Anti-Psychotics -- Segars Flashcards
Recurrent suicidal behavior – treatment
Clozapine
Schizophrenia - positive vs. negative symptoms
Positive = hallucinations, delusions, disorganized speech, agitation, behavioral dyscontrol
Negative = Apathy, avolition, alogia, cognitive deficits
Schizophrenia - cause of positive vs. negative symptoms
Name of this theory?
Positive = increased post-synaptic D2 receptor activity in mesolimbic system Negative = decreased D1 activity in pre-frontal cortex
Dopamine hypothesis
Typical antipsychotic agents (3)
Haloperidol
ChlorpromAZINE
FluphenAZINE
Atypical antipsychotic agents (8)
AriPIPRAZOLE
BrexPIPRAZOLE
ClozAPINE
OlanzAPINE
QuetiAPINE
PaliperIDONE
RisperIDONE
ZiprasIDONE
***Major SE difference between the typicals and atypicals
TYPICALS have movement-disorder side effects (extrapyramidal symptoms)
MoA of antipsychotics (in general)
Block D2 post-synaptic receptors
**Partial agonists at D2/3 and 5HT-1A receptors
AriPIPRAZOLE
BrexPIPRAZOLE
**Blocker of NE reuptake transporter (NERT)
NorquetiAPINE (metabolite of QuetiAPINE)
Which agents are more likely to block D1 and D4 receptors also?
Which agents are more likely to block 5-HT receptors also?
ATYPICALS
ATYPICALS
**Typical agent(s) – sedation, hypotension, seizures
Why?
Chlorpromazine
Low potency blocker of D2
**Typical agent(s) – dystonia, akathisia, dyskinesia, parkinson-like symptoms
Why?
Fluphenazine
**HALOPERIDOL
High potency blockers of D2
***Extrapyramidal symptoms (EPS) – treatments?
***Anticholinergics
- Diphenhydramine (Benadryl)
- Benztropine
- Trihexyphenidyl
Amantadine
Propranolol/Clonazepam (for akathisia)
**3 other receptors that can be blocked by antipsychotics and cause symptoms (w/ symptoms)
Muscarinic (dry mouth, constipation, blurred vision, etc.)
Alpha-adrenergic (orthostatic hypotension, impotence)
Histamine (SEDATION)
**Non-behavioral side effect related to dopamine inhibition
Hyperprolactinemia – amenorrhea, erectile dysfunction, infertility, decreased libido, galactorrhea)
***Agranulocytosis - drug cause?
Must do what?
Clozapine
Monitor WBCs
Autonomic instability, stupor, hyperpyrexia, muscle rigidity, altered mental status
Cause?
Neuroleptic malignant syndrome (NMS)
Injectable, high-potency typical agents
ALL patients taking antipsychotics should FIRST have what things measured/recorded?
***Why?
Glucose, lipids, weight, BP, waist size, FHx, etc.
Some (atypicals especially) may cause: weight gain, hyperlipidemia/hyperglycemia, QT prolongation
**Highest risk of mortality from taking anti-psychotics
**Drugs? (4)
STROKE – in elderly w/ dementia
Aripiprazole, Olanzapine, Paliperidone, Risperidone
Sedation (anti-histamine effect) – drugs? (3)
Chlorpromazine
Olanzapine
Quetiapine
Anti-muscarinic effects – drugs? (3)
Chlorpromazine
**Clozapine
Olanzapine
Orthostatic hypotension (anti-alpha effect) – drugs? (2)
Chlorpromazine
Clozapine
QT prolongation/ECG changes – drugs? (4)
Chlorpromazine
Fluphenazine
Paliperidone
**ZIPRASIDONE
EPS – drugs? (3)
***Haloperidol
Fluphenazine
Chlorpromazine
Weight gain – drugs? (2)
- **Clozapine
* **Olanzapine
Hyperglycemia, Hyperlipidemia - drugs? (2)
- **Clozapine
* **Olanzapine
Seizures - drugs (3)
Chlorpromazine
Clozapine
Olanzapine
Hyperprolactinemia - drugs? (2)
Haloperidol (other 2 are less)
Risperidone
2 things to think about when choosing a drug
Previous dosing history (efficacy vs. SEs)
Tolerance to SEs
**Patient w/ non-compliance can be treated w/ what?
**Drugs? (6)
Long-acting injectable agents
Typicals = Haloperidol, Fluphenazine
Atypicals = Risperidone, Olanzapine, Aripiprazole, Paliperidone
Anti-psychotics in pregnancy?
ALL but 2 are Category C – can use if truly needed
