Pharm, Antipsychotics, Linger Flashcards Preview

Year 2 Psych exam I > Pharm, Antipsychotics, Linger > Flashcards

Flashcards in Pharm, Antipsychotics, Linger Deck (57):
1

atypical antipsychotics

ariprprazole
lurasidone
olanzapine
quetiapine
risperidone
ziprasidone

2

special use atypical antipsychotics

clozapine

3

typical low potency agents for antipsychotic

chlorpromazine

4

typical high potency agents for anitpsychotic

haloperidol

5

chlorpromazine

dopamine R antagonist

6

most widely used type of antipsychotic

atypical like clozapine

7

dopamine R densities in schizophrenics

increased

8

phenothiazine derivative

chlorpromazine

9

butyrophenone derivative

haloperidol

10

common pharm attribute of atypical antipsychotics

greater effects at 5HT2a than at D2 R
most are partial agonists at 5HT1a which is synergistic with 5 HT2a R antagonisms

11

PK antipsychotics

first pass meatbolism
highly lipid soluble and protein bound
longer clinical duration than estimated
discontinuation well tolerated

12

which antipsychotic does not have a well tolerated discontinuation

clozapine
cause cholinergic rebound, and movement disorders

13

metabolism antipyschotics

cytochrone P450

14

all effective antipsychotics block what R

D2

15

atypical antipsychoitcs block what R more than D2

5-HT2a

16

mesolimbic-mesocortical pathway

involved in behavior and cognitive function
cell bodies in ventral tegmental area
antipsychotic if inhibit dopaminergic acitivy in pathway

17

nigrostriatal pathway

coordination voluntary movement
striatum
inhbition of dopaminergic activity causes extrapyramidal side effects

18

tuberoinfundibular system

regulates prolactin release (dopamine is inhibitory)
arcuate and periventricular nucli project hypothal and post pituitary

19

adverse effect if anti dopamine works in tuberinfundibular system

hyperprolactinemia

20

d2 like dopamine R

D2-4

21

how do d2 like R work

decrease cAMP via Gi and inhibit Ca Ch, open K Ch
pre and post synaptically and in caudate putamen

22

typical antipsychotics need what occupancy of D2 R to be effective

60%

23

extrapyramidal side effects from D2 antagonists occur at waht saturation

>80%

24

how can aripiprazole inhibit D2 with no EPS

partial agonist at D2

25

what reduces suicide attempts in schizophrenics

clozapine

26

nonpsych indications for antipsychotics

antiemesis
neurleptanesthesia
sleep onset and maintanence

27

first line for schizoprenia

atypical antipsychotics (not clozapine or olanzapine)

28

what is used for maintenance of uncooperative patients

IM formualations
haloperidol decanoate, fluphenazine decanoate, Risperdal consta

29

side effect clozapine

agranulocytosis
dose related lowering of seizure threshold
myocarditis

30

disadvantage to risperidone

EPS at high dose
hypotension at high dose

31

disadvantage olanzapine

weight gain
dose related lowering seizure threshold

32

disadvantage questiapine

high dose if assoc hypotension
twice day dosing from low halt life

33

advantage questiapine

less weight gain

34

disadvantage ziprasidone

QT prolongation

35

which antipsychotics have lower weight gain

quistiapine
ziprasidone
aripiprazole

36

Tx for how long before full effect

16-20 weeks

37

electroconvulsive therapy

in adjunct for treating mood Sx and + Sx
can augment clozapine if max dose ineffective

38

behavioral effects of antipsychotics

older drugs: anhedonia cannot expierieve pleasure, akinesia, toxic confusional state, sedation of antimuscarinic drugs

39

early motor effects from antipsychotics

EPS like parkinsonism, increased acitivity (akathisia), acute dystonic reactions, dystonic reactions

40

what is used to Tz early dystonic features of antispychotics

anticholinergic like benztropine or antihistamine antimuscarinic.
NEVER levodopa

41

late motor effects antipsychotics

tardive dyskinesia, choreathetoid movements
imabalance

42

which drugs have lower risk tardive dyskinesia

questiapine or clozapine

43

if drug change or reduction does not help with tardive dyskinesia next step is to

remove all drugs with central anticholinergic acivity like tricyclic antidepressants,

44

which antipyschotic may cause seziures

clozapine

45

ANS effects antipsychoics

older drugs that bind alpha 1 and histamine
leads to anti PAN side effects: dry mouth, loss accomodation, difficulty urinating, constipation and anti alpha adrenergic side effects like orthostatic hypotensions, dizziness, sedation, impotence and failure to ejeculate

46

weight gain is seen with what antipsychotics

majority
greatest effect with clozapine and olanzapine
be careful in DM because of hyperglycemia and ketoacidosis

47

intermediate risk weigh gain

iloperidone
paliperidone
quetiapine
risperidone

48

lowest risk weight gain

aripiprazole
lurasidone
ziprasidone

49

hyperprolactinemia can cause

amenoorhea galactorrhea
infertility
osteoporosis in women
men: infertility, loss libido, impotence, breast enlargement

50

which drugs can cause hyperPRL

risperidone and paliperidone

51

minimal effects on PRL

quetiapine
olanzapine and aripiprazole

52

is agranulocytosis from clozapine reversible

yes upon discontinuance

53

what CV medications should be avoided in patients on antipsychotics

antiarrhythmics, and erythromycin because also prolong QT

54

which antipsychotics preferred in pregnancy

atypical
category C

55

Neuroepileptic Malignant Syndrome

patients sensitive to EPS
rare but life threatening
acute severe parkinsonism, muscl rigidity, ANS instability and HTN, hyperthermia and keukocytosis

56

Tx neuroleptic Malignant Syndrome

mm relaxants like diazepam or dantrolene
dopamine agonists like bromocriptine

57

what antipsychotic overdose is fatal

thioridazine- arrhythmia