Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

TN Psychiatry > 22.1 Pharmacotherapy: Antipsychotics > Flashcards

22.1 Pharmacotherapy: Antipsychotics Flashcards

1
Q

“antipsychotics” used to be called what? (1)

A

“neuroleptics”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe: Overall mechanism of action of antipsychotic (1)

A

block, to varying degrees, DA activity in target brain pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Antipsychotic described for what? (2)

A
  • primarily indicated for psychotic symptoms in: schizophrenia and related disorders, manic episodes, depressive episodes, substance use, medical conditions (i.e. neoplasm)
  • other uses: treatment-resistant MDD, severe GAD, complex PTSD, severe OCD, borderline PD, behavioural symptoms of dementia, delirium, Tourette Syndrome, substance abuse in dual diagnosis, Huntington’s disease, ASD, impulse control disorders
    • adjunctive management of agitation, aggression, severe anxiety, severe sleep difficulties when sedative-hypnotics are contraindicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe onset: Antipsychotic (2)

A
  • rapid calming effect and decrease in agitation;
  • thought disorder responds in 1-4 wk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name reasons to combine antipsychotics (1)

A
  • no reason to combine two or more antipsychotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name effectiveness of antipsychotics (3)

A
  • all antipsychotics are equally effective, except for clozapine (considered to be most effective in treatment-refractory psychosis)
  • atypical antipsychotics (second generation) are as effective as typical (first generation) antipsychotics but are thought to have better adverse effect profiles; main difference is lower risk of EPS and TD
  • choose a drug to which the patient has responded to in the past or that was used successfully in a family member
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe duration antipsychotics (2)

A
  • if no response in 4-6 wk, switch drugs
  • duration: minimum 6 mo and usually for life in most patients with primary psychotic disorders; variable for other indications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name Dopamine Pathways Affected by Antipsychotics (4)

A
  • Mesolimbic
  • Mesocortical
  • Nigrostriatal
  • Tuberoinfundibular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe effects and associated pathology of this dopamine pathway affected by antipsychotic: Mesolimbic (2)

A
  • Effects: Emotion orginiation, reward
  • Associated Pathology: HIGH dopamine causes positive symptoms of schizophrenia (delusions, hallucinations)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe effects and associated pathology of this dopamine pathway affected by antipsychotic: Mesocortical (2)

A
  • Effect: Cognition, executive function
  • Associated Pathology: LOW dopamine causes negative symptoms of schizophrenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe effects and associated pathology of this dopamine pathway affected by antipsychotic: Nigrostriatal (2)

A
  • Effects: Movement
  • Associated pathology: LOW dopamine causes EPS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe effects and associated pathology of this dopamine pathway affected by antipsychotic: Tuberofundibular (2)

A
  • Effect: Prolactin hormone release
  • Associated pathology: LOW dopamine causes hyperprolactinemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe: Long-Acting Preparations of antipsychotics (6)

A
  • antipsychotics formulated in oil for IM injection
  • received on an outpatient basis
  • indications: individuals with schizophrenia or other chronic psychosis who relapse because of non- adherence
  • should have been exposed to oral form prior to first injection
  • dosing: start at low dosages, then titrate every 2-4 wk to maximize safety and minimize side effects
  • side effects: risk of EPS, parkinsonism, increased risk of NMS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe: Canadian Guidelines for the Treatment of Acute Psychosis in the Emergency Setting (4)

A
  • haloperidol 5 mg IM ± lorazepam 2 mg IM
  • loxapine PO 25 mg ± lorazepam 2 mg IM
  • olanzapine 2.5-10 mg (PO, IM, quick dissolve)
  • risperidone 2 mg (M-tab, liquid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Compare Typical (First Generation) vs. Atypical (Second Generation) Antipsychotics: Mechanism

A
  • Typical: Block postsynaptic dopamine receptors
  • Atypical:
    • Block postsynaptic dopamine receptors (D2)
    • Block serotonin receptors (5-HT2) on presenaptic dopaminergic terminals, triggering DA release and reversing DA blockade in some pathways
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Compare Typical (First Generation) vs. Atypical (Second Generation) Antipsychotics: Pros

A
  • Typical:
    • Inexpensive
    • Plenty of injectable forms are available
  • Atypical:
    • Fewer EPS
    • Low risk of tardive syndroms
    • Mood stabilizing effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Compare Typical (First Generation) vs. Atypical (Second Generation) Antipsychotics: Cons

A
  • Typical:
    • More EPS
    • Tardive syndromes long-term
    • Not mood stabilizing
  • Atypical:
    • Expensive
    • Few injectable forms available
    • Metabolic side effects (weight gain, hyperglycemia, lipid abnormalities, metabolic syndromes)
    • Exacerbation (or new onset) of obsessive behaviour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name: Commonly Used Atypical Antipsychotics (5)

A
  • Risperidone (Risperdal®)
  • Olanzapine (Zyprexa®, Zydis®)
  • Quetiapine (Seroquel®)
  • Clozapine (Clozaril®)
  • Ariprazole (Abilify®)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Name advantages: Risperidone (Risperdal®) (2)

A
  • ​Lower incidence of EPS than typical antipsychotics at lower doses (<8 mg)
  • Associated with less weight gain compared to clozapine and olanzapine
20
Q

Name disadvantages relative to other SGAs: Risperidone (Risperdal®) (7)

A
  • ​Highest risk of EPS/TD among SGAs- avoid if high risk for EPS or existing movement disorder or elderly
  • Elevated prolactin
    • Sexual dysfunction
    • Galactorrhea
    • Gynecomastia
    • Menstrual disturbance
    • Infertility
21
Q

Name formulations: Risperidone (Risperdal®) (2)

A
  • Quick dissolve (M-tabs)
  • Long- acting (Consta®)
22
Q

Name advantages: Olanzapine (Zyprexa, Zydis) (3)

A
  • ​Better overall efficacy compared to haloperidol
  • Well tolerated
  • Low incidence of EPS and TD
23
Q

Name disadvantages relative to other SGAs: Olanzapine (Zyprexa, Zydis) (2)

A
  • Weight gain and metabolic effects - avoid in DM
  • Sedating - avoid if high risk for falls or fracture
24
Q

Name formulations: Olanzapine (Zyprexa, Zydis) (2)

A
  • Quick dissolve formulation (Zydis®) used commonly in ER setting for better compliance
  • IM form available
25
Q

Name advantages: Quetiapine (Seroquel) (2)

A
  • ​Associated with less weight gain compared to clozapine and olanzapine
  • Mood stabilizing
26
Q

Name disadvantages relative to other SGAs: Quetiapine (Seroquel) (2)

A
  • ​Sedating/ortho hypotension - avoid if high risk for falls or fracture
  • QT prolongation in high doses - caution if cardiac risk
27
Q

Name advantages: Clozapine (Clozaril®) (3)

A
  • ​Most effective for treatment-resistant schizophrenia
  • Does not worsen tardive symptoms; may treat them
  • Approximately 50% of patients benefit, especially paranoid patients and those with onset after 20 yr
28
Q

Name disadvantages relative to other SGAs: Clozapine (Clozaril®) (6)

A
  • ​Weight gain and metabolic effects - avoid in DM
  • Sedating/ortho hypotension - avoid if high risk for falls or fracture
  • Potentially severe constipation - avoid if risk of fecal impaction or bowel perforation
  • Cardiomyopathy – caution if existing heart disease
  • Seizures – caution if seizure disorder
  • Agranulocytosis (1%) – avoid in existing leukopenia/ neutropenia
29
Q

Name considerations: Clozapine (Clozaril®) (2)

A
  • ​Weekly blood counts for 6 mo, then q2wk
  • Do not use with other drugs that may cause bone marrow suppression due to risk of agranulocytosis
30
Q

Name advantages: Aripiprazole (Abilify®) (3)

A
  • ​Less weight gain and risk of metabolic syndrome compared to olanzapine
  • a lower incidence of EPS compared to haloperidol
  • mood stabilizing
31
Q

Name disadvantages relative to other SGAs: Aripiprazole (Abilify®) (2)

A
  • ​Insomnia
  • akathisia
32
Q

Classify commonly used atypical antipsychotics according to risk of weight gain (Risperidone, Clozapine, Quetiapine, Olanzapine)

A

Risk of weight gain: Clozapine > Olanzapine > Quetiapine > Risperidone

33
Q

Describe: Neuroleptic Malignant Syndrome (3)

A
  • psychiatric emergency
    • due to strong DA blockade; increased incidence with high potency and depot antipsychotics
  • risk factors
    • medication factors: sudden increase in dosage, starting a new drug
    • patient factors: medical illness, dehydration, exhaustion, poor nutrition, external heat load, male, young adults
  • mortality: 5%
34
Q

Describe clinical features: Neuroleptic Malignant Syndrome (5)

A
  • tetrad:
    • mental status changes (usually occur first)
    • fever
    • rigidity
    • autonomic instability
  • develops over 24-72 h
35
Q

Describe labs: Neuroleptic Malignant Syndrome (3)

A
  • ⬆️ creatine phosphokinase
  • leukocytosis
  • myoglobinuria
36
Q

Describe tx: Neuroleptic Malignant Syndrome (6)

A
  • supportive
  • discontinue antipsychotic drug
  • hydration
  • cooling blankets
  • dantrolene (hydrantoin derivative, used as a muscle relaxant)
  • bromocriptine (DA agonist)
37
Q

Name extrapyramidal sx of antipsychotics (4)

A
  • Dystonia
  • Akathisia
  • Pseudoparkinsonism
  • Dyskinesia
38
Q

Describe this extrapyramidal sx in antipsychotics: Dystonia

  • Acute or Tardive
  • High Risk Groups
  • Presentation
  • Onset
A
  • Acute or Tardive: Both
  • High Risk Groups: Acute: Young asian and black males
  • Presentation: Sustained abnormal posture; torsions, twisting, contraction of muscle groups; muscle spasms (i.e. oculogyric crisis, laryngospasm, torticollis)
  • Onset:
    • Acute: within 5d
    • Tardive: >90d
39
Q

Describe this extrapyramidal sx in antipsychotics: Dystonia

  • Treatment (2)
A

Acute:

  • benztropine
  • diphenhydramine
40
Q

Describe this extrapyramidal sx in antipsychotics: Akathisia

  • Acute or Tardive
  • High Risk Groups
  • Presentation
  • Onset
A
  • Acute or Tardive: Both
  • High Risk Groups: Older females
  • Presentation:
    • Motor restlessness; crawling sensation in legs relieved by walking
    • very distressing, increased risk of suicide and poor adherence
  • Onset:
    • Acute: within 10d
    • Tardive: >90d
41
Q

Describe this extrapyramidal sx in antipsychotics: Akathisia

  • Treatment (4)
A
  • Acute:
    • lorazepam
    • propranolol
    • diphenhydramine
  • reduce dose or change antipsychotic to lower potency
42
Q

Describe this extrapyramidal sx in antipsychotics: Pseudoparkinsonism

  • Acute or Tardive
  • High Risk Groups
  • Presentation
  • Onset
A
  • Acute or Tardive: Acute
  • High Risk Groups: Older females
  • Presentation:
    • Tremor; rigidity (cogwheeling); akinesia; postural instability (decreased/absent arm- swing, stooped posture, shuffling gait, difficulty pivoting)
  • Onset: Acute: within 30 d
43
Q

Describe this extrapyramidal sx in antipsychotics: Pseudoparkinsonism

  • Treatment (2)
A

Acute:

  • benztropine
  • reduce dosage or change antipsychotic to low potency atypical antipsychotic
44
Q

Describe this extrapyramidal sx in antipsychotics: Dyskinesia

  • Acute or Tardive
  • High Risk Groups
  • Presentation
  • Onset
A
  • Acute or Tardive: Tardive
  • High Risk Groups: Older patients
  • Presentation:
    • Purposeless, constant movements, involving facial and mouth musculature
    • less commonly – the limbs; rarely, the diaphragm (“hiccups”)
  • Onset: Tardive: >90d
45
Q

Describe this extrapyramidal sx in antipsychotics: Dyskinesia

  • Treatment
A
  • no good treatment
  • may try clozapine
  • discontinue drug or reduce dosage
46
Q

Describe use of anticholinergic agents with antipsythotics (3)

A
  • types
    • benztropine (Cogentin®) 2 mg PO, IM, or IV OD (1-6 mg)
    • diphenhydramine (Benadryl®) 25-50 mg PO/IM qid
  • do not routinely prescribe with antipsychotics
    • give anticholinergic agents only if at high risk for acute EPS or if acute EPS develops
  • do not give these for tardive syndromes because they worsen the condition

TN Psychiatry (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions