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Flashcards in Antipsychotics Deck (51):
1

The antipsychotic drugs fall into 2 major groups.. What are they?

First generation antipsychotics (FGAs)
-aka conventional antipsychotics

Second generation antipsychotics (SGAs)
-aka atpyical antipsychotics

2

Which group is better: FGA or SGA?

They are both equally effective

3

All of the FGAs produce strong blockade of receptors for ____ in the CNS. What does this result in?

Strong blockade of receptors for DOPAMINE in the CNS; this results in serious movement disorders

4

Extrapyramidial symptoms (EPS)

Serious movement disorders

5

What do the SGAs produce (like what blockade)?

Moderate blockade of receptors for dopamine; much stronger blockade of receptors for serotonin

6

Which has a lower risk for EPS: FGA or SGA?

SGA, since the blockade of receptors for dopamine is only moderate, whereas FGA has strong blockade of receptors for dopamine

7

Even thought the SGAs carry a lower risk for EPS, they cause significant risk for metabolic effects. What are some examples?

-Weight gain
-Diabetes
-Dyslipidemia

8

Define: A chronic psychotic illness characterized by disordered thinking and a reduced ability to comprehend reality

Schizophrenia

9

When do symptoms of schizophrenia usually emerge?

During adolescence or early adulthood

10

What are the positive symptoms of schizophrenia?

*Positive symptoms are viewed as an exaggeration or distortion of normal function

Hallucinations
Delusions
Disorganized speech
Bizarre behavior

11

What are the negative symptoms of schizophrenia?

*Negative symptoms can be viewed as a loss or diminution of normal function

Blunted affect
Poverty of thought
Loss of motivation
Inability to experience pleasure

12

Do FGAs improve positive symptoms, negative symptoms, or both?

Positive symptoms only

13

What are the 4 examples of FGAs?

Chlorpromazine
Haloperidol
Thiothixene
Trifuperazine

14

Which is more potent? Haloperidol or chlorpromazine?

Haloperidol

15

What does it mean when we say a drug is more potent?

The dose of the more potent drug (ex: haloperidol) required to believe psychotic symptoms is smaller than the required dose of the less potent drug (ex: chlorpromazine)

It DOES NOT mean that the more potent drug will produce greater effects.

16

If low potency and high potency neuroleptics (another name for FGAs) are equally effective, why do we distinguish between them?

These agents produce identical antipsychotic effects, but they differ SIGNIFICANTLY in their side effects

17

What is the primary indication for antipsychotic drugs?

Schizophrenia

18

FGA agents are equally effective, but individual patients may respond differently from one FGA to another. So how is selection on an FGA based?

It's side effects

19

Do FGAs have many or few side effects?

Many

20

Of the many side effects that FGAs may produce, what is the most troubling?

Extrapyramidal reactions--especially tardive dyskinesia (TD)

21

What are 4 types of EPS?

Acute dystonia
Parkinsonism
Akathisia
Tardive dyskinesia

22

Three of the 4 types of EPS occurs early in therapy. What are they? Can they be managed?

Acute dystonia
Parkinsonism
Akathisia
Yes, they can be managed with a variety of drugs

*The early reactions occur LESS FREQUENTLY with LOW-POTENCY agents than with high potency agents

23

What is the type of EPS that occurs late in therapy? Does it have satisfactory treatment?

Tardive dyskinesia; No satisfactory treatment

*The risk of TD is equal with ALL FGAs

24

Describe what happens in acute dystonia

-Muscle tightening (spasms) usually of the neck and shoulders
-Can involve the tongue and eyes
-Occur early in therapy

25

Describe what happens in akathisia

-Literally means "can't sit"
-A motor restlessness--> constant drive to move
-Occurs early in therapy

26

Describe what happens in Parkinsonism

-Exact same presentation as Parkinson's disease (tremor, shuffling gait, decreased arm swing, and mask-like facies)
-Occurs early in therapy

27

Describe what happens in Tardive dyskinesia

-Means "late movement disorder"
-Occurs late in therapy
-Usually permanent
-Involuntary movement of tongue, eyes, lips, and face

28

If a schizophrenia patient has been on FGAs for 2 years and begins showing symptoms of involuntary movement of the tongue and eyes, what kind of EPS would she have?

Tardive dyskinesia

*Even though acute dystonia has these same characteristics, the key word of the patient having been taking the drug for 2 years already lets you know that this is TD.

29

Which FGA drugs are used more often: low or high potency?

High; because they produce fewer side effects

30

High potency FGAs causes more ____, but less ____, ____, ____.

More early EPS, but less sedation, orthostatic hypotension, and anticholinergic effects

31

FGA: Is haloperidol low or high potency?

High

32

FGA: What is haloperidol a preferred agent for?

Tourette's syndrome

-It can also be used to control severe behavior problems in children
-It is used more than other FGAs

33

FGA: Haloperidol is a high potency drug. Based on what we know, what kind of effects may we see?

Early EPS;
As well as:
-less sedation
-less orthostatic hypotension
-less anticholinergic effects

34

FGA: Is trifluoperazine low or high potency?

High potency

35

FGA: is thiothixene low or high potency?

High potency

36

FGA: is haloperidol low or high potency?

High potency

37

FGA: is chlorpromazine low or high potency?

Low potency

38

FGA: Chlorpromazine is a low potency drug. What sort of adverse effects may be seen here?

(the opposite of a high potency drug)
-Sedation
-Orthostatic hypotension
-Anticholinergic effects

39

Which antipsychotic drug class is less likely to cause EPS effects, including TD?

SGAs

40

SGAs may have less of a risk for getting EPS, but what do SGAs carry a serious risk for?

Metabolic effects
-Weight gain
-Diabetes
-Dyslipidemia (can lead to cardiovascular events and premature death)

*Can also cause sedation, orthostatic hypotension, and can increase the risk of death when used to treat demential-related psychosis in older adults

41

So even though SGAs and FGAs are similar in effectiveness, which one costs 10-20x more than the other

SGAs cost 10-20x more than FGAs

42

What is the MOA of SGAs?

Block dopamine and serotonin

43

What are the 4 types of SGAs?

clozapine
rrisperidone
olanzapine
quetipine

44

Do SGAs treat both positive and negative effects, or only one?

They treat both!

45

What is the most effective SGA for schizophrenia?

clozapine

46

What problem does clozapine cause that makes it a drug only given to patients who have not responded to safer alternatives?

It causes agranulocytosis

47

What is agranulocytosis

An increased deficiency in granulocytes in the blood causing an increased vulnerability to infection

48

What is NMS?

Neuroleptic malignant syndrome

49

Is NMS more likely to occur with FGA or SGA drugs?

FGA

50

Is NMS more likely to occur with high or low potency FGAs?

High potency

51

What are the symptoms of NMS?

"lead pipe rigidity"
Fever
Encephalitis
VS instability
Elevated WBC & CPK
Rigidity
Sweating