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Flashcards in Antipsychotics Deck (34)
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1
Q

What do you have to routinely do for any patient on clozapine?

A

All pts on clozapine shuold have routine WBC counts to monitor for agranulocytosis… should be performed weekly for the first 6 monhts and can decrease in frequency thereafter

2
Q

What labs should you monitor with a patient on lithium?

A

1) Bun/Creatinine
2) thyroid
3) lithium levels (0.6-1.2 is a therapeutic level)
* if starting on lithium in a female make sure to get a pregnancy test before initiating

3
Q

What is the MOA of “typical/1st gen” antipsychotics/

A

they block only DA (specifically D2 receptors)… also known as “neuroleptics”

4
Q

Whats the deal with potency in typical antipsychotics/

A

they all have similar efficacy, but are categorized by how “potent” they are; either low, mid, or high.

5
Q

What are the “low potency” typical antipsychotics?

A

1) chlorpromazine

2) thioridazine

6
Q

What kind of side effects should i look for with low potency antipsychotics?

A
  • higher incidence of anticholinergic and anti-histaminergic side effects vs high-potency…
  • LOWER incidence of EPS/NMS
  • MORE lethal in overdose due to QT prolongation
  • slightly higher seizure risk than high-potency
7
Q

What are specific SE with chlorpromazine

A

Ortho hypotension (anti-cholinergic)
photosensitivity and bluish skin discoloration
Corneal deposits and cataracts

8
Q

What are specific SE with thioridazine

A

Retinitis pigmentosa

9
Q

What are the 4 midpotency typical antipsychotics?

A

1) loxapine (higher risk of seizure)
2) thiothixene
3) trifluoperazine
4) perphenazine

10
Q

What are the 2 most important high potency typical antipsychotics?

A

1) Haloperidol
2) fluphenazine
* both are available in long-lasting IM formats that are useful for non-compliant patients

11
Q

What causes the positive symptoms of schizo?

A

excess dopamine in the mesolimbic pathway nuc accumbens, hippocampus, amygdala etc

12
Q

what causes the negative symptoms of schizo?

A

too little dopamine in the mesocortical pathway

13
Q

What causes extrapyramidal symptoms (EPS)?

A

excess dopamine in the nigrostriatal pathway… this is more frequently caused by typicals… and risperidone (an atypical)… it is least often caused by clozapine (an atypical)

14
Q

Which antipsychotics are better at treating the positive symptoms of schizo?

A

Both are effective in treating the positive symptoms but atypicals are “preferred” because they are less likely to cause EPS (however they are more likely to cause metabolic syndrome and weight gain)

15
Q

Which antipsychotics are better at treating the negative symptoms of schizo?

A

Atypicals are more effective than typicals for negative symptoms

16
Q

What are the specific types of EPS?

A

1) parkinsonism - treated with amantadine
2) akathisia
3) dystonia - sustained painful contractions of muscles of neck, tongue, eyes (oculogyric crisis)

17
Q

What is tardive dyskinesia and how long does it take to develop?

A

repetitive motions like lip smacking, and moving the mouth/ tongue… it occurs with 1-6 months of using an antipsychotic medication… 50% can resolve… however 50% can remain permanently even after stoppin medication

18
Q

Which antipsychotics should you especially look for this types of side effects?

A

Typicals + risperidone (and atypical) antipsychotics are most likely to cause EPS and Tardive Dyskinesia… where as all typicals and atypicals can cause NMS

19
Q

Which atypical is least likely to cause EPS/TD?

A

Clozapine!

20
Q

Who is most likely to get TD?

A

little old ladies

21
Q

Which antipsychotics are more likely to cause seizures?

A

low-potency typicals are actually MORE likely to cause seizures than high potency!

22
Q

How long does it take for dystonia, EPS/akathisia, and TD side effects to develop?

A

Dystonia - hours to days!!! 4 hours

EPS/Akathisia - days to months! 4 days

TD: months to years! 4 months

23
Q

What are the chances of developing tardive dyskinesia?

A

roughly 1% chance for each year on a typical antipsychotic!

24
Q

What are the 6 atypical (aka DA + 5-HT blockers) that I should know/

A

1) clozapine
2) risperidone
3) olanzapine
4) aripiprazole
5) quetiapine
6) ziprasidone

CROAQ-Z
“-pines, -dones, 2 -pips, and a rip”

25
Q

Whats the deal with atypicals? aka why are they useful?

A

less likely to cause EPS, TD, or NMS… better at treating negative symptoms… and ALSO used to treat

acute mania
bipolar disorder
adjunct in unipolar depression

26
Q

Whats important about clozapine?

A

less likely to cause any movement disorder side effect

30% of treatment resistant psychosis will respond to clozapine

myocarditis can develop

1-2% risk of agranulocytosis and 2-5% risk of seizures!!!!

ONLY antipsychotic known to decrease risk of suicide

27
Q

When do I need to stop a patient from taking clozapine/

A

if their absolute neutrophil count (ANC) falls below 1,500

28
Q

Whats important about risperidone?

A

can cause increase in prolactin… and MOST likely to cause EPS among atypicals

29
Q

What are some common side effects of olanzapine/

A

weight gain!

30
Q

What is special about aripiprazole (abilify)?

A

A slightly different MOA; partial D2 agonism… there is LESS potential for weight gain compared to all other atypicals… but slightly more activating (increased akathisia)

31
Q

What are common side effects of quetiapine (seroquel)?

A

sedation!
ortho hypotension
Cataracts!

32
Q

what is unique about ziprasidone?

A

it is less likely to cause weight gain

33
Q

Which of the 6 atypicals are approved to treat mania?

A
  1. .. all except clozapine!
    so. ..
risperidone
olanzapine
aripiprazole
quetiapine
ziprasidone
34
Q

What are some key side effects with atypicals? (4)

A

1) metabolic syndrome; should monitor baseline weight, waist, BP, glucose, TGs
2) weight gain!
3) liver function tests done annually

4) QT prolongation
those are the 4 big ones… sometimes DKA can occur