Psych: Antipsychotics Flashcards by Mitch Nichols

Q

Which antipsychotic is useful for suicidal behavior?

A

Clozapine

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Q

Which antipsychotic is useful for the hallucinations/delusions associated with Parkinson’s Disease?

A

Pimavanserin

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Q

How long does it take for antipsychotics to work?

A

Minimum of 2-3 weeks

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Q

MOA of Chlorpromazine, fluphenazine, perphenazine, thioridazine, trifluoperazine?

A

D2 receptor antagonists
-also block muscarinic, H1

First generation (Typical) antipsychotics

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Q

MOA of haloperidol?

A

D2 receptor antagonists
-also block muscarinic, H1

First generation (Typical) antipsychotics

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Q

MOA of loxapine, molindone, pimozide, and thiothixene?

A

D2 receptor antagonists (D2>5HT)
-also block muscarinic, H1

First generation (Typical) antipsychotics

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Q

MOA of iloperidone, lurasidone, paliperidone, risperidone, ziprasidone?

A

5HT2A and D2 blockers (5HT>DA)

Second generation (Atypical) antipsychotics

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Q

MOA of apripiprazole and brexipiprazole?

A

Partial DA/5HT1 receptor agonists

Second generation (Atypical) antipsychotics

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Q

MOA of cariprazine ?

A

5HT2/D2 antagonist and partial DA/5HT1 agonist

Second generation (Atypical) antipsychotics

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Q

MOA of asenapine, clozapine, olanzapine, quetiapine and lumateperone?

A

Multi-acting Receptor target agents

Second generation (Atypical) antipsychotics

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Q

MOA of pimavanserin?

A

Inverse 5HT agonist

Second generation (Atypical) antipsychotics

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Q

What are some of the adverse effects associated with the first-generation antipsychotics?

A

Muscarinic
-dry mouth, constipation, urinary retention, blurred vision

Alpha-adrenergic
-orthostatic hypotension, dizziness/syncope

Other
-risk of QTc

Hyperprolactinemia

Extrapyramidal symptoms

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Q

What are the acute extrapyramidal symptoms associated with first generation antipsychotics?

A

Acute akathisia, dystonia, parkonsonian like

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Q

What are the late symptoms of first generation antipsychotics?

A

Tardive dyskinesia

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Q

How do you treat the extrapyramamidal symptoms?

A

Benztropine and Trihexyphenidyl

Also diphenhydramine

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Q

How do you treat tardive dyskinesia associated with first gen antipsychotics?

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A

Selective VMAT2 inhibitors

Valbenazine and deutetrabenazine

Q

What are common side effects among all the second generation antipsychotics?

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A

Weight gain and metabolic effects

QT prolongation

Stroke

Q

What do you have to test for before starting a patient on second gen antipsychotics?

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A

serum glucose, lipids, BMI, BP, waist circumference, personal/family history of CV disease

Mainly establishing baseline of metabolic issues due to the risk**

Q

Which second gen antipsychotic is associated with agranulocytosis?

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A

Clozapine

-monitor WBC

Q

Which second gen antipsychotic is associated with DRESS syndrome?

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A

Olanzapine

Q

What is a severe adverse reaction that includes severe fever and muscle rigidity that is associated with all antipsychotics?

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A

Neuroleptic Malignant Syndrome (NMS)

-Tx: dantrolene

Q

How do you treat Neuroleptic Malignant Syndrome (NMS)?

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A

Dantrolene

-Ca++ channel blocker (RYR channel)

Q

Which drugs should be used for non-adherence to meds?

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A

Haloperidol decanoate
Fluphenazine decanoate

Risperidone
Olanzapine
Ariprazole lauroxil
Paliperidone palmitate

Q

Which second-generation antipsychotics are LEAST associated with weight gain? (3)

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A

Aripiprazole
Lurasidone
Ziprasidone

which subclass of first-generation antipsychotics is LEAST associated with sedation, anticholinergic, and orthostatics? (H1, M1, and a1 blockage in other terms)

Haloperidol, Thiothixene, and Fluphenazine -High potency Hal Tries Flying High

which subclass of first-generation antipsychotics is MOST associated with sedation, anticholinergic, and orthostatics? (H1, M1, and a1 blockage in other terms)

Chlorpromazine and thioridazine -low potentcy Cheating Thieves are Low

Which class, 1st or 2nd, is more associated with extrapyramidal symptoms?

1st

Which class, 1st or 2nd, is more associated with metabolic symptoms?

2nd

Antagonism of what receptor causes amenorrhea and galactorrhea? What could you prescribe to prevent this?

D2 antagonists (Resperidone is worst of this) To prevent, prescribe a D2 partial agonist (ie Ariprazole)