Segars: Antipsychotics

Question 1

Which drug is good for recurrent suicidal behavior?

Answer 1

-Clozapine

Question 2

Positive sx of schizophrenia

Answer 2

• hallucinations, delusions, disorganized speech/thinking, agitation, abnormal motor behavior
• meso-limbic pathway

Question 3

What is the main difference between agent-groups?

Answer 3

-reduction in movement-disorder SE’s

Question 4

What are the 2 kinds of antipsychotics?

Answer 4

• First gen

- second gen

Question 5

First Generation agents (typical)

Answer 5

• Choropromazine
• fluphenazine
• haloperidol
• Thioridazine
• Thiothixene

Question 6

Second generation agents (atypical)

Answer 6

-Aripiprazole
-clozapine
-olanzapine
-quetiapine
=risperidone
=ziprasidone

Question 7

Negative sx for schizo

Answer 7

• apathy, avolition, alogia, cognitive deficits, social withdrawal
• mesocortical pathway

Question 8

What does dopamine inhibit?

Answer 8

• prolactin release

- tuberoinfundibular pathway

Question 9

Which brain pathways are associated with side effects?

Answer 9

-Nigrostriatal pathway and the EPS

Question 10

what do first gen antipsychotics do?

Answer 10

-block DA type 2 (D2) post synaptic receptors

Question 11

what other receptors do FGA’s bind to?

Answer 11

• muscarinic
• Histamin
• alpha adrenergic receptors
• D2 receptors

Question 12

Muscarinic FGA SE’s

Answer 12

• dry mouth
• cant poo
• cant pee
• blurred vision
• sedation

Question 13

Alpha adrenergic effects of FGA’s

Answer 13

-orhtostatic hypotension
-dizziness/syncope
-

Question 14

Histamine effects for FGA’s

Answer 14

-sedation

Question 15

What does dopamine affect?

Answer 15

-hyperprolactinemia

=extrapyramidal sx (like parkinsonism)

Question 16

Tx for extrapyramidal sx

Answer 16

-anticholinergic agents
-Diphenhydramine
=beztropine
=trihexyphenidyl

Question 17

What does High D2 occupancy lead to?

Answer 17

-High EPS risk

Question 18

What 2 categories do we divide the FGA’s into?

Answer 18

• Low potency: chlorpromazine
• thioridazine
• high potency
• High potency:
• Fluphenazine
• Haloperidol
• Thiothixene

Question 19

What doe SGA’s do?

Answer 19

• block D2 receptors and also 5HT2A

- stronger for serotonin

Question 20

What is the D2 partial agonist?

Answer 20

• Aripiprazole

- aiding in dysregulation in the mesocortical pathway

Question 21

what is clozapine only reserved for?

Answer 21

-recurrent suicidal effects

Question 22

SGA SE’s

Answer 22

• weight gain

- metabolic effects: hyperglycemia/insulin resistance, hyperlipidemia

Question 23

Which drugs will give you weight gain and diabetes?

Answer 23

• the SGA’s!
• Clozapine
• olanzapine
• but aripiprazole and ziprasidone are good

Question 24

Which drugs will give us hypercholesterolemia

Answer 24

• clozapine

- olanzapine

Question 25

Which first gen drug had a lot os +'s

Answer 25

-Chorpromazine

Question 26

Which drug will give us EPS/ tardive dyskinesia?

Answer 26

-haloperidol

Question 27

Which drug will give us prolactin elevation?

Answer 27

-the FGA's!

Question 28

Which drugs will give us sedation?

Answer 28

- Chlorpromazine - Thioridazine - clozapine (the suicide question is the only one when this will be the answer) - Quetipaine (quieting the patient lol)

Question 29

Which drugs are the really good ones generally?

Answer 29

- Aripiprazole | - ziprasidone

Question 30

Which drugs will give us Anticholinergic SE's

Answer 30

- Chlorpromazine - Thioridazine - Clozapine

Question 31

Which drug will give us QT prolongation

Answer 31

-Thioridazine

Question 32

rare but severe SE for Clozapine

Answer 32

-agranulocytosis

Question 33

Which drug will give us a drug reaction w/ eosinophilia and systemic sx?

Answer 33

-olanzapine

Question 34

What is the tx for Neuoleptic malignant syndrome?

Answer 34

- dantrolene | - blocks RyR

Question 35

What is the baseline antipsychotic monitoring we want to do?

Answer 35

- Medical and gamily hx including CV disease - Weight - Waist circumference - Blood Pressure - Fasting glc - fasting lipid

Question 36

Which agents are more commonly recommended and utilized as first line, initial therapy?

Answer 36

-the atypical agents

Question 37

What is critical?

Answer 37

- adherence - non adherence can be managed with long acting jecectable agents - ROAP - Risperidone - olanzapine - aripiprazole - Paliperidone palmitiate

Question 38

Does antipsychotic tx take long?

Answer 38

-yes, god yes

Question 39

What drug do we give for multi drug resistance or suicidal thoughts?

Answer 39

-clozapine

Question 40

Which agents are known for having EPS related SE's?

Answer 40

- First Gen! | - Haloperidol

Question 41

Easy way to remember the SGA's?

Answer 41

-the ending "apine"