Exam 11: Antipsychotics Flashcards Preview

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Flashcards in Exam 11: Antipsychotics Deck (32):
1

4 Phenothiazines

-Azines
Chlorpromazine
Fluphenazine
Prochlorperazine
Trifluoperazine

2

Name 1 Butyrophenone

Haloperidol

3

6 Second Generation (Atypical) Antipsychotics

Clozapine
Olanzapine
Risperidone
Ariprazole
Quetiapine
Ziprasidone

4

What kind of symptoms are 1st generation antipsychotics (Phenothiazines and haloperidol) good at treating?

Positive symptoms of schizophrenia

5

General effects of typical/1st gen antipsychotics

Decreased initiation of behavior, flattened affect

6

What is a major problems with the use of antipsychotics that affects their use?

their effects are perceived as unpleasant by the patient

7

What effect occurs before the antipsychotic effects in treatment?

Sedation
Tolerance develops to the though in time

8

CNS side effect of antipsychotics

Lowered seizure threshold

9

Which antipsychotic is also an especially good antiemetic?

Prochlorperazine

10

Autonomic side effect of antipsychotics

Anticholinergic

11

2 Cardiovascular side effects of antipsychotics

1. Orthostatic hypotension
2. Tachycardia

12

Endocrine side effects of typical antipsychotics

Increased prolactin due to dopamine antagonism
Gynecomastia, lactation, menstrual problems
May affect other GH, corticosteroids, gonadotropins, insulin

13

Common unwanted side effect of antipsychotics

Weight gain, metabolic disturbances

14

How safe are antipsychotics

Very large margin of safety, but there is a small risk of idiosyncratic and allergic reactions that can be serious

15

Neuro side effects of antipsychotics

Extrapyramidal
Can be severe and limit their use

16

Mechanism of antipsychotics

Inhibition of DA receptors
Typical inhibit D2
Others may affect other DA receptors/other neurotransmitters

17

Which DA pathway is involved in psychosis

Mesolimbic and mesocortical systems

18

Tardive dyskinesia

too much dopamine activity relative to cholinergic activity
opposite of parkinson's

19

Aliphatic phenothiazine

Chlorpromazine

20

3 piperazine phenothiazines

trifluoperazine
fluphenazine
prochlorperazine

21

Trifluoperazine

Phenothiazine
More potent than chlorpromazine
less sedation/anticholinergic
More extrapyramidal problems

22

Fluphenazine

Phenothiazine
Comes in long acting injections (decanoate and enathate), good for compliance

23

Prochlorperazine

Phenothiazine
Commonly used as an antiemetic

24

Haloperidol

Butyrophenone
Less anticholinergic than chlorpromazine
more extrapyramidal side effects
less sedation
Available in long acting form

25

Clozapine

2nd gen antipsychotic
blocks D4 and 5-HT2 receptors
Can cause granulocytopenia and agranulocytosis***
Can cause weight gain and type 2 diabetes**
Strongly anticholinergic
Few extrapyramidal side effects
Very expensive

26

Olanzapine

2nd gen antipsychotic
like clozapine, but doesnt cause bone marrow toxicity
Also causes weight gain and hyperglycemia

27

Risperidone

2nd gen antipsychotic
Blocks DA and serotonin receptors
More extra pyramidal side effects than clozapine/olanzapine, but less than the typicals

28

Quetiapine and Zirprasidone

2nd ben antipsychotics
mechanism similar to clozapine
metabolic side effects (fewer with quetiapine)

29

Aripiprazole

2nd gen antipsychotic
Partial agonist at D2 and 5-HT1 receptors
No extrapyramidal problems
Also approved for refractory depression

30

general pharmacokinetics of antipsychotics

metabolized in liver, excreted in kidney
Long half lives

31

Most effective antipsychotic. Problem?

Clozapine
2nd line due to it's potential toxicity

32

General rule of thumb about side effects of antipsychotics

high potency drugs have fewer cardiovascular and anticholinergic effects, but more extrapyramidal effects
the opposite is true of lower potency drugs.