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NMSP > 17. Antipsychotics- Segars > Flashcards

17. Antipsychotics- Segars Flashcards

1
Q

What antipsychotic drug is indicated for recurrent suicidal behavior?

A

Clozapine

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2
Q

What antipsychotic drug is indicated for Parkinson Disease Psychosis?

A

Pimavanserin

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3
Q

What is often utilized as a first line, initial therapy in treatment of psychotic disorders?

A

Second generation antipsychotics

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4
Q

Chloropromazine is what?

A

FGA

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5
Q

Fluphenazine is what?

A

FGA

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6
Q

Perphenazine is what?

A

FGA

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7
Q

Thioridazine is what?

A

FGA

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8
Q

Trifluoperazine is what?

A

FGA

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9
Q

Haloperidol is what?

A

FGA

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10
Q

Loxapine is what?

A

FGA

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11
Q

Molindone is what?

A

FGA

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12
Q

Pimozide is what?

A

FGA

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13
Q

Thiothixene is what?

A

FGA

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14
Q

Iloperidone is what?

A

SGA

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15
Q

Luprasidone

A

SGA

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16
Q

Paliperidone

A

SGA

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17
Q

Risperidone

A

SGA

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18
Q

Ziprasidone

A

SGA

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19
Q

Aripiprazole

A

SGA

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20
Q

Brexpiprazole

A

SGA

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21
Q

Cariprazine

A

SGA

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22
Q

Lumateperone

A

SGA

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23
Q

Asenapine

A

SGA (patch)

24
Q

Clozapine

A

SGA

25
Q

Olanzapine

A

SGA

26
Q

Quetiapine

A

SGA

27
Q

Pimavanserin

A

SGA

28
Q

What is MOA of first generation antipsycotics?

A

Block dopamine type 2(D2) post synaptic receptors more than 5HT2

  • a lot end in -azine
29
Q
  • Muscarinic receptors
  • Histaminic receptors (H1)
  • Alpha-adrenergic receptors (a1)
  • D2 receptors

are blocked by what antipsychotic?

A

First generation antipsychotics

-D2 receptors are involved in the nigrostriatal pathways and tuberoinfundibulnar pathways creating side effects of EPS movements and prolactin increase respectively

30
Q

hyperprolactemia –> (amenorrhea/galactorrhea/gynecomastia/decreased libido)

And Extrapyramidal sx/ tardive dyskinesia are side effects of what?

A

Dopamine associated SE of first generation antipsychotics

31
Q

What receptors are blocked by first generation antipsychotics

A
  • 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

32
Q

What is the MOA of Second generation antipsychotics? (2)

A
  1. Block D2 dopamine post synaptic receptors
  2. Block 5HT(2A)

SGAs are stronger 5HT(2A) receptor blockers than D2 receptors*

33
Q

What does suffix -idone indicate?

A

A second generation antipsychotic that is a

  1. 5HT-2A antagonist
  2. DA antagonist
Iloperidone
Lurasidone
Paliperidone
Risperidone
Ziprasidone

(Lurasidone is also partial 5HT-1A agonist

34
Q

What does suffix -piprazole indicate?

A

a second generation antipsychotic that is a

  1. Partial DA receptor agonist
  2. 5HT-1A agonist

Aripiprazole
Brexpiprazole

35
Q

What does suffix -apine mean?

A

Multi-Acting receptor- target Agent second generation antipsychotic

Asenapine
Clozapine
Olanzapine
Quetiapine
Lumateperone
36
Q

What second generation antipsychotic is an inverse serotonin agonist/antagonist?

A

Pimavanserin –> to treat Parkinson psychosis

37
Q

What are second generation antipsychotic side effects?

A
  1. weight gain
  2. Metabolic effects–> hyper glycemic and hyperlipidemia
  3. QT prolongation and ECG changes–> greater risk for women, elderly and those on antiarrhythmics
  4. Stroke–> greater risk in elderly with dementia
38
Q

What FGA have high risk of Tardive Dyskinesia?(3)

A
  1. Clorpromazine
  2. Fluphenazine
  3. Haloperidol
39
Q

What FGA have a high risk of prolactin elevation (amenorrhea, galactorrhea) and extrapyramidal sx? (2)

A
  1. Fluephenazine

2. Haloperidol

40
Q

What FGA has the most adverse side effects including:

  • Tardive dyskinesia
  • Sedation
  • Anticholinergic Side effects
  • Orthostatic hypertension
  • QTc prolongation
A

Chlorpromazine

41
Q

What FGA has a low risk of EPS and tardice dyskinesia but a high risk of anticholinergic side effects and orthostatic hypotension?

A

Thioridazine

42
Q

What second generation antipsychotic agent has the lowest risk of all adverse side effects?

A

Aripiprazole

43
Q

What second generation antipsychotic agents has a high risk of:

  • weight gain
  • Hyperglycemia
  • hyperlipidemia
  • sedation
  • anticholinergic side effects*
A

Clozapine

Olanzapine is high risk in all of these except cholinergic side effects

44
Q

What second generation antipsychotic is mostly low risk of side effects?

A

Lurasidone

45
Q

What second generation antipsychotic agents has a high risk of (1):

  • weight gain
  • Hyperglycemia
  • hyperlipidemia
  • sedation
A

Olanzapine (no cholinergic effects is only difference from clozapine)

46
Q

What SGA has a high risk of hyperlipidemia and sedation?

A

Quetiapine

47
Q

What SGA has an increased risk of prolactin elevation but not really any other side effects?

A

Risperidone

48
Q

What 2 SGAs have the highest risk of metabolic effects such as weight gain, hyperglycemia, and hyperlipidemia?

A

Cariprazone

Clozapine

49
Q

What SGa has the lowest risk of all adverse side effects but the highest risk of QTc prolongation?

A

Ziprasidone

50
Q

What needs to be consistently monitored in patients on second generation antipsychotics?

A
  • Medical and family hx including CV disease
  • Weight
  • Waist circumference
  • blood pressure
  • fasting glucose level

fasting lipid profile

51
Q

Agranulocytosis can be seen in what second generation antipsychotic?

A

Clozapine–> requires REM certification

-need baseline WBC before prescribing

52
Q

What Second generation antipsychotic increases the risk of Drug Reaction w/ Eosinophilia and Systemic Symptoms(DRESS)?

A

Olanzapine

-very rare potentially life threatening drug induced hyper sensitivity rxn

53
Q

What is Neuroleptic malignant syndrome?

A

Rare, potentially fatal, severe Parkinson’s like movement disorder with wide spread muscle contractions
-altered mental status
-hyperthermia
dehydration

54
Q

What is a treatment for malignant hyperthermia of Neuroleptic Malignant Syndrome?

A

Dantrolene

  • closes the Ryanodine receptor
55
Q

What drug do you give if the patine has not responded to any other drugs or is psychotic with anti-suicidal thought/behaviors?

A

Clozapine

56
Q

What second generation antipsychotics can be managed as long-acting injectable agents?

A

ROAP

Risperidone
Olanzapine
Aripiprazole Lauroxil
Paliperidone palmatate

  • for patients that have non adherence

NMSP (14 decks)

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