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Flashcards in Antipsychotics Deck (42):
1

How many categories of antipsychotics exist?

2; 1st generation created before Clozapine, 2nd generation created after Clozapine

2

Why were the 2nd generations made?

1st generations have too many issues with movement disorders (tardive dyskinesia)

3

What are the 3 main categories represented by extrapyramidal side effects of 1st generation antipsychotics?

-MC akathisia (restlessness)
-Parkinsonian syndrome (shuffling gate, bradykinesia, tremor, rigidty)
-Dystonia

4

What monitoring schedule is important for antipsychotics?

Weekly until dose is stable for AT LEAST 2 weeks; 2x a week after dose increase

5

What is important information about tardive dyskinesia in antipsychotic use?

-Worse with first generation use
-Tardive dyskinesia is permanent even if D/C meds

6

What are tardive dyskinesia symptoms?

-Sucking/ smacking of lips
-lateral jaw movements
-Facial grimacing
-Choreoathetoid movements of the tongue, trunk, or extremities

7

What is Valbenazine (Ingrezza) significance?

1st drug to treat tardive dyskinesia

8

What are metabolic effects of antipsychotic drugs?

1. Weight gain 2. DM 3. HLD 4. HTN

9

What are other significant ADRs of antipsychotic drugs?

1. Seizures most can cause
2. Orthostatic hypotension
3. Neuroleptic malignant syndrome
4. QT prolongation
5. Myocarditis and Cardiomyopathy
6. Sudden death
7. Hyperprolactinemia (women galactorrhea and menstrual disturbances) (men sexual dysfunction and gynecomastia)
8. Temperature regulation (dehydration, ACH properties, strenuous activity, heat exposure)

10

What disease should antipsychotics not be used to treat?

Dementia in elderly due to increased mortality

11

What drugs have the highest risk of causimg neuroleptic malignant syndrome?

First generation antipyschotics

12

What are risk factors for NMS?

-higher dosage
-switch from one agent to another
-parenteral administration

13

What is the tetrad of sx in NMS?

-Mental status change (intial sx) agitated, delirium confusion
-Muscle rigidity
-Hyperthermia
-Autonomic dysfunction

14

What labs are helpful in Dx of NMS?

Serum CK elevation (>1000 IU/L)

15

How to tx pts with NMS?

-Stop causative agent (antipsychotics)
-Also top lithium, anticholinergics, serotonergics
-Supportive care
-Admit to ICU for cardiopulmonary care
-BZDs if agitated
-Last line Electroconvulsive therapy

16

How to restart neuroleptic drugs post-NMS?

- Allow for a 2 week minimum "cleanse" before resuming therapy from when sx stop
-Use lower rather than higher potency drugs

17

First generation antipsychotics drugs that are high potency

-Haloperidol (haldol)
-Fluphenazine (Prolixin)
-Perphenazine

18

What are ADRs associated with high potency FGAs?

-High risk of EPS
-Prolactinemia

19

What are low potency FGA drugs?

-Chlorpromazine (Thorazine)
-Thioridazine

20

What ADRs exist with the low potency FGAs?

-High histamine and muscarinic activity
-Increased sedation
-Prolactinemia

21

What FGAs are aviailable as injectables? What types?

-Haloperidol and Fluphenazine (both are high potency)
-Long acting injectable (dosed 2-6 weeks) a d immediate release

22

What PK issues exist for FGAs?

-PO absorption is erratic
-Highly protein/ tissue bound
-Long 1/2 lifes
-All metabolized by CYP450 with many having active metabolites

23

What is the MOA of FGA drugs?

Strong antagonism of dopamine D2 receptors

24

What is MOA of second generation antipsychotics?

Higher affinity for blocking serotonin 2 receptors

25

What are some of the second generation antipsychotics (atypicals)?

-Aripiprazole (Abilify)
-Clozapine
-Olanzapine
-Quetiapine
-Risperadone

26

What is Clozapine indicated for?

Refractory psychosis

27

What drug has the highest risk for EPS in SGAs?

Risperadone

28

What drugs have the highest risk for metabolic effects?

Olanzapine and Clozapine

29

What SGAs have the lowest risk of EPS and tardive dyskinesia?

-Quetiapine
-Iloperidone
-Clozapine

30

What generation of antipsychotics have better control over negative symptoms?

SGAs

31

QT interval prolongation is mild in SGAs, what drugs should be avoided in high risk pts?

Iloperidone and Ziprasidone

32

What SGA has a FDA warning for DRESS syndrome?

Olanzapine

33

What SGA has a warning for agranulocytosis and must be checked every month?

Clozapine

34

How should treatment be administered when treating with antipsychotics?

Titrate as quickly as possible from low dose to therapeutic dose

35

What is the typical titration with antipsychotics?

5/ 7 days- weeks

36

What is important about response times with antipsychotic use?

Response occurs within 4-6 weeks with the most improvements in the 1st 2 weeks

37

When can the current drug treatment of an antipsychotic be termed ineffective?

After a stable dose of a drug has been administered for 2-6 weeks

38

When is it helpful to switch antipsychotics?

When poor response of drug is related to ADRs

39

When is changing antipsychotics less beneficial? What to use?

-When drug has poor efficacy
-Clozapine

40

When can psychosis be considered refractory?

Response remains inadequate after trying 2 different antipsychotics for at least 6 weeks

41

Switching to Clozapine requires what?

-Close monitoring
- Patient/ family agree to adhere to therapy and monitoring
-Absolute neutrophil count >= 150 cell/microliter

42

What is one of the biggest problems with refractory psychosis?

Pt drug adherence