Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PMHNP > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

Schizophrenia positive symptoms

A

Positive Symptoms
Hallucinations
Delusions (bizarre, persecutory)
Disorganized Thought
Perception disturbances
Inappropriate emotions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Schizophrenia Negative Symptoms

A

Blunted emotions (e.g.
flat affect)
Anhedonia
Lack of feeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Schizophrenia Mood symptoms

A

Loss of motivation
Social withdrawal
Insight
Demoralization
Suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Schizophrenia Cognitive symptoms

A

New Learning
Memory
Trouble focusing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Dopamine Hypothesis of Schizophrenia

A

Reduced dopamine activity in mesocortical dopamine pathway may be associated with negative and cognitive symptoms of schizophrenia
An abnormality in DA function has been detected in patients with schizophrenia
A reduction in cortical dopamine transmission (both at the pre- and postsynaptic level)
Hyperactivity of dopamine neurons in the mesolimbic pathway may lead to positive symptoms of schizophrenia

Several drugs (e.g. amphetamines, cocaine, cannabis) have been linked psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Schizophrenia diagnostic criteria

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Antipsychotic medications overview

A

Target symptoms: Psychosis (alteration in thought process and/or content)
Types
Typical
Atypical
Absorption: variable
Clinical effects seen 30-60 min
IM less variable (avoid 1st pass)
When immobile, less absorption
Metabolism: liver
Excretion: slow
accumulates in fatty tissues
1/2 life of 24 hours or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Typical Antipsychotics

A

-Also known as conventional or first-generation antipsychotics
-Complex mechanism of action
Used as early treatments of schizophrenia and other psychotic disorders
-Antipsychotics may block D2 receptors in nigrostriatal DA pathway and mesolimbic pathway.
-Movement disorders may appear as a result of this blockage
-Extrapyramidal symptoms mimic Parkinson’s symptoms (e.g. tremors)
-Tardive Dyskinesia may occur with long term use(e.g. tongue protrusion, facial grimacing)
-Mesolimbic pathway hyperactivity is believed to cause positive symptoms (e.g. hallucinations)
-Reduces hyperactivity in MP reducing positive symptoms
-A reduction of D2 receptors in other areas of the brain may block reward mechanisms
-May cause worsening of negative symptoms (e.g. anhedonia)
-Best drug to treat positive symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Common side effects of antipsychotics

A

Cardiovascular - orthostatic hypertension
Weight-gain, dizziness, sedation, dry mouth, constipation
Endocrine and sexual: block dopamine, interfere with prolactin
Blood dyscrasias - agranulocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Sedation in antipsychotics

A

initially considerable; tolerance usually develops after a few weeks of therapy; dysphoria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Postural hypotension in antipsychotic medications

A

results primarily from adrenergic blockade; tolerance can develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anticholinergic effects with antipsychotic medications

A

include blurred vision, dry mouth, constipation, urinary retention; results from muscarinic cholinergic blockade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Endocrine effects of antipsychotics

A

increased prolactin secretion can cause galactorrhea; results from anti-dopamine effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hypersensitivity reactions to antipsychotics

A

‑ jaundice, photosensitivity, rashes, agranulocytosis can occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is an idiosyncratic reaction to antipsychotics

A

Neuroleptic Malignant syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Neuroleptic Malignant syndrome (features, time of max onset, treatment)

A

Neuroleptic malignant syndrome: combination of motor rigidity, hyperthermia, and autonomic dysregulation of blood pressure and heart rate (increased). Features may be catatonia, stupor, fever, myoglobinemia, can be fatal.
Time of maximal risk: weeks, can persist days after stopping neuroleptic.
Treatment: stop neuroleptic immediately, dantrolene or bromocriptine may help.
Antiparkinsonian agents not helpful.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Dantrolene in neuroleptic malignant syndrome

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Bromocriptine in neuroleptic malignant syndrome:

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which medications are in the typical antipsychotic class?

A

Phenothiazines and haloperidol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which medications are in the atypical antipsychotic class?

A

Clozapine (Clozaril)
Risperidone (Risperdal)
Paliperidone (Invega)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Haloperidol

A

Dosages: 1-40 mg/day for po forms
Immediate Release Injection: 2-5 mg
Decanoate Injection: 50-100 mg/ML

Weight gain – weight gain may occur
Sexual dysfunction result from NE and SE blockade (erectile dysfunction, retrograde ejaculation, loss of libido and anorgasmia in men and women)
Seizures-generalized grand mal
Photosensitivity, jaundice, agranulocytosis
Muscle spasm, restlessness, loss of balance, uncontrolled movement, EPS, akathisia.

Neuroleptic malignant syndrome: combination of motor rigidity, hyperthermia, and autonomic dysregulation of blood pressure and heart rate (increased)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which medications are in the phenothiazine class

A

Chlorpromazine(thorazine), thioridazine(mellaril), Trifluoperazine(stelazine).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Common side effects of phenothiazines

A

Weight gain - weight gain is common
Sedation : More common
Sexual dysfunction result from NE and SE blockade (erectile dysfunction, priapism (Thorazine), loss of libido and anorgasmia in men and women)
Seizures - <1% for generalized grand mal
QTc prolongation in Thioridazine
Photosensitivity, jaundice, agranulocytosis
Akathisia
Neuroleptic malignant syndrome: combination of motor rigidity, hyperthermia, and autonomic dysregulation of blood pressure and heart rate (increased)

25
Common side effects of typical antipsychotics:
Prolactin elevation Galactorrhea and amenorrhea may occur Anticholinergic effects (e.g. dry mouth, constipation, etc) Weight gain, orthostatic hypotension, and drowsiness
26
Common doses of phenothiazines
Thorazine dose 200-800 mg/day, Mellaril 200-800 mg/day Stelazine: 15-20 mg/day
27
Beers criteria warning for antipsychotics
BEERS criteria: avoid in elderly unless is necessary due to danger to self or others.
28
Black Box Warning for antipsychotics
Black box warning: Avoid in elderly patients with dementia related psychosis due to increased risk of CVA and death.
29
What are extrapyramidal symptoms
30
Tardive dyskinesia Etiology, features, time of maximal risk
Etiology: Chronic blockade of D2 receptors in nigrostriatal pathway Features: Oral-facial dyskinesia, widespread choreoathetosis or dystonia Time of maximal risk: After months or years of treatment. Treatment: antiparkinsonian agents often help
31
Tardive Dyskinesia Treatment
FDA Approved Treatment for tardive dyskinesia: -Valbenazine (Ingrezza) starting dose, 40mg, after 7 days, 80 mg daily -Deutetrabenazine (Austedo) starting dose 12mg, increase by 6mg daily, 48mg daily maximum
32
Valbenazine (Ingrezza)
need to look up
33
Deutetrabenazine (Austedo)
need to look up
34
How common are acute movement disorders associated with antipsychotics:
Can occur in 90% of all patients
35
Acute movement disorders (etiology)
D2 receptors blockade in nigrostriatal pathway
36
Acute Movement disorders (treatment)
Anticholinergic medication for dystonia, parkinsonism (Artane and Cogentin) Akathisia does not usually respond to anticholinergic medication. Beta blockers have best success.
37
akathisia
Akathisia: Inability to sit still, restlessness, It is motor restlessness rather than anxiety. Time of maximal risk: 5-60 days Treatment: reduce dose or change drug: antiparkinsonian agents, benzodiazepene or propranolol may help
38
Parkinsonism:
Parkinsonism: rigidity, akinesia (slow movement), and tremor, masklike face, loss of spontaneous movements, bradykinesia, shuffling gait. Time of maximal risk: 5-30 days Treatment: antiparkinson agents may help.
39
Acute Dystonia
Acute Dystonia: involuntary muscle spasms, abnormal postures, oculogyric crisis, torticollis, -involuntary spasms of muscles of tongue, face,neck, back. May mimic seizures. Not hysteria. Time of maximal risk: 1-5 days Treatment: antiparkinsonian agents are diagnostic and curative.
40
Treatment for acute muscular symptoms related to antipsychotics:
Diphenhydramine hydrochloride, 25 or 50 mg intramuscularly or po Benztropine, 1 or 2 mg intramuscularly or slowly intravenously, followed by oral medication. Propranolol, 20-80 mg per day Bromocriptine, 10-40 mg per day Selective beta1-adrenergic receptor antagonists, less effective.
41
Perioral tremor("Rabbit syndrome")
Features: Perioral tremor(may be late variant of parkinsonism). Time of maximal risk: After months or years of treatment Treatment: Antiparkinsonian agents can help.
42
Clozaril
-Atypical, 2nd Generation Antipsychotic -(Gold Standard) Used when other antipsychotics have failed -Dose: Initiate at 12.5 mg once a day or BID, then titrate up based on clozapine plasma level ranging from 250 to 350 ng/ml. -Reduces the risk of suicide in patients with schizophrenia      -Neutropenia (WBC <3,000/mcL and Agranulocytosis <500/mcL) may occur      -Major side effects include seizures in high doses, increased weight gain, increased cardiovascular risks -Strict ANC monitoring must be adhered to
43
Asenapin(saphris)
FDA Approved: Schizophrenia (Acute and maintenance) Antagonist to D2 and 5-HT2A receptors Given sublingually as an oral disintegrating tab to enhance absorption Usual dose 5mg to 10mg bid May be used as a rapid PRN agent Major side effects include sedation, lower risk of EPS, weight gain, dyslipidemia, mouth numbing and foul taste Do not eat or drink for 10 minutes after administration
44
Lurasidone(Latuda)
Antagonist to D2 and 5-HT2A receptors Starting dose 40mg, maintenance dose 40mg-160mg daily Antidepressant properties, useful in bipolar depression Less risk for sedation, lesser risk of weight gain and dyslipidemia Moderate EPS, recommended to be given at night Must be taken with a 350 calorie meal for optimal absorption
45
Olanzapine (zyprexa)
5HT2A and D2 receptor antagonist Available in tablets, disintegrating tablets, and long acting injection Schizophrenia dosing: 5mg-10mg daily up to 20mg daily maintenance dose Widely prescribed and used in combination with other agents (e.g. antidepressants) Major side effects include significant weight gain, increased cardiometabolic risks, increased triglycerides, and insulin resistance may occur
46
Risperidone(Risperdal)
Antagonist to D2 and 5-HT2A receptors Usual dose 2mg-8mg daily Also used in adolescents and children with psychosis Used to treat irritability in children and adolescents with autism disorder Available in tablets, dissolvable tablets, liquid, and depot injectable formulations Major side effects include sedation, lower risk of EPS, weight gain, dyslipidemia
47
Paliperidone(Invega)
Antagonist to D2 and 5-HT2A receptors Active metabolite of risperidone. Not hepatically metabolized, excreted in urine. Available in sustained release tablets (ER) and long-acting injections, usually 4 weeks Usual dose 6mg daily, up to 12 mg daily Less risk for sedation, orthostasis, fewer EPS, increase hyperprolactinemia, Increase risk for hyperprolactinemia, prolonged QTc interval Used more frequently to enhance patient drug compliance Monitor for tolerability to risperidone or po paliperidone prior to giving long acting injection
48
Quetiapine (seroquel)
Higher potency on D2 receptor but has affinity towards 5-HT2A, H1, alpha 1 and 5-HT1A Available in various formulation forms (IR, XR and tabs) Maintenance dose 150mg-750mg divided bid or tid It has antipsychotic, antidepressants, and hypnotic effects depending on the dose (lower dose=hypnotic effects) Major side effects include weight gain, increased cardiometabolic risks, increased triglycerides, and insulin resistance may occur
49
Ziprasidone (Geodon)
Antagonist to D2 and 5-HT2A receptors Starting dose, 20mg po bid, Maximum 160mg daily Available in tablets and intramuscular forms (not long acting) May have antidepressant actions Taken with at least 500 calories of food for optimal absorption Less risk of weight gain, less risk of triglyceride elevation, insulin resistance, dyslipidemia Known to significantly prolong QTc interval
50
Aripiprazole (abilify)
Partial D2 and 5-HT1A agonist, 5-HT2A antagonist Starting and target dose, 10mg to 15mg, max dose 30mg Used to treat schizophrenia. Also used in children and adolescents to treat schizophrenia Used with SSRIs/SNRIs to manage treatment-resistant major depressive disorder and bipolar depression Less risk for weight gain, dyslipidemia, QTc prolongation Can reduce drug induced hyperprolactinemia
51
Prescribing recommendations for antipsychotics
Recommendations for PMHNPs prescribing Antipsychotics Prescribing antipsychotics may be challenging with certain patients Patients co-morbidities should be considered Studies may or may not match the actual patients’ conditions Different atypical antipsychotics have distinctive effects Consider risks/benefits for choosing the right antipsychotic for a patient
52
EPS etiology:
Etiology D2 receptors blockade in nigrostriatal pathway Increases in antipsychotics
53
EPS Treatment
Treatment Prevention by using lowest possible dosage, Minimize use of PRN, Closely monitor individuals in high-risk groups Monitoring tools (AIMS Scale)
54
What is tardive dyskinesia
-Irregular, repetitive involuntary movements of mouth, face, and tongue, including chewing, tongue protrusion, lip smacking, puckering of the lips, and rapid eye blinking. Abnormal finger movements are common. -Begin after 6 months, but also as antipsychotics are withdrawn Irreversible – controversy
55
Atypical antipsychotic overview:
-Also known as second-generation antipsychotics -Antipsychotic actions to manage positive symptoms similar to typical antipsychotics -Lower risk of EPS and hyperprolactinemia -Serotonin-Dopamine Antagonists -Best drugs to treat negative symptoms
56
Actions of atypical antipsychotics:
-Primarily Block D2 and 5HT2A receptors -Hypothetically regulate downstream dopamine release -Act as brakes to dopamine release -Low risk of EPS due to blockage of D2 and 5HT2A receptors -Hyperprolactinemia is impaired by blocking 5HT2A receptors -Antidepressant actions in bipolar and unipolar depression -Antimanic actions -Anxiolytic actions -Sedative-hypnotic actions
57
Major side effects of atypical antipsychotics
Metabolic actions Weight gain Risk for obesity Risk for dyslipidemia Risk for diabetes Cardiovascular disease
58

PMHNP (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions