Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clinical pharmacology > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What are the three atypical antipsychotics available as a depot?

A

risperidone
olanzapine
aripiprazole

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

What is the test dose of haloperidol

A

25mg

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

What is the test dose of zuclopenthixol

A

100mg

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

What is the test dose of flupentixol

A

20mg

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

What is the test dose of pipothiazine

A

25mg

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

What is the test dose of fluphenazine

A

12.5mg

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

Which antipsychotic is associated with post-injection syndrome

A

olanzapine

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

What are the features of post injection syndrome?

A

Sedation
Confusion, disorientation
Agitation, anxiety, aggression
Extrapyramidal symptoms, dysarthria, ataxia
Dizziness, weakness
Hypertension
Convulsion

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

What causes post injection syndroe?

A

accidental injury into a blood vessel on administration

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

When are patients most likely to deteriorate on a depot?

A

immediately after a depot

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

What drug is suggested by Maudsley for management of akathisia?

A

propranolol

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

In who is dystonia more common?

A

Young males
Neuroleptic naïve
High potency drugs e.g. haloperidol

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

In who is pseudo-parkinsonism more common in ?

A

elderly females
those with preexisting neuro damage e.g. stroke

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

What is the prevalence of akathisia?

A

25%

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

In whom is tardive dyskinesia more common?

A

Elderly women
Affective illness
If EPSE early on in treatment

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

How long does it take for dystonia to develop?

A

Hours or minutes within commencing antipsychotics

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

How long does it take for pseudoparkinsonism to develop?

A

days to weeks after antipsychotic started

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

How long does it take for akathisia to develop?

A

hours to weeks

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

How long does it take for tardive dyskinesia to develop?

A

months to years

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

What is the treatment of dystonia?

A

Anticholinergic drugs
Switch to different AP
Botox

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

What is the treatment of pseudoparkinsonism?

A

reduce dose
switch to different AP
Anticholinergics

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

What is treatment of akathisia?

A

Reduce dose
Switch to different AP
Propranolol
Mirtazapine
Anticholinergic drugs - trihexyphenidyl, procyclidine
Cyproheptadine
Benzos - diazepam or clonazepam
Clonidine

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

What is treatment of tardive dyskinesia?

A

Stop anticholinergic
Reduce dose
Switch to atypical AP
Tetrabenazine
Ginkgo biloba

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

Other than APs, what else can cause EPSEs?

A

SSRIs
TCAs
Schizophrenia if never received medication
Withdrawal of APs
Anti-emetics - metoclopramide and prochlorperazine
Lithium
CCBs - particularly flunarizine and cinnarizine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is dystonia
Prolonged and unintentional muscular contractions of voluntary or involuntary muscles
26
What is a lifethreatening complication of EPSEs
Laryngeal dystonia
27
What is torticollis?
Cervical muscle spasms resulting in a twisted posturing of the neck
28
What is trismus
lock jaw
29
What is opisthotonus?
Arched posturing of the head trunk and extremities
30
What are oculogyric crises
involuntary contraction of one or more of the extraocular muscles, which may result in a fixed gaze with diplopia
31
What causes EPSEs?
Antagonism of dopaminergic D2 receptors in basal ganglia
32
What are the suggested mechanisms of weight gain caused by APs?
5HT2a and 5-HT2c antagonism D2 and D3 antagonism H1 and M3 antagonism Hyperprolactinemnia Increased serum leptin (leading to leptin desensitisation) Ghrelin
33
What is the hardest EPSE to treat?
Akathasia
34
Which 2 APs confer a high risk of weight gain?
Clozapine and olanzapine
35
Which four APs confer a moderate risk of weight gain?
Chlorpromazine Quetiapine Risperidone Paliperidone
36
What APs are advised to switch to for weight gain?
Aripiprazole Ziprasidone Lurasidone
37
What AP is recommended for AP induced weight gain as augmentation?
Aripiprazole
38
What are potential medical treatments of AP induced weight gain ?
Metformin Orlistat Liraglutide (for clozapine induced weight gain) Topiramate
39
What is the cause of hyperprolactinaemia?
Dopamine inhibits prolactin so dopamine antagonists increase prolactin levels
40
What are the features of hyperprolactinaemia?
Galactorrhoea Menstrual difficulties Gynaecomastia Hypogonadism Sexual dysfunction
41
What does longstanding hyperprolactinaemia increase the risk of ?
Osteoporosis Breast cancer
42
What APs are prolactin sparing?
Clozapine Aripiprazole Asenapine Quetiapine
43
What APs cause a minor change in prolactin?
Lurasidone Olanzapine Ziprasidone
44
What APs cause a major change in prolactin?
All the typical antipsychotics Risperidone Amisulpride Paliperidone Sulpiride
45
How often should prolactin be measured when on APs?
Before starting AP Measure at 3 months if sx present If no symptoms present measure annually
46
What antipsychotic is most likely to cause EEG changes?
Clozapine
47
What antipsychotic is least likely to cause EEG changes?
Quetiapine
48
Give examples of typical APs
Chlorpromazine Flupenthixol Zuclopenthixol Perphenazine Trifluoperazine Sulpiride Haloperidol
49
Give examples of atypical APs
Clozapine Risperidone Olanzapine Quetiapine Ziprasidone Amisulpride
50
Give examples of third generation APs
Aripiprazole Brexpiprazole Cariprazine
51
What is the main mechanism of action of typical APs?
D2 antagonism
52
What are the other effects of typical APs?
Antagonism of M1, H1 and alpha-1 receptors
53
What are the mechanisms of action of atypical APs?
D2 antagonism 5-HT2a antagonism 5-HT1a agonism Rapid D2 dissociation
54
What are other mechanisms of action for atypical APs?
Antagonism of M1, H1 and alpha 1 receptors
55
Give an example of a phenothiazine with an aliphatic side chain
Chlorpromazine
56
Give an example of phenothiazine with a piperidine side chain?
Thioridazine Pipothiazine
57
Give an example of a phenothiazine with a piperazine side chain?
Trifluoperazine Fluphenazine
58
Give an example of a butyrophenones?
Haloperidol
59
What are the structural characteristics of butyrophenones?
Butyrophenone structure with a tertiary amine
60
Give examples of thiaxanthenes?
Flupenthixol Zuclopenthixol
61
Give an example of a diphenylbutylpiperidine?
pimozide
62
What is the class and structure of clozapine?
Dibenzodiazepine Two benzene rings and a diazepine ring
63
What class is risperidone?
Benzoxasole
64
What structure is olanzapine
thienobenzodiazepine with a benzodiazepine and thiophene ring
65
Give the structure of quetiapine
Dibenzothiazepine with a benzothiazepine ring
66
Give examples of substituted benzamides
Sulpiride Amisulpride
67
What is the hypothesis for what causes tardive dyskinesia?
post-synaptic dopamine D2 receptor super sensitivity due to chronic blockade of receptors
68
What are non-modifiable risk factors for tardive dyskinesia?
advancing age female sex ethnicity - african and white descent Longer illness duration LD and brain damage Negative sx in schizophrenia mood disorders
69
What are modifiable risk factors in tardive dyskinesia?
Diabetes Smoking Alcohol and substance misuse FGA vs SGA treatment Higher antipsychotic dose Anticholinergic co-treatment Akathisia
70
Which antipsychotics have a lower propensity for TD?>
Clozapine - best Quetiapine Olanzapine Aripiprazole
71
Which APs are highest risk of postural hypotension
Quetiapine and clozapine
72
Which APs have lowest risk of hypotension?
Lurasidone Asenapine
73
What APs should be tried if postural hypotension is a problem?
Amisulpride Aripiprazole Haloperidol Sulpiride Trifluoperazine
74
What is the CATIE study stand for? What was it?
Clinical Antipsychotic Trials of Intervention Effectiveness. Nationwide clinical trial comparing the effectiveness of older and newer APs in schizophrenia
75
What was phase I of CATIE?
Compared new and old APs
76
What were the results of phase I of CATIE?
Olanzapine slightly better than the other drugs, most associated with weight gain Older less expensive med (perphenazine) performed as well as newer meds Movement disorder not seen more frequently with perphenazine than with newer drugs
77
What was phase II of CATIE?
sought to provide guidance on which AP to try next if the first failed Participants who discontinued their first antipsychotic medication because of inadequate management of symptoms were encouraged to enter the efficacy (clozapine) pathway, while participants who discontinued their first treatment because of intolerable side effects were encouraged to enter the tolerability (ziprasidone) pathway. clozapine more effective
78
Which was the first AP used specifically for psychosis
chlorpromazine
79
How is chlorpromazine metabolised? What enzymes break it down
CYP450 - primarily CYP2D6 and CYP1A2
80
What are the contraindications of chlorpromazine?
Bone marrow depression Myasthenia gravis History of agranulocytosis Dopaminergic antiparkinsonism agents Citalopram, escitalopram
81
What are the monitoring requirements for chlorpromazine?
prolactin and FBCs
82
What should patients avoid when taking chlorpromazine?
direct sunlight due to risk of photosensitisation
83
What drugs are contraindicated with chlorpromazine
neuroleptics
84
Which APs are associated with postural hypotension?
Risperidone Clozapine Olanzapine Paliperidone Quetiapine Ziprasidone
85
What medications should be tried if postural hypotension is an issue?
Amisulpride Aripiprazole Haloperidol Sulpiride Trifluoperazine
86

Clinical pharmacology (27 decks)

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