17. Antipsychotics- Segars Flashcards
What antipsychotic drug is indicated for recurrent suicidal behavior?
Clozapine
What antipsychotic drug is indicated for Parkinson Disease Psychosis?
Pimavanserin
What is often utilized as a first line, initial therapy in treatment of psychotic disorders?
Second generation antipsychotics
Chloropromazine is what?
FGA
Fluphenazine is what?
FGA
Perphenazine is what?
FGA
Thioridazine is what?
FGA
Trifluoperazine is what?
FGA
Haloperidol is what?
FGA
Loxapine is what?
FGA
Molindone is what?
FGA
Pimozide is what?
FGA
Thiothixene is what?
FGA
Iloperidone is what?
SGA
Luprasidone
SGA
Paliperidone
SGA
Risperidone
SGA
Ziprasidone
SGA
Aripiprazole
SGA
Brexpiprazole
SGA
Cariprazine
SGA
Lumateperone
SGA
Asenapine
SGA (patch)
Clozapine
SGA
Olanzapine
SGA
Quetiapine
SGA
Pimavanserin
SGA
What is MOA of first generation antipsycotics?
Block dopamine type 2(D2) post synaptic receptors more than 5HT2
- a lot end in -azine
- Muscarinic receptors
- Histaminic receptors (H1)
- Alpha-adrenergic receptors (a1)
- D2 receptors
are blocked by what antipsychotic?
First generation antipsychotics
-D2 receptors are involved in the nigrostriatal pathways and tuberoinfundibulnar pathways creating side effects of EPS movements and prolactin increase respectively
hyperprolactemia –> (amenorrhea/galactorrhea/gynecomastia/decreased libido)
And Extrapyramidal sx/ tardive dyskinesia are side effects of what?
Dopamine associated SE of first generation antipsychotics
What receptors are blocked by first generation antipsychotics
- Muscarinic receptors–> dry mouth, constipation, urinary retention, blurred vision
- Histaminic receptors (H1)–> sedation
- Alpha-adrenergic receptors (a1)–> orthostatic hypotension, dizziness/syncope
- D2 receptors
also rish of QT prolongation and seizure activity
What is the MOA of Second generation antipsychotics? (2)
- Block D2 dopamine post synaptic receptors
- Block 5HT(2A)
SGAs are stronger 5HT(2A) receptor blockers than D2 receptors*
What does suffix -idone indicate?
A second generation antipsychotic that is a
- 5HT-2A antagonist
- DA antagonist
Iloperidone Lurasidone Paliperidone Risperidone Ziprasidone
(Lurasidone is also partial 5HT-1A agonist
What does suffix -piprazole indicate?
a second generation antipsychotic that is a
- Partial DA receptor agonist
- 5HT-1A agonist
Aripiprazole
Brexpiprazole
What does suffix -apine mean?
Multi-Acting receptor- target Agent second generation antipsychotic
Asenapine Clozapine Olanzapine Quetiapine Lumateperone
What second generation antipsychotic is an inverse serotonin agonist/antagonist?
Pimavanserin –> to treat Parkinson psychosis
What are second generation antipsychotic side effects?
- weight gain
- Metabolic effects–> hyper glycemic and hyperlipidemia
- QT prolongation and ECG changes–> greater risk for women, elderly and those on antiarrhythmics
- Stroke–> greater risk in elderly with dementia
What FGA have high risk of Tardive Dyskinesia?(3)
- Clorpromazine
- Fluphenazine
- Haloperidol
What FGA have a high risk of prolactin elevation (amenorrhea, galactorrhea) and extrapyramidal sx? (2)
- Fluephenazine
2. Haloperidol
What FGA has the most adverse side effects including:
- Tardive dyskinesia
- Sedation
- Anticholinergic Side effects
- Orthostatic hypertension
- QTc prolongation
Chlorpromazine
What FGA has a low risk of EPS and tardice dyskinesia but a high risk of anticholinergic side effects and orthostatic hypotension?
Thioridazine
What second generation antipsychotic agent has the lowest risk of all adverse side effects?
Aripiprazole
What second generation antipsychotic agents has a high risk of:
- weight gain
- Hyperglycemia
- hyperlipidemia
- sedation
- anticholinergic side effects*
Clozapine
Olanzapine is high risk in all of these except cholinergic side effects
What second generation antipsychotic is mostly low risk of side effects?
Lurasidone
What second generation antipsychotic agents has a high risk of (1):
- weight gain
- Hyperglycemia
- hyperlipidemia
- sedation
Olanzapine (no cholinergic effects is only difference from clozapine)
What SGA has a high risk of hyperlipidemia and sedation?
Quetiapine
What SGA has an increased risk of prolactin elevation but not really any other side effects?
Risperidone
What 2 SGAs have the highest risk of metabolic effects such as weight gain, hyperglycemia, and hyperlipidemia?
Cariprazone
Clozapine
What SGa has the lowest risk of all adverse side effects but the highest risk of QTc prolongation?
Ziprasidone
What needs to be consistently monitored in patients on second generation antipsychotics?
- Medical and family hx including CV disease
- Weight
- Waist circumference
- blood pressure
- fasting glucose level
fasting lipid profile
Agranulocytosis can be seen in what second generation antipsychotic?
Clozapine–> requires REM certification
-need baseline WBC before prescribing
What Second generation antipsychotic increases the risk of Drug Reaction w/ Eosinophilia and Systemic Symptoms(DRESS)?
Olanzapine
-very rare potentially life threatening drug induced hyper sensitivity rxn
What is Neuroleptic malignant syndrome?
Rare, potentially fatal, severe Parkinson’s like movement disorder with wide spread muscle contractions
-altered mental status
-hyperthermia
dehydration
What is a treatment for malignant hyperthermia of Neuroleptic Malignant Syndrome?
Dantrolene
- closes the Ryanodine receptor
What drug do you give if the patine has not responded to any other drugs or is psychotic with anti-suicidal thought/behaviors?
Clozapine
What second generation antipsychotics can be managed as long-acting injectable agents?
ROAP
Risperidone
Olanzapine
Aripiprazole Lauroxil
Paliperidone palmatate
- for patients that have non adherence
