Anti-psychotics Flashcards

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1
Q

high potency typical

A

block D2 rec
advantages- not sedating, injectable, depot, inexpensive

disadvantages- EPS

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2
Q

low potency typical

A

block D2 rec
advantages- highly sedating, inheritable, inexpensive

disadvantages- highly sedating, QT prolong, EPS risk, anti-HAM
antiH1: sedation, weight gain
anti a1- orthostatic hypotension, cardiac abnl
anti-m- dry mouth, blurry vision, constipation, urinary retain, glaucoma

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3
Q

atypical

A

block D2 and 5HT2A rec

less EPS/prolactin release

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4
Q

haloperidol (haldol)

A

high potency typical

depot form

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5
Q

fluphenazine (prolixin)

A

high pot typical

depot form

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6
Q

chlorpromazine (thorazine)

A

low pot typical
also used to tx hiccups
antiHAM

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7
Q

thioridazine (mellaril)

A

low pot typical

anti HAM

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8
Q

clozapine (clozaril)

A

atypical
most efficacious (tx refractory pts, substance abuse, persistent positive symptoms, suicidal/violent) but most dangerous
most metab syndrome/weight gain
antiHAM- seizures, agranulocytosis (weekly blood draw for first 6 months)
decrease risk of suicide (like Li)

least risk for EPS (tx Tardive dyskinesia)

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9
Q

risperidone (risperdal)

A

atypical
depot form, sublingal disintegrating form most potent
more effective for short term tx than halloo

prolactinemia/EPS in doses >6mg/day (most similar to typical, moderate weight gain risk)

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10
Q

quetiapine (seroquel)

A

atyprical
antiHAM
orthostatic hypotension, sedation, longer dose titration (9 days to max dose?)
lowest risk of EPS/TD

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11
Q

olanzapine (zyprexa)

A

atypical
depot form, sublingual disintegrating form
available- fast
highest risk metal syndrome, weight gain, sedation

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12
Q

ziprasidone (geodon)

A

atypical
lowest risk metal syndrome/weight gain

QT prolong, best when given with food

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13
Q

aripiprazole (abilify)

A

atypical
partial agonist- longest slim half life
depot form
low risk of metab syndrome/weight gain, or sedation

more activating (akathisia) at higher doses

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14
Q

paliperidone (invega)

A

atypical (expensive)
depot form
does not require hepatic metabolism (active metabolite)

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15
Q

asenapine (saphris)

A

atypical (expesnive)
must be taken sublingually
risk of EPS

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16
Q

FDA approved for mania

A

qrazo- quetiapine, risperidone, aripiprazole, riprasidone, olanzapine

NOT Clozapine, paliperidone, asenapine

17
Q

antiH tx

A

diphenhydramine (benadryl)

18
Q

anti-a tx

A

phenoxybenzamine

19
Q

antiM tx

A

benztropine (cogentin)

20
Q

Dopa agonist tx

A

amantadine

21
Q

antiEPS

A

akathisia- propranolol

TD- temp inc antyipsychotic dose (acute tx- suppress symptoms), benzos (acute tx), clozapine (maintenance tx)

22
Q

antiNMS

A

NMS= sudden depletion of dopa

fever- fever, encephaopathy, vitals unstable, elevated CPK, rigid muscles (lead pipe)

supportive tx lorazapam, aantadine (release dopa), bromocriptine (dopa agonist), dantrolene (muscle relaxant)

23
Q

note

A

Psychosis = increased Dopamine (DA)

Important dopaminergic systems:

1) mesolimbic/mesocortical pathway- regulates behavior (treatment goal is to block these DA receptors = reduce +/- psychotic symptoms)
2) nigrostriatal pathway- coordination of voluntary movements (block these DA receptors = basal ganglia/EPS effects)
3) tuberoinfundibular pathway- controls prolactin secretion (block these DA receptors = hyperprolactinemia)

24
Q

haloperidol, trifluoperzine, fluophenazine

A

Antipsychotics- high potency
block dopamine D2 receptors (increase cAMP)
psychosis (+symptoms of Schizophrenia), agitation
Nigrostriatal (basal ganglia/EPS- dyskinesias, parkinsonian), and Tubuloinfundibular (hyperprolactinemia)

Evolution of EPS side effects:
4hrs- acute dystonia (sudden onset sustained muscle spasms, stiffness, spasmodic torticollis, opisthotonus, oculogyric crisis)
4days- akathisia (restlessness)
4weeks- bradykinesia (parkinsonism)
4months- tardive dyskinesia (involuntary movements after chronic use)
Treat EPS with benztropine (anticholinergic)

Neuroleptic malignant syndrome (haywire DA system- fever, muscle rigidity, unstable ANS/vitals, mental status changes)
Antidote- dantrolene (refer to anti-NMJ)

Tardive dyskinesia (irreversible oral-facial movements from long term drug use)

25
Q

chlorpromazine, thioridazine

A

Antipsychotics- low potency
block dopamine D2 receptors (increase cAMP)
psychosis (+symptoms of Schizophrenia)
Non neurologic side effects- anti-muscarinic (blurry vision, dry mouth, constipation), anti-alpha1 (hypotension), and anti-H1 (sedation)
C- Corneal deposits
T- reTinal deposits

26
Q

Clozapine, Olanzapine, Quetipine (-pine)

Ziprasidone, Risperidone (-idone)

A

Atypical antipsychotics
multiple receptor effects (decrease DA related side effects due to dual 5-HT2 and DA rec. block)
psychosis (+/- symptoms of Schizophrenia)
Fewer EPS and anti-cholinergic side effects than traditional antipsychotics
C,O- metabolic syndrome (weight gain, glucose intolerance, dyslipidemia, DM)
C- reserved for treatment resistant schizo (those that failed 2 other med trials), due to risk of agranulocytosis (requires weekly WBC monitoring), and seizures
R- may increase prolactin (like 1st gen- high potency)
Z- prolong QT interval

27
Q

Aripiprazole

A

Atypical antipsychotic

different MOA- partial D2 agonist