Antipsychotics

Question 1

Antipsychotic Agents

Answer 1

Used for diverse spectrum of psychotic disorders

Question 2

What population of people should antipsychotics NOT be used in?

Answer 2

Elderly w/ dementia
Increases risk of death substantially
-Cardiac and infection causes

Question 3

MOA of first generation antipsychotics (FGA’s)

Answer 3

Block receptors for dopamine (DA) in CNS

DA antagonists

Question 4

Serious side effects of FGA’s

Answer 4

Extrapyramidal symptoms ( acute dystonia, akathisia, parkinsonism, and tardive dyskinesia)
Malignant Neuroleptic Syndrome

Question 5

Serious side effects of SGA’s

Answer 5

Metabolic effects (dyslipidemia, diabetes, weight gain)

Question 6

Symptoms of schizophrenia

Answer 6

Disordered thinking
Difficulty comprehending reality
Hallucinations (auditory & visual)

Question 7

What type of hallucinations are more common in schizophrenia?

Answer 7

Auditory is more common

Question 8

Positive symptoms of schizophrenia

Answer 8

Hostility
Suspicion
Violence
Persecutory hallucinations

Question 9

Negative symptoms of schizophrenia

Answer 9

Withdrawn
Hermit
quiet
stop caring for self (hygiene, employment etc)
Blunted affect
talk slowly
Monotone

Question 10

Treatment for EPS reactions

Answer 10

Anticholinergics like diphenhydramine & benztropine

Restore balance of Ach and Dopamine in brain

Question 11

How quickly does acute dystonia occur

Answer 11

5 hours- couple days of starting therapy

Question 12

Akathisia

Answer 12

Incredible need for motion

Pacing back and forth

Question 13

Acute dystonia

Answer 13

Back spasm
Laryngospasm–emergency!
Facial spasm
Oculogyric crisis

Question 14

Parkinsonism

Answer 14

Shuffling feet
rigid movements
mask like face

Question 15

Tardive dyskinesia

Answer 15

First generation antipsychotics
Occurs months to years after therapy
Worm like movements of face and lounge
Permanent

Question 16

Depot preps

Answer 16

Long-acting injectable form available for antipsychotic medications
Last for 1-2 weeks
Slow release

Question 17

Drug therapy purpose

Answer 17

Suppression of acute episodes
Prevention of acute exacerbations
Maintenance of highest level of functioning as possible

Question 18

Dosing of antipsychotics

Answer 18

Start at smallest dose
Highly individualized
Older adults need less

Question 19

Haloperidol MOA

Answer 19

Blocks DA, NE, Ach, and histamine

Question 20

Haloperidol classification

Answer 20

High potency FGA

Question 21

Haloperidol adverse effects

Answer 21

EPS
Higher frequency of NMS
Cardiovascular (prolong QT)
Neuroendocrine effects are seen on occasion

Question 22

Neuroendocrine effects of some antipsychotics

Answer 22

Galactorrhea
Menstrual irregularities
Gynecomastia

Question 23

Chlorpromazine classification

Answer 23

Low potency FGA

Question 24

Chlorpromazine MOA

Answer 24

Blocks DA, alpha 1 & 2 adrenergic receptors, NE, Ach, and histamine
AKA antagonists of these receptors

Question 25

Chlorpromazine MOA

Answer 25

``` M/c effects: -sedation & orthostatic hypotension Lowers seizure threshold Cardiovascular (prolongs QT interval) Early EPS are uncommon ```

Question 26

PD drugs vs. antipsychotics

Answer 26

PD drugs are DA agonists and schizophrenia drugs are DA antagonists

Question 27

SGA names (3)

Answer 27

Risperidone Olanzepine Aripiprazole

Question 28

Drugs to treat NMS

Answer 28

Dantrolene- Direct acting muscle relaxant | bromocriptine-Dopamine receptor agonist