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Flashcards in Antipsychotics Deck (54)
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1
Q

dopamine

CNS function

A

reward, emotion, cognition, memory, motor activity

2
Q

increased dopamine

A

schizophrenia

over stimulates sensory cortex

3
Q

decreased dopamine

A

parkinsons

less stimulation of motor cortex

4
Q

endocrine function dopamine

A

regulate prolactin secretion from pituitary gland

5
Q

dopamine

cardio

A

N.E./E. release

low con = vasoDILATION
high con = vasoCONSTRICTION

6
Q

schizophrenia pathophys

A

excessive dopamine

5HT2A agonism

Glutamate antagonism

7
Q

positive symptoms of schizophrenia

A

increased DA to sensory cortex

hallucinations, delusions, paranoia

8
Q

negative symptoms of schizophrenia

A

decrease DA to frontal cortex

social withdrawal, lack of personal hygiene

9
Q

which antipsychotic is good for POSITIVE symptoms

A

first generation and second generation antipsychotics effective

10
Q

which antipsychotic for NEGATIVE symptoms

A

second generation antipsychotics

11
Q

antipsychotic BBW

A

elderly patients with dementia psychosis are at higher risk of death

12
Q

FGA antipsych

have more ____, less ___

A

more extrapyramidal symptoms (EPS) and tardive dyskinesia

doesn’t block negative symptoms

13
Q

SGA MOA

A

blocks 5TH2 receptors – reducing negative symptoms

14
Q

antipsychotic

anticholinergic side effects

A

dry mouth
constipation
blurred vision
urinary hesitancy

15
Q

antipsychotic system side effects (8)

A
  • sedation
  • orthostatic hypotension
  • anticholinergic
  • EPS
  • endocrine
  • weight gain
  • sexual dysfunction
  • QT prolongation
  • agranylocytosis
16
Q

EPS symptoms

A
  1. parkinsonism
  2. dystonia
  3. akathisia
  4. tardive dyskinesia
17
Q

parkinsonism

A

bradykinesia, rigidity, tremor, akinesia

respond to anticholinergics (benadryl)

18
Q

dystonia

A

torticollis, larynogospasm

anticholinergics

difficult movements

19
Q

akathisia

A

somatic restlessness
inability to stay calm

reduce antipsychotic dose or switch age

beta blockers work

20
Q

tardive dyskinesia

A

abnormal, involuntary orofacial movements “lip smacking”

can be irreversible with continued drug exposure

DON’T GIVE ANTICHOLINERGICS

21
Q

endocrine effects of antipsychotics

A

prolactin secretion

galactorrhea, menstrual changes

22
Q

rare but severe side effect of antipsychotics

A

agranulocytosis

23
Q

neuroleptic malignant syndrome

A

dopamine antagonism drugs

significant fever (103-108)
absence of GI 
elevated CK (muscle rigidity/cell lysis) --> kidney dysfunction
24
Q

NMS treatment

A

dantrolene IV skeletal muscle relaxant to prevent

25
Q

FGAs

A
  1. Chlorpromazine
  2. Fluphenazine
  3. Haloperidol (Haldol)
  4. Loxapine
  5. Perphenazine
  6. Pimozide
  7. Thiothizene
  8. Thioridazine
  9. Tricluroperazine
26
Q

IM FGAs

A

chlorpromazine
fluphenazine
haldol

27
Q

LAI FGAs

A

fluphenazine

haldol

28
Q

chlorpromazine side effects

A

hypercholestolemia/weight gain/DM

anticholinergic S.E.

orthostatic hypotension

29
Q

thiothizene S.E.

A

anticholinergics and orthostatic HTN

30
Q

MC s.e. of all FGAs

A

weight gain

EPS and prolactin

31
Q

SGA drug list

A
  1. ariprprazole/abilify
  2. asenapine
  3. brexpiprazole
  4. caripraszine
  5. clozapine
  6. iloperidone
  7. lurasidone
  8. olanzapine
  9. paliperidone
  10. pimacanserin
  11. quetiapine
  12. risperadone
  13. ziprasidone
32
Q

aripiprazole

A

abilify

33
Q

olanzapine

A

zyprexa

34
Q

quetiapine

A

seroquel

35
Q

risperidone

A

risperidal

36
Q

ziprasidone

A

geodon

37
Q

LAI SGAs

A

abilify
paliperidone
risperidone

38
Q

IM SGA

A

abilify

zyprexa

39
Q

clozapine S.e.

A

weight gain and diabetes

hypercholesterolemia

anticholinergics

40
Q

olanzapine s.e.

A

weight gain and diabetes

hypercholesterolemia

41
Q

prolactin elevation and EPS symptoms of SGA

A

paliperidone

risperidone

42
Q

antipsychotics with QTC prolongations

A

IV halloo or Ziprasidone

43
Q

apriprazole

moa, brand, …

A

5HT1 partial agonist

low risk for EPS, high akathisia

abilify maintena ( long lasting injectable)

44
Q

lurasidone

A

Latuda

45
Q

lurasidone gen

A

theorized to have beneficial cognitive and anxiolytic effects (5HT1 and 5HT1 antagonism)

46
Q

Paliperidone

A

active metabolite of risperidone

available as monthly injection (Invega Sustenna)

47
Q

ridperidone unique to

A

hyperprolactinemia

watch doses – EPS

long acting (Risperdal Consta) every 2 weeks

48
Q

quetiapine

A

high histamine affinity, lowest EPS risk

preferred for parkinson’s psychosis

49
Q

agranulocytosis is common for which medication

A

clozapine

req. ANC monitoring

50
Q

clozapine

A

only use for treatment resistant schizoprehnia (lack of response in 2+ trials)

need an 8 week trial

51
Q

CATIE trial

A

difference between FGA and SGA are not as great as we thought

still SGA has less sideeffects

52
Q

PORT recommendations

A

first episode of schizophrenia

use any agent other than clozapine or olanzapine

53
Q

pregnancy special populations

A

risks for mom or baby

caution with clozapine/olanzapine with breastfeeding CROSSES into breastmilk

54
Q

geriatric special populations

A

avoid sedation, orthostatic hypotension

more prone to QTc prolongation