Antipsychotics

Question 1

___ given to pts with mania

Answer 1

Chlorpromazine - induces state of indifference in pts

Question 2

antipsychotics theory

Answer 2

DA receptor overstimulation

Question 3

do antipsychotic meds take away dlusions?

Answer 3

no still on the back burner but helps them work thorugh other sx.. normal thoughts however also blocked

Question 4

side effect of antipsychoitcs

Answer 4

dysphoria: state where they have no feelings or emotions at all

Question 5

6 antipsychotic inidications

Answer 5

Schizophrenia 
Bipolar disorder 
Acute psychosis - mania 
major depression with pshyosis 
severe behavioral problems  
Tourette syndrome - haloperidol

Question 6

first gen antipsychotics aka

Answer 6

dopamine antagonists, typical antipsychotics, neuroleptics

Question 7

5 first gen antipsychotics

Answer 7

haloperidol 
fluphenazine 
perphenazine 
thioridazine 
chlorpromazine 

Hint: haloperidol + “azine”

Question 8

MOA first gen antipsychotics

Answer 8

D2 receptor antagonist  
5HT2c receptor antagonist - weight gain 
Alpha 1 antagonist - sedation 
H1 antagonist - sedation, weight gain 
M1 antagonist - anticholinergic effects

Question 9

3 effects of antipsychotics

Answer 9

relief of positive sx (hallucinations etc)
induction of EPS : akathisia, dystonia, etc
Increased prolactin levels (will mess with DA)

Question 10

indications aripiprazole

Answer 10

schizo, 
bipolar manic / mixed (mono or add to lithium or valproate)  
add on major depressive 
irritability with autisim for kids
acute tx agitation

Question 11

indications asenapine

Answer 11

acute schizo

bipolar mixed/ manic

Question 12

indications clozapine

Answer 12

Tx resistant schizo

reduce SI in younger pts / adults

Question 13

indications iloperidone

Answer 13

adult acute schizo

Question 14

indications olanzapine

Answer 14

schizo bipolar disorder
bipolar disorder
tx resistant depression
agitation with schiszo and bipolar mania

Question 15

indications paliperidone

Answer 15

schizo

schizoaffective disorder

Question 16

indications quetiapine

Answer 16

schizo
bipolar disorder depression, maintainince, acute mainia
add on major depressive disorder

Question 17

Risperidone

Answer 17

schizo
bipolar disorder
irritable with autism (5-16)

Question 18

ziprasidone

Answer 18

schizo

bipolar disorder manic, mixed, depression

Question 19

Antipsych ADRS with anticholinergic effects

Answer 19

Clozapine

Question 20

Antipsych ADRS with dyslpidemia

Answer 20

olanzapine and clozapine

Question 21

risperidone has ___

Answer 21

extrapyramidal sx

Question 22

clozapine has postural__

Answer 22

hypotension ADR

Question 23

ziprasidone can produce

Answer 23

long QT probs

Question 24

clozapine can induce a __

Answer 24

seizure

Question 25

risperidone can lead to ___ dysfunction

Answer 25

sexual

Question 26

2 antiphyscs that can lead to DM 2 or worsen

Answer 26

clozapine and olanzapine

Question 27

weight gain seen with...

Answer 27

clozapine, olanzapine | and also quetiapine and risperidone

Question 28

___ first drug to tx tardive dyskinesia

Answer 28

valbenazine

Question 29

MOA valbenazine

Answer 29

VMAT2 inhibitor.. turns down signal path and lowers DA release

Question 30

ADR of valbenazine

Answer 30

somnolence, balance disorder, fall, HA, akathisisa, arthralgia

Question 31

black box on all psychotics

Answer 31

dementia related psychosis - higher mortality elderly | infection, CV with atypical antipsychotics

Question 32

clozapine monitor

Answer 32

baseline WBC then weekly then 6 mo.. due to agranulocytosis watch for: myocarditis, orthostatsis, bradycardia, lower seizure threshold

Question 33

clozapine drug int

Answer 33

cigarette smoke..why? tobacco 1A2 inducer, and clozapine is a substrate.. may change the drugs metabolism KEY: clozapine caution with smokers

Question 34

if former smoker on clozapine decreases or quits smoking need to ...

Answer 34

lower the dose with other 1A2 inhibitors - ciprofloxacin

Question 35

clozapine avoid using with ___

Answer 35

strong 3A4 inhibitors

Question 36

7 day antipsych goal

Answer 36

decrease agitiation, hostility etc normalize sleep and eat titrate meds close or effective dose

Question 37

2 to 3 wk goals

Answer 37

increase socialization, self care, mood | get to target dose and maintain

Question 38

ilioperidone p450

Answer 38

2D6 and 3A4 substrate

Question 39

paliperidone MOA and indication

Answer 39

schizo | DA 5ht2 H1 alpha receptor blocker

Question 40

asenapine ADR

Answer 40

constipation, agitation, N/v somnolence, insomnia psychosis

Question 41

brexipiprazole increased..

Answer 41

mortality old ppl with psychosis tardive dyskinesia, NMS

Question 42

brexipiprazole ADR

Answer 42

high sugars, fats, weight gain, blood dyscrasia, restlessness

Question 43

dystonia 3 meds

Answer 43

benztropine mesylate diphenhydramine (Benadryl) trihexyphenidyl

Question 44

5 akathisia meds

Answer 44

``` clonazepam lorazepam pramipexole propranolol ropinirole ```

Question 45

neuroleptic malignant syndrome 4 options

Answer 45

dantrolene sodium anticholinergics: benztropine, trihexyphenidyl dopamine agonists: amantadine, bromocriptine, ropinirole

Question 46

parkinsonism 4 options

Answer 46

amantadine anticholinergic pramipexole ropinirole

Question 47

neuroleptic induced catatonia 3

Answer 47

anticholinergics, bromocriptine and other DA agonists

Question 48

lithum is first line for__

Answer 48

manic episodes of bipolar disorder | maintenance tx for bipolar disorder

Question 49

major warnings lithum 2

Answer 49

teratogenic | renal toxicity

Question 50

lithum toxic over 1.5 mEq/L sx...

Answer 50

V/D, lack coorditiation | tinnitus, dilute urine, giddy, blurr vision

Question 51

lithium can mask

Answer 51

BRUGADA SYNDROME

Question 52

when lithium CI? 3

Answer 52

renal cv dz dehydration or na depletion pt on diuretics