ventricles
-its a risk factor for ventricular tachyarrhytmias (especially torsades de pointes) AND sudden death
A normal QT wave depends on a (blank). How do you correct a QT wave for differences in heart rate?
What is a normal QTc?
-The QTC (estimates QT interval at a heart rate of 60bpm)
-less than 400 ms
There is a risk of sudden death with a QTc of....
Borderline for males?
Abnormal for males?
Borderline for females?
Abnormal for females?
What are risk factors for increased QTc?
What 2 antipsychotics can cause increased QTC and by how much?
4 ms for risperidone
30 ms for thioridazine
In dementia what are some behavioral problems associated with it?
psychosis, agitation, suspiciousness, irritability
How do you treat dementia often times?
How well does this work?
-antipsychotics and benzodiazepines
short term-> may work
Long term-> danger and ineffective
Treating dementia with Benzos can result in what two serious side effects?
How should you treat dementia instead?
-psychosocial interventions, especially managing environmental cues (including social interactions) should be the first step
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of (blank). (blank) is not approved for the tx of patients with dementia-related psychosis
What is a drug you should use instead of a antipsychotic in the treatment of dementia related psychosis and why? When cant you use this
citalopram -> has equal efficacy to risperidone
May not work in vascular dementia
IV Haloperidol increases the risk of (blank).
Drug-induced long QT and arrhythmia propensity substantially increase when specific psychotropic drugs are administered to patients with (blank X 4)
hypokalemia, abnormal T wave morphology, HCV infection, and HIV infection.
What atypical antipsychotic results in a lot of sedation and how is this drug taken?
does lurasidone effect the QT interval?