Antipsychotics Flashcards Preview

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Flashcards in Antipsychotics Deck (35):
1

positive symptoms of Schizophrenia

Hallucinations, delusions, disorganized speech and behavior

2

negative symptoms of Schizophrenia

apathy, lack of motivation, difficulty speaking

3

cognitive symptoms of Schizophrenia

deficits in working memory, central processing, social cognition, problem solving

4

conventional; typical (Neuroleptic) effects of antipsychotic drugs

-induce EPS
-increase circulating [Prolactin]
-block D2 receptors (and many other receptors)
-sedation and autonomic effects

5

atypical effects of antipsychotic drugs

-less EPS
-block DA and 5-HT1,5-HT2,6,7 receptor subtypes;some have partial agonist activity; variable blockade of other receptors
-variable effect of [prolactin]

6

effects of low potency antipsychotics

more sedation and autonomic effects

7

effects of high potency antipsychotics

more EPS; less sedation and hypotension

8

clozapine has greater usefulness in treating

resistant pts

9

AE of atypical antipsychotics

-hypotension, seizures, weight gain, hyperglycaemia, hyperlipidemia

10

what are the 4 major dopamine pathways

1. Nigrostriatal (pars compacta; Parkinsons)
2. Mesocortical; mesolimbic (frontal cortex)
3. tuberoinfundibular (-prolactin)
4. chemoreceptor trigger zone (emesis)

11

what are pharmacologic effects of typical agents

-CNS (sedation; dec. seizure threshold)
-extrapyramidal rxn (acute dystonia, parkinsonism, Akathisia, Tardive dyskinesia)
-Neuroleptic malignant syndrome

12

what is neuroleptic malignant syndrome

-relatively rare rxn associated w/ antipsychotic agents, especially parenterally administered high-potency drugs
-mortality rate ~5%

13

what is neuroleptic malignant syndrome associated w/

hyperthermia, diffuse muscular rigidity, autonomic dysfunction and fluctuating levels of consciousness

14

what lab values does neuroleptic malignant syndrome alter

-elevate creatine kinase
-leukocytosis
-elevate hepatic transaminase
-increase myoglobin

15

which antipsychotics are long-acting

Fluphenazine Decanoate
Haloperidol Decanoate
Risperidone

16

who are long acting antipsychotics useful in

noncompliant pts

17

what autonomic effects do antipsychotics have

-hypotension (orthostatic) from alpha receptor blockade
-anticholinergic effects (dry mouth, tachcardia, blurred vision, urinary retention, constipation, confusion/toxic delirium)
-impairment of thermoregulation

18

cardiac effects of antipsychotics

-direct negative inotropic and quinidine-like effects (phenothiazines)
-Q-T prolongaion: thioridazine, mesoridazine, pimazide, haloperidol, ziprasidone)

19

neuroendocrine effects of antipsychotics

-hyperprolactinemia which may cause galactorrhea (women) and gynecomastia (men)

20

other AE of antipsychotics

-edema, weight gain; delayed ovulation, menstruation, amenorrhea; sexual dysfunction
-rare ophthalmic, hepatic, and hematologic effects

21

clozapine

-minimal risk of extrapyramidal effects

22

what SE have been reported with Clozapine

-akathisia, muscle stiffness, NMS
*agranulocytosis, benign hyperthermia, seizures, hypersalivation; weight gain; sedation, dizziness
-tachycardia; orthostatic hypotension

23

what are the atypical antipsychotics

-Risperidone
-Olanzapine
-Quetiapine
-Ziprasidone
-Aripiprazole
-Asenapine
-Iloperidone

24

SE of Risperidone

movement disorders; sexual dysfunction

25

SE of Olanzapine

weight gain; glucose intolerance; hyperlipidemia

26

SE of Quetiapine

cataracts

27

SE of Ziprasidone

prolong QT interval; less weight gain

28

what are the label warnings for Atypicals

-increased risk of weight gain, glucose intolerance/diabetes mellitus, and hyperlipidemia

29

pharmacokinetics of antipsychotics

-half life 10-35 hrs
-metabolized by hepatic oxidation

30

Asenapine and Olanzapine are primarily cleared by

glucuronidation

31

what are the drug interactions of antipsychotics

-block a-recptors
-potentiate CNS (and respiratory depression)
-may potentiate cardiovascular depression
-competitive inhibitor of CYP2D6 and/or 3A4

32

clinical uses of antipsychotics

-acute phase schizophrenia
-maintenance phase schizophrenia

33

other psychiatric uses

Mania
Schizoaffective disorder
Delusional disorder
Major depression with psychotic features
Delirium, brief reactive psychoses, sensory deprivation syndromes, rage reactions
Organic mental syndromes
Pervasive developmental disorder (autism)
Agitated behavior associated w/mental retardation or dementia
Borderline personality disorder

34

what effects do antipsychotics have in the elderly

-increase morality

35

what are non-psychiatric uses of antipsychotics

Tourette's syndrome
Chorea of Huntington's disease
Ballism
Intractable hiccups
Emesis