Antipsychotics Flashcards Preview

Behavioral Science > Antipsychotics > Flashcards

Flashcards in Antipsychotics Deck (34)
Loading flashcards...
1

hallucinations, delusions, disorganized speech, agitation, behavioral dyscontrol caused by change in what neurotransmitter and receptor?

increased dopamine binding to post synaptic D2-receptors (positive symptoms)

2

apathy, avolition, alogia + cognitive deficits caused by change in what neurotransmitter and receptor?

decreased dopamine binding to D1-receptors (negative symptoms)

3

D1 or D2 sx easier to tx?

D2 (positive) - all antipsychotic drugs target D2

4

class of antipsychotic:
Haloperidol
Chlorpromazine
Fluphenazine

typical agents - "azine"

5

class of antipsychotic:
Aripiprazole
Brexpiprazole

Clozapine
Olanzapine
Quetiapine

Paliperidone
Risperidone
Ziprasidone

atypical agents - "piprazole" and "apine" and "idones"

6

Main difference between typical and atypical antipsychotics

Reduction in movement‐disorder SE’s (EPS) with atypical drug development - esp high potency fluphenazine and haloperidol

7

Four receptors that atypicals can block

D1, D2, D4, 5H-T

8

***2 Atypical agents also a partial agonist at presynaptic (D2 /D3 & 5HT1A)

apripirazole and brexpiprazole

9

1 Atypical agent’s metabolite that also potently blocks NERT

(norquetiapine) quetiapine

10

Typical Antipsychotic agent that is low potency - drug name and this means?

Chlorprimazine
-More sedation, hypotension and seizure‐threshold reduction - less mvmt disorders.

11

AE of high potency typical antipsychotics - and name of two drugs

fluphenazine, haloperidol
-EPS movement disorder if >80% D2 receptor occupancy

12

Three receptors, other than Dopamine Receptors, that may be blocked by antipsychotics and side effects.

o Muscarinic (anti-cholinergic) = dry mouth, constipation, urinary retention, blurred vision, sedation
o Histaminic (H1 primarily) = sedation
o Alpha‐adrenergic (α1 & α2) = orthostatic hypotension and impotency

13

**Three possible (anti-cholinergic) drugs to treat acute Dystonia/Akathisia/Dyskinesia/Parkinsonism‐like symptoms (EPS) caused by Typical Class

Anticholinergic agents
• Diphenhydramine (Benadryl)
• Benztropine (Cogentin)
• Trihexyphenidyl

14

Severe side effect of clozapine. So monitor what?

agranulocytosis
-monitor WBC

15

Define Neuroleptic Malignant Syndrome

Rare but potentially‐fatal, severe Parkinson’s‐like movement disorder
• Autonomic instability, Stupor, Hyperpyrexia, Muscle rigidity, Altered mental status
• More common with injectable, high‐potency Typical agents but possible with all agents

16

Four classic Atypical Class side effects. So monitor what?

-Seizure threshold reduction
-Stroke
-Metabolic syndrome - wt gain, hyperglycemia, hyperlipidemia
-QT prolongation/ECG changes

Monitor: Baseline serum glucose, lipids, weight, blood pressure, and when possible, waist circumference and personal and family histories of metabolic and CV disease.

17

A dementia patient taking Olanzapine, Paliperidone, Risperidone - major risk increase?

stroke

18

**EPS:
worst
best

worst: haloperidol
best: atypical class

19

**Weight gain:
worst
best

worst - clozapine, olanzapine "pines"
best - All of the typical class and the "piprazoles"

20

**Stoke risk:
worst
best

worst - olanzapine, paliperidone, risperidone
best - any other, esp typicals

21

**ECG changes
worst
best

worst - chlorpromazine (typical), fluphenazine (typical), ziprasidone (atypical)
best - "apine", "piprazole"

22

four drugs that affect 5HT1 receptors

atypicals - ariprazole, brexpiperazole, clozapine, ziprasidone

23

Used for?
• Haloperidol decanoate
• Fluphenazine decanoate

Ri Ol Ar Pa
• Risperidone
• Olanzapine pamoate
• Aripiprazole
• Paliperidone palmitate

Non‐adherence can be managed with long‐acting injectable agents (LAIAs) (every 1‐4 weeks, depending on agent, dose & patient factors)

24

Psychotic with anti‐suicidal‐thoughts/behaviors
Major adverse effect.

clozapine
SE: agranulocytosis - monitor WBC

25

In comparing typical antipsychotics, what is associated with skeletal muscle rigidity, tremor at rest, uncontrollable restlesness, and spastic torticollis?

haloperidol (this is EPS)

26

Woman has schizophrenia. Current tx is a typical agent, experiencing amenorrhea and galactorrhea. What antipsychotic agent would decrease severity?

atypical class

27

**Prolactin (amenorrhea and glactorrhea dt D effects)
worst
best

worst - typical class
best - atypical class

28

blurred vision, dry mouth, mydriasis - what receptor are these SE of?

muscarininc

29

**drug induced orthostatic hypotension

chlorpromazine or clozapine (*many SE - WBC, seizures)
(least-fluphenazine, haloperidol, paliperidone, ziprasidone)

30

first line drug with least weight gain

ziprasidone, paliperidone, aripiprazole, brexipiprazole