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NMSP Exam 3 > Antipsychotics- Segars > Flashcards

Antipsychotics- Segars Flashcards

(51 cards)

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1
Q

what antipsychotic drug do you use for recurrent suicidal behavior

A

clozapine

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2
Q

what antipsychotic do you use for Parkinson disease psychosis

A

Pimavenserin

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3
Q

what is the Schizophrenia hypothesis

A

there is direct overstimulation go D2 leading to increased dopamine

there is indirect overstimulation of dopamine through increase serotonin

there is decreased NMDA and GABA which leads to increase Dopamine (usually GABA will inhibit dopamine)

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4
Q

positive symptoms of schizophrenia are associated with what pathway

A

mesolimbic pathway

VTA to the NA (nucleus accumbens)

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5
Q

negative symptoms of schizophrenia are associated with what pathway ?

A

mesocortical pathway

VTA to cortex

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6
Q

positive symptoms of schizophrenia

A

hallucinations, delusions, disorganized speech/thinking, abnormal motor behavior, agitation

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7
Q

negative symptoms of schizophrenia

A

apathy, cognitive deficits, social withdrawal

*harder to treat

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8
Q

D1,5 “G protein”

A

stimulatory

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9
Q

D2,3,4. “G protein”

A

inhibitory

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10
Q

dopamine effects on the nigrostriatal pathways lead to?

A

stimulation of purposeful movement/EPS

antispychotics increase dopamine where it is lacking and also where it is already abundant (non selectivE)

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11
Q

dopamine effects in the tuberinfundibular pathway leads to

A

prolactin release

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12
Q

first generation antipsychotics

A

Chloropromazine
Fluphenanzine
Thioridazine
Trifluoperazine
Haloperidol
Loxapine
Molindone
Pimozide
Thiothiexene

-zine, Haloperidol and then the rest

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13
Q

what is the primary difference between 1st and 2nd generation antipsychotics

A

reduced movement disorders (EPS) in 2nd gens

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14
Q

the first generation antipsychotics primarily block the _ post synaptic receptors

A

dopamine D2

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15
Q

the first generation antipsychotics along with blocking the dopamine receptors also blocks what other receptors?

A

muscarinic (anticholinergic)

alpha adrenergic (a1)

histamine (H1)

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16
Q

muscarinic blockade effects from 1st gen antipsychotics

A

(anti cholingeric)

-dry mouth
-contipation
-urinary retention
-blurred vision
-sedation

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17
Q

alpha adrenergic blockade effects from 1st gen antipsychotics

A

orthostatic hypotension
dizziness/syncope

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18
Q

histamine blockade effects from 1st gen antipsychotics

A

sedation

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19
Q

what are some other side effects 1st generation antipsychotics can cause

A

QTc prolongation and seizure activity

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20
Q

EPS symptoms when taking 1st generation antipsychotics occurs when the D2 receptors have reach _ percent occupancy

A

78

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21
Q

low potency first generation antipsychotics cause more sedation, hypotension, tachycardia, and ECG changes

what are the low potency 1st gens?

Study These Flashcards
A

chlorpromazine
thioridazine

22
Q

which low potent antipsychotic is associated with tornadoes de points and sudden death

23
Q

high potency 1st generation antipsychotics cause more movement EPS and prolactin disorder

which drugs are high potency

Study These Flashcards
A

fluphenazine and haloperidol

24
Q

what are the dopamine associated side effects of first generation antipsychotics

Study These Flashcards
A

Acute Extrapyramidal symptoms
Tardive dyskinesia

25
what are the 3 EPS types
dystonia akathisia Parkinsonism
26
what is dystonia and how can you treat it
sustained muscle contraction Benztropine, diphenhydramine, trihexphenidyl (all anticholinergic)
27
what is Akathisia and how cause you treat it
constant movements with the 3 B's benztropine, beta blocker, benzodiazepam
28
what is Parkinsonism and how can you treat it
tremor/rigidity/bradykinesia Benzotropine or amantadine
29
what is tardive dyskinesia and how can you treat it
repetitive uncontrollable movements valbenazine, deutetrabenazine
30
hypereprolcatinmia is a side effect of first generation antipsychotic drugs what is the presentation
amenorrhea, galactorrhea, gynecomastia, decreased libido
31
second generation antipsychotics not only block dopamine type 2 receptors by they also block _
5HT2a (more blockage here at serotonin)
32
5HT1,5 G proteins
Gi
33
5HT2 g proteins
Gq
34
5HT467
Gs
35
what are the second generation antipsychotics
-idone -piprazole -apine Primavanserin Cariprazine Lumateperone
36
what are some of the side effects of 2nd gen antipsychotics
diabetes, weight gain, insulin resistance, hyperglycemia, CVD, dylipidemia
37
what labs should you get at baseline and monitor when you put a patient on a second generation antipsychotic
weight/BMI fasting/plasma glucose lipids blood pressure
38
which antipsychotics cause the most weight gain
clozapine and olanzapine
39
which antipsychotics causes the most metabolic effects
clozapine and olanzapine
40
which antipsychotic causes the most QTc prolongation
ziprasidone
41
there is a greater risk of _ in elderly patients with dementia that are put on antipsychotics
stroke
42
what are some of the monitoring tools for measuring side effects in antipsychotic drugs
AIMS, GASS (probably not on test)
43
which second generation antipsychotic should you monitor WBC count because of its associated risk of agranulocytosis
clozapine (REMS)
44
which second generation antipsychotic should you monitor for seizures
clozapine
45
what is a rare but potentially fatal severe Parkinson likemovemtn disorder with wide spread muscle contraction caused by antipsychotics
neuroleptic malignant syndrome
46
what is the progression of neuroleptic malignant syndrome
altered mental status (mesocortical) muscle rigitdity increased muscle metabolism and rhabdomyolysis (Nigro-striatal) hyperthermia (hypothalamic) dehydration (autonomic dysfunction)
47
treatment of neuroleptic malignant syndrome
dantrolene blocks ryanodine receptors and stops muscle contraction from stopping calcium from entering diazepam peripherally*** fyi
48
the goal of antipsychotic treatment is to get the patient into?
remission
49
what antipsychotics are available in an injectable form immediate release and is used in an acute setting to clam down most, behavior, affect, violence etc.
haloperidol , ziprasidone, olanzapine, aripiprazole
50
which antipsychotic do we use for multiple drug resistant schizophrenia
clozapine
51
adherence is critical in taking antipsychotic medication non-adherence can be managed with long acting injectable agents?
ROAP risperidone olanzapipne aripriprazol paliperidone - can last several months

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