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psychiatry > Antiphsychotics > Flashcards

Antiphsychotics Flashcards

exam 1

1
Q

Drug- induced physchoses

A
  • Anticholinergic drugs
  • Benzodiazepines
  • Antipsychotic agents
  • Dopaminergic agents
  • Corticosteroids
  • Withdrawal from sedatives/alcohol
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2
Q

Positive Symptoms vs. Negative Symptoms

A 
Positive symptoms:
Symptoms that you would expect to be present in patients with Psychosis/depression 
-Delusions
-Hallucinations
-Disorganized thoughts/speech

Negative Symptoms:
Harder to detect Symptoms that you would NOT expect to find in healthy patients, but find in mentally ill patients:

  • > Anhedonia (inability to feel pleasure)
  • > Flattened affect
  • > Apathy
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3
Q

Important OLDER Antipsychotics

A

1) Chlorpromazine -> low potency
2) Perphenazine, Thiothizene -> Medium potency
3) Haloperidol -> HIGH potency

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4
Q

Antipsychotics/Neuroleptics MOA:

A

1) Blockade of dopamine (D2) receptors
- > Older agents

2) Plus/minus blockade of serotonin (5HT2A) receptors
- > Newer agents (aka: atypicals)

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5
Q

4 dopamine tracts in the brain (these are the targets to block Dopamine activity):

A

1) Mesolimbic tract
2) Nigrostriatal tract
3) Mesocortical tract
4) Tuberoinfundibular tract

People with psychosis (ie Schizophrenia) have overactivity of one of these tracts

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6
Q

mesolimbic

A

antipsychotic (positive symptoms)

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7
Q

mesocortical

A

antipsychotic (negative symptoms)

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8
Q

nigrostriatal

A

extrapyramidal movements

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9
Q

tuberoinfundibular

A

prolactin release

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10
Q

Consequences of Blocking Mesolimbic Dopaminergic Pathway

A

Antipsychotic (pos symptoms)

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11
Q

Consequences of Blocking Mesocortical Dopaminergic Pathway

A

Antipsychotic (neg symptoms)

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12
Q

Consequences of Blocking Nigrostriatal Dopaminergic Pathway

A

Extrapyramidal movements

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13
Q

Consequences of Blocking Tuberoinfundibular Dopaminergic Pathway

A

Prolactin Release

Blocking dopamine at the pituitary -> more Prolactin is released (off target effect of these drugs)

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14
Q

Common ADVERSE reactions when using Antipsychotics:

A

1) Hyperprolactinemia
- > Galactorrhea, amenorrhea, gynecomastia, reduced libido
- > Less with newer agents

2) Postural HYPOTENSION
- > anti psychotic drugs BLOCK K+ channels
- > the potential for K+ to be released from the cell is inhibited
- > AL contrario -> STIMULANTS tend to stimulate Alpha 1 receptors and lead to higher BP

3) QT prolongation
- > IN some more than others

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15
Q

Anti Psychotic drugs and QT interval

A

Anti psychotic drugs lead to a LONGER QT interval because they block the K+ channel
-> (K+ CANT LEAVE the cell to reset the negative cell potential inside)

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16
Q

Common Adverse Reactions to Antipsychotic drugs

A

1) Extrapyramidal Syndromes (EPS)
-> Dystonias, akathesia, parkinsonism
-> Seen less with newer agents (atypicals)
-> Treat by lowering dose, changing drug
-> Drug therapy:
Benztropine (Cogentin)
Trihexyphenidyl (Artane)

2) Acute dystonic reaction
-> Oculogyric crisis, torticollis
-> Give single injection of ANTICHOLINERGIC agent:
(For example: Benztropine 1-2 mg)
-> Followed by oral therapy

3) Tardive Dyskinesia (TD)
- > Persistent EPS
- > Elderly at greater risk

STRATEGIES:

  • Use min. effective doses for min. duration
  • Gradual dose reduction
  • Change to atypical agent
  • Vitamin E? (kind of sucks, not actually that effective)

4) Neuroleptic Malignant Syndrome
- > Hyperpyrexia, rigidity, autonomic instability, delirium
- > Uncommon, but can be LETHAL
- > More likely w/high doses
- > Onset - any time

  • > Stop drug & control rigidity
  • > Supportive care, dantrolene, bromocriptine
17
Q

“Typical” Antipsychotics

A

Low Potency

  • > Chlorpromazine (Thorazine)
  • > Thioridazine (Mellaril)

Medium Potency

  • > Perphenazine (Trilafon)
  • > Thiothixene (Navane)
  • > Trifluoperazine (Stelazine)

High Potency

  • > Haloperidol (Haldol)
  • > Fluphenazine (Prolixin)
18
Q

Top 5 Most Commonly Prescribed “Atypical” Antipsychotics

A
  • Clozapine (Clozaril)
  • Risperidone (Risperdal) (also: paliperidone - Invega)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Aripiprazole (Abilify)
19
Q

Atypical Antipsychotics Adverse Effects/ Concerns

A

1) Increases in weight, blood glucose & lipids
2) Includes hypotension & miscellaneous others (somnolence, dizziness, increased LFTs (Liver Function Tests), CYP450 interactions)
3) Increase in Prolactin & EPS tend to be limited to higher doses

20
Q

Clozapine (Clozaril)

A

Atypical Antipsychotic Drug

Role:

  • May be of use if treatment refractory
  • Or if there are EPS (Extrapyramidal syndromes) with other agents
  • Usually dosed 3 times/day
Adverse effects:
- Little EPS or increase in prolactin
- Sedation and WEIGHT GAIN QUITE COMMON
- Also may see sialorrhea (drooling)
- Seizures in 1-4%
- More common with higher doses
- Agranulocytosis in about 1% 
(Requires frequent CBC monitoring)

Risk factors:

  • > Women > men
  • > Elderly
  • > Ashkenazi Jewish descent
  • > Between weeks 6-18 of treatment
21
Q

Notes on Atypical Antipsychotics

A

Risperidone
-> Lower cost than most other atypicals

Olanzapine
-> Clozapine derivative

Quetiapine
-> Cataracts?

Aripiprazole
-> Fewer metabolic side effects

22
Q

Clozapine vs. Olanzapine

A

Olanzapine -> no Choloride group, slightly modified chemical groups

  • > OVERALL safer drug for the bone marrow
  • > might not be quite as effective as Clozapine, but doesn’t cause Agranulocytosis
23
Q

Treatment Considerations for Atypical Antipsychotics

A

Time to effect:
-> Some symptoms improve rapidly
-> MOST IMPROVE SLOWLY
(Over weeks to months)

Duration of treatment:
-> Most require prolonged maintenance
(Need to balance against SEs)
-> Abrupt discontinuing of taking the drug can increase relapse risk

24
Q

Risk of Treating Dementia-related Psychosis

A

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death compared to placebo.

25
Q

FDA approved indication for the use of antipsychotic medication?

A

mejor depressive disorder

psychiatry (21 decks)

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