Antipsychotics-Kirkpatrick Flashcards by michelle granstrom

What are the appropriate uses of antipsychotics?

psychosis
non-psychotic mania
autism
adjunct to antidepressants
sometimes dementia w/ mood & behavioral issues (2nd or 3rd line)
delirium (2nd or 3rd line)

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What is the MOA of antipsychotics used to treat schizophrenia?

dopamine antagonists
one partial dopamine agonist–works same way tho
variable responses for patients

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In double-blind studies, psychotic symptoms have a transient increase with infusion of low doses of:

Ketamine (an NMDA antagonist)
MCPP (a sertonin antagonist)
Cannabis

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What are some important dopamine pathways?

Mesocorticolimbic
**Antipsychotic efficacy
Nigrostrital
**Extrapyramidal side effects

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What are commonly used 1st gen antipsychotics? aka typical antipsychotics aka neuroleptics

fluphenazine–Prolixin
perphenazine–Trilafon
trifluoperazine–stelazine
haloperiodol–haldol

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What are the 2nd gen drugs aka atypical antipsychotics?

aripiprazole 		(Abilify *)
olanzapine		(Zyprexa *)
quetiapine 		(Seroquel) 
risperidone		(Risperdal *)
ziprasidone 		(Geodon) 
iloperidone		(Fanapt)
asenapine 		(Saphris)
Paliperidone 		(Invega *)
Lurasidone		(Latuda)

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Which of the 2nd gen drugs are a dopamine partial agonist?

aripiprazole–abilify!

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What are the most commonly used 2nd gen antipsychotics?

aripiprazole-abilify
olanzapine-zyprexa
quetiapine-Seroquel
risperidone-risperdal
ziprasidone-geodon
**depot formulation & have to monitor in clinic for several hours
exists for ability, zyprexa, risperdal, invega

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T/FAll of the 2nd generation drugs have superior efficacy, especially for negative symptoms

False

No established superiority for negative symptoms
Improvement in neg sx is due to improvement in other psychiatric symptoms and/or motor side effects

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T/F 2nd generation drugs have no risk of extrapyramidal side effects.

False.

varies by drug & dose-related

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T/F If a patient’s psychotic symptoms haven’t responded you should raise the dose
If a patient has particularly severe psychotic symptoms, he or she needs a higher dose

False

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T/F If a patient has symptoms in the grey zone between odd experiences and clearcut psychosis, you should give a lower dose than usual

False.

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What is an important thing to keep in mind w/ the shared dose-response curve for antipsychotics?

they all plateau!

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What are the 3 efficacy groups for antipsychotics?

clozapine
risperidone & olanzapine
all other antipsychotics

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If clozapine is in the #1 efficacy group, why don’t more people prescribe it?

b/c it has greater side effects

& many people it does nothing for them.

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What are the side effects of 1st gen drugs?

extrapyramidal side effects
orthostatic hypotension
liver problems
neuroleptic malignant syndrome

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What are the side effects of 2nd gen drugs?

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Primary: weight gain, diabetes

sometimes–extrapyramidal side effects

Which drugs have extrapyramidal side effects sometimes–2nd gen?

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risperidone
geodon–akathisia
abilify-akathisia

What is the side effect profile of clozapine?

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agranulocytosis--get blood drawn to check, reversible
sustained tachycardia
weight gain
orthostatic hypotension
hypersalivation
sedation

What are extrapyramidal side effects?

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Rigidity 
Tremor 
Bradykinesia 
Hypersalivation
Neuroleptic malignant syndrome 
Akathisia

How do you treat extrapyramidal side effects? Except akathisia

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decrease dose
change medication
anticholinergic drugs: diphenhydramine (benadryl), trihexiphenidyl (artane), benzotropine (cogentin)
amantadine

How do you treat akathisia?

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beta blockers-propranolol
high doses of VIt B6
maybe clonazepam
anticholinergics don’t help

What’s the deal with discontinuation of antipsychotics?

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74% discontinued w/i 18 mo

b/c of side effects, inadequate symptoms control, or other reasons

Although olanzapine is in class 2 efficacy, what is a bad thing about it?

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weight gain! 2nd most weight-gain causing drug.
**efficacy-weight gain trade off with 2nd gen antipsychotics
1st gen-EPS trade off!

What is the extrapyramidal side effect of tar dive dyskinesia?

writhing or jerky movements syndrome of involuntary choreo-athetoid movements 1st ten drugs have more likelihood of causing this, also dose-related akathesia may be a precursor to this male & African American risk factors

Why are many people with schizophrenia overweight?

iatrogenic b/c of antipsychotic side effects | naturally thin

What do you do with treatment of weight gain w/ antipsychotic meds?

exercise nutritional counseling metformin consider decreasing dose or changing medication

Weight gain is probably caused by lack of specificity of antipsychotics, binding which receptor?

histamine-H1 | **also causes sedation & dizziness

When D2 is bound...what are the side effects?

EPS | prolactin elevation

When M1 is bound...what are the side effects?

``` cognitive deficits dry mouth constipation increased heart rate urinary retention blurred vision ```

IF alpha 1 is bound...SE?

hypotension

What is a QT prolongation?

Electrical depolarization & repolarization of the ventricles Increased interval a risk factor for ventricular tachyarrhythmias especially torsades de pointes (“twisting of the spikes") sudden death **a side effect of some antipsychotics

QT interval is normal based off of heart rate. Normal is roughly ____. What is considered a risk for sudden death in males & females?

``` Normal: ≤400 ms (some disagreement) Risk of sudden death: Borderline for males: 431-450 Abnormal for males: < 450 Borderline for females: 451 – 470 Abnormal for females: > 470 ```

What are some additional risk factors or increased QTc?

``` Hypokalemia Hypomagnesemia Hypocalcemia Hypothermia Hep C HIV Myocardial ischemia Post-cardiac arrest Increased intracranial pressure Congenital long QT syndrome Medications ```

What are some medications that can cause increased QT interval?

``` Amisulpride Clozapine Fluphenazine Haloperidol Olanzapine Perphenazine Quetiapine Risperidone Thioridazine Ziprasidone ``` 4 ms for risperidone 30 ms for thioridazine

What can be some difficult features of dementia?

psychosis, agitation, suspiciousness, irritability are common **frequently treated with antipsychotics & benzos Good treatment: psychosocial intervention

If you treat dementia with benzos...what might happen?

increased confusion | falls! b/c of sedation. could lead to death in an older person.

What is the black box warning of every antipsychotic?

increased mortality in elderly patients with dementia related psychosis

what is an alternative to antipsychotics to treat dementia patients?

citalopram | **may not work in patients with vascular dementia

Focus on which drugs?

haloperidol (haldol) top 5 2nd gen abilify-different MOA partial dopamine agonist. still stops dopaminergic transmission know EPS symptoms weight gain w/ clozapine & olanzapine keep in mind agranulocytosis possible w/ clozapine

What is the categorization of clozapine?

2nd gen antipsychotics

Antipsychotics-Kirkpatrick Flashcards

(41 cards)