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Anti-psychotics Flashcards

1
Q

syndrome of chronic disordered thinking and disturbed behavior

A

psychoses

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2
Q

deficits in integrating ______ and ______ with ________

A

thoughts and perception with emotions

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3
Q

schizophrenia primarily develops between the ages of ______. cases are rare before age ____ and after age ______

A

16-30. rare before 12 and after 40

males: 16-25, females: 25-30

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4
Q

schizophrenia is a _________ group of _______ disorders

A

heterogeneous group of heritable disorders

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5
Q

3 classes of schizophrenia symptoms

A

positive symptoms, negative mood, negative cognition

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6
Q

positive symptoms

A

delusions, hallucinations, disorganized speech, disorganized behavior

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7
Q

negative mood symptoms

A

dysphoria, suicidality, anxiety, hopelessness, anxiety, hostility

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8
Q

negative cognition symptoms

A

attention deficit, memory deficit, abstract thought deficit

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9
Q

pharmacological agents address the _______ of psychosis

A

symptoms

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10
Q

Dopamine Hypothesis: _________ dopaminergic activity in schizophrenia

A

excessive

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11
Q

antipsychotics strongly block postsynaptic ____ receptors

A

D2

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12
Q

Serotonin Hypothesis: psychosis may result from _______ of 5HT2A receptors

A

hyperactivation

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13
Q

Atypical antipsychotics are _______ ________ of the 5HT2A receptor; they _______ the level of constitutive activity of these receptors

A

inverse agonists, decrease

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14
Q

excess glutamate release may ________ the mesolimbic pathway, causing _______ dopamine in ventral striatum

A

activate, excess

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15
Q

Glutamate hypothesis: psychosis may result from _______ NMDA receptors on GABA neurons

A

hypofunctional

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16
Q

decreased GABAergic activity causes _______ of glutamatergic signaling, which can cause ________ dopamine release

A

dis-inhibition, excess

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17
Q

2 NDMA receptor antagonists

A

Phencyclidine, Ketamine

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18
Q

The NMDA receptor is an ________ ________, it requires _________ as a co-agonist for full activation. in schizophrenics this site may not be fully _______

A

ion channel, glycine, saturated

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19
Q

________ muscarinic antagonism in CNS leads to delusional behavior

A

Excessive

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20
Q

________ of H1 receptors was once thought to be important in anti-psych activity

A

blockade

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21
Q

Typical or Atypical: Chlorpromazine

A

Typical

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22
Q

Typical or Atypical: Perphenazine

A

Typical

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23
Q

Typical or Atypical: Trifluoperazine

A

typical

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24
Q

Typical or Atypical: Thioridazine

A

typical

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25
Q

Typical or Atypical: Fluphenazine

A

typical

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26
Q

Typical or Atypical: Haloperidol

A

Typical

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27
Q

Typical or Atypical: Thiothixene

A

Typical

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28
Q

Typical or Atypical: Mesoridazine

A

Typical

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29
Q

Typical or Atypical: Loxapine

A

Typical

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30
Q

Typical or Atypical: Molindone

A

Typical

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31
Q

Typical or Atypical: Pimozide

A

Typical

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32
Q

Typical or Atypical: Clozapine

A

Atypical

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33
Q

Typical or Atypical: Risperidone

A

Atypical

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34
Q

Typical or Atypical: Olanzapine

A

Atypical

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35
Q

Typical or Atypical: Quetiapine

A

Atypical

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36
Q

Typical or Atypical: Ziprasidone

A

Atypical

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37
Q

Typical or Atypical: Aripiprazole

A

Atypical

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38
Q

Typical or Atypical: Paliperidone

A

Atypical

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39
Q

Typical or Atypical: Iloperidone

A

Atypical

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40
Q

Typical or Atypical: Asenapine

A

Atypical

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41
Q

Typical or Atypical: Lurasidone

A

Atypical

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42
Q

Typical or Atypical: Brexipiprazole

A

Atypical

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43
Q

Typical or Atypical: Cariprazine

A

Atypical

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44
Q

_________ antipsychotics primarily block D2 receptors

A

Typical

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45
Q

_________ antipsychotics block D2 and 5HT2A receptors (some have higher affinity for 5HT2A)

A

Atypical

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46
Q

_________ antipsychotics are associated with Extrapyramidal Side Effects

A

Typical

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47
Q

_________ antipsychotics are associated with Metabolic Side Effects

A

Atypical

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48
Q

Typical antipsychotics primarily block _______ receptors

A

D2

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49
Q

Atypical antipsychotics block ______ and ______ receptors

A

D2 and 5HT2A

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50
Q

typical antipsychotics are more associated with which type of side effects

A

Extrapyramidal

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51
Q

Atypical antipsychotics are more associated with which type of side effect

A

Metabolic

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52
Q

what symptoms do antipsychotics improve

A

hallucinations, delusions, combativeness, anorexia, self care, withdrawal

53
Q

the potency of typical antipsychotics correlates ________ with their affinity for the ______ receptor

A

linearly, D2

54
Q

typical antipsychotics generally have a higher affinity for the _____ receptor

55
Q

atypical antipsychotics generally have a higher affinity for the _____ receptor

56
Q

which TYPICAL antipsychotic has the most side effects

A

Chlorpromazine

57
Q

which ATYPICAL antipsychotic has the most side effects

58
Q

D2 receptors in the ________ and _______ areas control psychoses

A

Cortex and Limbic

59
Q

D2 receptors in the _________ and _________ areas are more associated with adverse effects

A

Basal Ganglia and Hypothalamus/Pit

60
Q

Adverse effects can occur because of the ________ of the D2 receptors

61
Q

which Typical antipsychotic has metabolic side effects

A

Chlorpromazine

62
Q

what are metabolic side effects

A

weight gain, lipids, glucose

63
Q

which typical antipsychotics are NOT phenothiazine derivatives

A

Loxapine, Haloperidol, Molindone

64
Q

MOST typical antipsychotics are ____________ derivatives

A

phenothiazine

65
Q

which 3 Atypical antipsychotics are NOT associated with metabolic side effects

A

Aripiprazole, Asenapine, Ziprasidone

66
Q

Extrapyramidal side effects are due to _____ receptor antagonism in the ________

A

D2, Basal ganglia

67
Q

what are Extrapyramidal side effects

A

Parkinsonism, Restlessness, Dystonia, Tardive Dyskinesia

68
Q

what are Extrapyramidal side effects

A

Parkinsonism, Restlessness, Dystonia, Tardive Dyskinesia

69
Q

How do you treat Parkinsonism

A

anticholinergics

70
Q

How do you treat Dystonia

A

IM or IV diphenhydramine or benztropine (anticholinergics)

71
Q

How do you manage akathisia

A

lower dose, change drugs, adjunctive med (propranolol, benztropine, benzodiazepines)

72
Q

adjunctive medications for akathisia

A

propranolol, benztropine, benzodiazepines

73
Q

what is akathisia

A

restlessness, pacing, fidgeting

74
Q

how to PREVENT tardive dyskinesia

A

use minimum effective dose, use atypical

75
Q

how to TREAT tardive dyskinesia

A

lower dose, switch to atypical, Valbenazine

76
Q

can you use anti-muscarinic drugs to treat tardive dyskinesia

A

NO, they will not improve

77
Q

what is tardive dyskinesia

A

involuntary movements, often choreoathetoid

78
Q

are men or women more likely to get tardive dyskinesia

79
Q

what drug is used to treat tardive dyskinesia

A

Valbenazine

80
Q

MOA of Valbenazine

A

VMAT2 inhibitor, increases cytoplasmic DA

81
Q

side effects of Valbenazine

A

sleepiness, QT prolongation

82
Q

newer drug for tardive dyskinesia but has a boxed warning for depression

A

Deutetrabenazine

83
Q

cause of Neuroleptic Malignant Syndrome

A

High parenteral doses of antipsychotics into skeletal muscle

84
Q

what 3 antipsychotics cause NMS-atypical

A

Clozapine, Olanzapine, Risperidone

85
Q

Treatment of Neuroleptic Malignant Syndrome

A

Dantrolene or Bromocriptine (D/C antipsych)

86
Q

spasm of muscles of tongue, face, neck, back

A

acute dystonia

87
Q

restlessness

88
Q

bradykinesia, rigidity, tremor, shuffling gait

A

Parkinsonism

89
Q

extreme rigidity, fever, unstable BP, can be fatal

A

neuroleptic malignant syndrome

90
Q

what drug has been used to treat/prevent metabolic syndrome

91
Q 
Metabolic Syndrome: 
FBGL > \_\_\_\_\_,
 \_\_\_\_\_\_\_\_ BP, 
Triglycerides > \_\_\_\_\_\_\_\_, 
\_\_\_\_\_\_\_\_ Waist Circumference,
\_\_\_\_\_\_\_\_ HDL, 
Weight \_\_\_\_\_\_\_
A 
FBGL > 100,
INCREASED BP, 
Triglycerides > 150, 
INCREASED Waist Circumference,
DECREASED HDL, 
Weight GAIN
92
Q

what is monitored at baseline, 1 month, and 3 months

A

weight, BP, fasting glucose, fasting lipid panel

93
Q

what is monitored yearly

A

weight, BP, fasting glucose

94
Q

what is monitored every 3 years

A

fasting lipid panel

95
Q 
what changes are you looking for when monitoring for metabolic syndrome:
\_\_\_\_\_\_% increase in weight, 
BMI > \_\_\_\_\_\_, 
Fasting glucose > \_\_\_\_\_\_\_, 
BP > \_\_\_\_\_\_\_
A

5-7% increase in weight,
BMI > 25,
Fasting glucose > 126,
BP > 140/90

96
Q

_________ antipsychotics (other than _______) are first choice drugs

A

atypical, Clozapine

97
Q

most metabolically neutral atypical antipsychotics

A

Ziprasidone, Aripiprazole, followed by Asenapine

98
Q

what 4 antipsychotics come in long acting injectables

A

Haloperidol, Fluphenazine, Risperidone, Paliperidone

99
Q

how often are Fluphenazine and Risperidone injections needed

A

every 2 weeks

100
Q

how often are Haloperidol injections needed

A

every 4 weeks

101
Q

How often are Paliperidone injections needed

A

every 3 months

102
Q

which antipsychotic can cause Agranulocytosis

103
Q

fall in granulocytes

A

Agranulocytosis

104
Q

Clozapine and prominent anti ____ and _____ receptor effects, which cause ______ and _______

A

M and H1, constipation, Sedation

105
Q

what is the most effective antipsychotic (but is limited by side effects)

106
Q

which antipsychotic is used for Autism

A

Risperidone

107
Q

what is the most effect antipsych after Clozapine (but is also limited by side effects)

A

Olanzapine

108
Q

which antipsych can be used for depression monotherapy

A

quetiapine

109
Q

which antipsych has increased absorption when taken with food

A

Ziprasidone

110
Q

what is the active metabolite of Risperidone

A

Paliperidone

111
Q

which antipsych is used for anxiety and depression

A

Iloperidone

112
Q

which antipsych is an add on agent for MDD

A

Brexpiprazole

113
Q

which antipsych is used for Bipolar Type 1

A

Cariprazine

114
Q

which antipysch is only a partial agonist at D2 (decrease EPS, positive side effect profile)

A

Aripiprazole

115
Q

Bipolar 1

A

depression and mania

116
Q

Bipolar 2

A

major depression and hypomania

117
Q

Cyclothymia

A

hypomania and less severe depression

118
Q

elevated, expansive mood with increased energy and goal directed behavior. associated with functional impairment requiring hospitalization

119
Q

what is the difference is mania and hypomania

A

hypomania doesn’t require hospitalization

120
Q

PREVENT bipolar episodes with

A

mood stablizers (lithium, valproate, carbamazepine, lamotrigine)

121
Q

TREAT bipolar episodes with

A

atypical antipysch and/or benzodiazepine

122
Q

2 common features between bipolar disorder and epilepsy

A

episodic nature and kindling

123
Q

Lithium inhibits __________, which decreases levels of ________ and ________. This pathway is normally ________ during mania

A

IMPase, Inositol and PIP2, increased

124
Q

Lithium inhibits _______ by enhancing ______ activity, which increases ________ levels in the hippocampus

A

GSK3, Akt, beta-catenin

125
Q

elevated dopamine normally _______ GSK3

126
Q

therapeutic levels of Lithium

A

0.75-1.25 mEq/L

127
Q

lithium has a _____ therapeutic index

128
Q

how is lithium excreted

129
Q

lithium treatment may cause ________ and __________ due to inhibition of ________

A

polyuria and polydipsia, Anti-Diuretic Hormone

Pharmacology (5 decks)

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