Antipsychotics (Segars)

Question 1

main difference between 1st gen agents (conventional/typical) vs 2nd gen agents (novel/atypical)? BIG STAR

Answer 1

Reduction in movement-disorder Side effects

Question 2

chlorpromazine, fluphenazine, haloperidol, thioridazine, and thiothexine are __ antipsychotics

Answer 2

1st gen/conventional/typical

Question 3

aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone are __ antipsychotics

Answer 3

2nd gen/novel/atypical

Question 4

if an antipsychotic end in -AZINE, it is a __ generation

if an antipsychotic ends in -PIPRAZOLE, -APINE, or -IDONE, it is a __ generation

Answer 4

1st

2nd

Question 5

recurrent suicidal behavior can be tx with __

Answer 5

clozapine (2nd gen)

Question 6

__ antagonists reduce positive symptoms of schizophrenia (hallucinations, delusions, disorganized speech/thinking, agitation, abnormal motor behavior)

Answer 6

D2

Question 7

2 dopamine pathways relevant to schizophrenia symptoms?

Answer 7

Mesolimbic –> overactivity –> positive symptoms

Mesocortical –> dysfunction –> negative and cognitive symptoms

Question 8

D2 antagonism of Nigrostriatal pathway induces __ symptoms

Answer 8

extrapyramidal

Question 9

D2 antagonism effects on prolactin levels?

Answer 9

increases prolactin levels

Question 10

the FGA’s primarily block __ receptors

Answer 10

D2 post-synaptic

block D2&raquo_space; 5HT2

Question 11

other receptors that FGAs also block (with varying potencies)?

Answer 11

Muscarinic –> anti-cholinergic SE’s
H1 receptors –> Sedation SE
a1 receptors –> Orthostatic hypotension, dizziness/syncope SE’s
D2 in nigrostriatal (movements) and tuberoinfundibular (prolactin)

can get risk of QTc prolongation and seizure activity

Question 12

Treatment for acute dystonia/akathisia/dyskinesia/parkinsonism-like SEs from using FGA’s? BIG STAR

Answer 12

Anticholingeric agents: Diphenhydramine (benadryl), benztropine (cogentin), and trihexyphenidyl

Question 13

what are the high potency FGAs that cause more movement (EPS) and endocrine effects (prolactin)?

Answer 13

Fluphenazine
Haloperidol
Thiothixene

Question 14

SGA’s block what receptors?

Answer 14

D2 post-synaptic AND 5HT2a

5-HT2a&raquo_space; D2

Question 15

what is the dual 5-HT2a/D2 theory?

Answer 15

5-HT2a antagonism increases DA transmission in nigrostriatal pathway –> may contribute to improved negative and cognitive symptoms via increased DA release in PFC, reduced EP SE’s

Question 16

This SGA is a D2 partial agonist, aids in dysregulation in mesocortical pathway

Answer 16

Aripiprazole

Question 17

common SEs of SGAs?

Answer 17

Common:
weight gain
metabolic –> hyperglycemia/insulin resistance, hyperlipidemia

Rare:
QTc prolongation
Stroke --> greater risk in elderly w/dementia (class warning)

Question 18

which gen more associated with +++ weight gain? which drugs?

Answer 18

2nd gen –> Clozapine and Olanzapine

Aripiprazole and Ziprasidone not associated with weight gain as 2nd gen drugs

Question 19

which gen more associated with hypercholesterolemia? which drugs?

Answer 19

2nd gen –> Clozapine, Olanzapine

Aripiprazole and Ziprasidone less associated with hypercholesteremia as 2nd gen drugs

Question 20

which gen more associated with EPS/tardive dyskinesia? drugs?

Answer 20

1st gen –> fluphenazine, haloperidol, and thiothixene

chlorpromazine and thioridazine less associated as 1st ten drugs

Question 21

which gen more associated with prolactin elevation? drugs?

Answer 21

1st gen –> fluphenazine, haloperidol, thioridazine

Question 22

which gen more associated with sedation?

Answer 22

1st gen –> chlorpromazine and thioridazine

Question 23

which gen more associated with anticholinergic side effects? drugs?

Answer 23

1st gen –> Thioridazine and chlorpromazine

Question 24

which gen more associated with orthostatic hypotension? drugs?

Answer 24

more so 1st gen –> thioridazine and chlorpromazine

2nd gen –> clozapine

Question 25

which 1st gen associated with QTc prolongation? 2nd gen?

Answer 25

1st --> thioridazine 2nd --> ziprasidone

Question 26

which 2nd gen drug to avoid weight gain and DM?

Answer 26

Ziprasidone and then aripiprazole

Question 27

which 2nd gen drug to avoid hypercholesterolemia?

Answer 27

Ziprasidone and then aripiprazole

Question 28

which 1st gen drug less likely to cause EPS/tardive dyskinesia?

Answer 28

chlorpromazine

Question 29

which 2nd gen drug likely to have anticholinergic side effects?

Answer 29

clozapine

Question 30

which 1st gen drugs to avoid orthostatic hypotension?

Answer 30

fluphenazine and haloperidol

Question 31

which SGA do you want to monitor WBC and REMS program d/t agranulocytosis?

Answer 31

Clozapine

Question 32

tx for neuroleptic malignant syndrome (rare but severe antipsychotic drug SE)?

Answer 32

dantrolene

Question 33

what assessment parameter to monitor in ALL pts on SGA's? **BIG STAR**

Answer 33

``` Serum glucose lipids weight (BMI) BP When possible --> waist circumference, personal hx, FH of metabolic and CV disease ```

Question 34

which agents more commonly recommended and utilized at 1st line, initial therapy?

Answer 34

atypical agents (2nd gen)

Question 35

how to manage non-adherence tx of psychotic disorders? **BIG STAR**

Answer 35

long-acting injectable agents (LAIAs) every 2-12 wks, depending on agent, dose, pt factors 1st gen --> haloperidol decanoate and fluphenazine decanoate 2nd gen --> risperidone, olanzapine, aripiprazole lauroxil, and paliperidone palmitate

Question 36

which drug to use for multi-drug resistant disease and/or psychotic with anti-suicidal thoughts/behaviors?

Answer 36

clozapine

Question 37

which 2nd gen drug to use to avoid galactorrhea?

Answer 37

aripiprazole avoid risperidone