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Spring Pharm Block 3 > Anti-Psychotics Part II > Flashcards

Anti-Psychotics Part II Flashcards

1
Q

What is the mechanism of action of atypical anti-psychotics and how is this clinically relevant?

A

Antagonize serotonin-2A –> makes them better at treating negative symptoms

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2
Q

T/F: Atypical anti-psychotics increase depression.

A

False: The serotonin-2A receptor has no impact on depression

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3
Q

In addition to psychosis, what is the other indication for atypical anti-psychotics?

A

Bi-polar manic phase –> insomnia, risky behavior, grandiosity, etc.

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4
Q

What common medication can trip a manic episode in bi-polar patients?

A

SSRIs or other antidepressants

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5
Q

What are the disadvantages of atypical anti-psychotics?

A

Weight gain, even more than typical anti-psychotics
Acceleration of development of DM
Hyperlipidemia –> increase cardiovascular morbidity and mortality in patients older than 65
Cost

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6
Q

What are the advantages of atypical anti-psychotics?

A

Less risk of EPS
Treats negative symptoms
Available in a variety of dosage forms (helps with adherence)

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7
Q

List groups of atypical antipsychotics that are “related”.

A

Risperidone and Paliperidone
Olanzapine, Quetiapine, and Clozapine
Aripiprazole and Brexiprazole

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8
Q

What are the effects of quetiapine at various doses?

A

Low dose: hypnotic (great for insomnia)
Medium dose: antidepressant
High dose: anti-psychotic

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9
Q

What are the main advantages and disadvantages of quetiapine?

A

Adv: very low risk of EPS and hyperprolactinemia
Disadv: causes weight gain

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10
Q

What was the first atypical anti-psychotic?

A

Clozapine

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11
Q

T/F: Clozapine is commonly used. State why or why not.

A

False: Used last line because it has 5 black box warnings

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12
Q

What are the black box warnings associated with clozapine?

A 
Agranulocytosis (monitor WBC count)
Orthostatic hypotension
Seizures
Increased mortality in elderly with dementia related psychosis
Myocarditis/cardiomyopathy
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13
Q

What is the advantage of utilizing olanzapine?

A

It is structurally similar to clozapine but it has no black box warnings

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14
Q

What is the major disadvantage of olanzapine?

A

Significant weight gain –> decreases adherence

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15
Q

What are the primary advantages and disadvantages of risperidone?

A

Adv: less weight gain
Disadv: significant hyperprolactinemia (must monitor prolactin level)

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16
Q

What S/S result from hyperprolactinemia?

A

Galactorrhea, sexual dysfunction, bone density changes

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17
Q

What are the indications for use of risperidone?

A

Schizophrenia in adults and adolescents
Acute bipolar mania
Behavioral disturbances in autistic children

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18
Q

What is the difference between paliperidone and risperidone?

A

Same effects –> paliperidone is an active metabolite of risperidone

19
Q

When would you prescribe paliperidone over risperidone?

A

If the patient could not tolerate risperidone, they may be able to take paliperidone since it is an active metabolite of risperidone.

20
Q

What are the advantages of lurasidone?

A

Less sedating and low metabolic risk (less weight gain, hyperlipidemia, etc.)

21
Q

How is lurasidone administered?

A

Taken with a 500 calorie meal to increase absorption

22
Q

What is the advantage of ziprasidone?

A

Low risk of metabolic effects

23
Q

What are the advantages and disadvantages of aripiprazole?

A

Adv: low risk of: weight gain, hyperprolactinemia, sedation, and dyslipidemia
Disadv: high cost

24
Q

T/F: Aripiprazole is a commonly used atypical anti-psychotic.

A

True –> one of the cleanest anti-psychotics

25
Q

What is an additional use of aripiprazole in addition to its use as an anti-psychotic?

A

Added to an SSRI/SNRI for severe depression

26
Q

What effect will administration of anti-psychotic medications have on Parkinson’s Disease?

A

Worsen Parkinson’s because anti-psychotics decrease dopamine

27
Q

What drug can be given for psychosis in a Parkinson’s patient and why?

A

Pimavanserin –> modulates hallucinations and delusions without antagonizing dopamine

28
Q

What is the primary indication for administration of Lithium?

A

Mood stabilizer in bi-polar disorder

29
Q

If Lithium is not used for bi-polar disorder, what other class of medications is likely used?

A

Anti-psychotics

30
Q

Describe and state the dose range of Lithium and state what affect this has on patient management.

A

It has a narrow therapeutic window –> 0.4 - 1.0 mmol/L.

Monitor serum Li weekly until stabilized.

31
Q

What affect will most diuretics have on serum lithium levels?

A

Lithium has an inverse relationship with Na. Diuretics waste Na causing lithium levels to rise.

32
Q

When are therapeutic effects seen after lithium administration is started?

A

2-3 weeks after the drug is started

33
Q

What are the AEs of Lithium?

A

Fine tremor, polyuria, polydipsia, hypothyroidism, weight gain, metallic taste, rash

34
Q

What is the hallmark sign of lithium toxicity?

A

Coarse tremor

35
Q

What serum lab must be monitored in patients on lithium and why?

A

TSH –> monitor for elevation of TSH as indication of hypothyroidism

36
Q

Name an anti-epileptic medication that has an off label use for agitation.

A

Valproic acid –> not first line for agitation

37
Q

What are the AEs of valproic acid?

A

Alopecia, weight gain, sedation

38
Q

What serum levels must be monitored in patients taking valproic acid?

A

Serum valproic acid, LFTs, ammonia if hepatic encephalopathy is suspected

39
Q

Describe the dosing availability of valproic acid.

A

Available in many dosage forms –> PO tablets, capsules, oral syrup, IV, etc.

40
Q

What are the concerns of using second generation anti-psychotics in patients over 65 years of age?

A

Increased morbidity and mortality from cardiovascular events

Increased rates of metabolic syndrome –> dyslipidemia, development of DM, etc.

41
Q

Describe the use of anti-psychotic medications in pregnancy.

A

Can’t use anti-psychotics in the third trimester - should try to avoid throughout pregnancy

42
Q

List some drugs that sound like anti-psychotics but are not anti-psychotics.

A

Brand name Zyrtec (antihistamine) sounds like Zyprexa
Clonazepam (BZD) sounds like Clozapine
All the PPIs sound like Aripiprazole

43
Q

Name all the drugs approved by the FDA for treatment of tardive dyskinesia.

A

Only one –> valbenazine

44
Q

What is the mechanism of action of valbenazine?

A

Vesicular Monoamine Transporter-2 (VMAT-2) inhibitor

Spring Pharm Block 3 (7 decks)

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