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Psych Pharm > Antipsychotic Drugs > Flashcards

Antipsychotic Drugs Flashcards

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1
Q

Name the typical antipscyhcotics

A 
Chlorpromazine
Fluphenazine
Perphenazine
Thiothixene
Haloperidol
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2
Q

Name the atypical antipsychotics

A 
Clozapine
Risperidone
Olanzapine
Quetiapine
Ziprasidone
Aripiprazole
Paliperidone
Lurasidone
Asenapine
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3
Q

What is alogia?

A

Lack of speech

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4
Q

What is avolition?

A

Lack of initiative (motivation)

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5
Q

Which Dopamine receptors inhibit Adenylate Cyclase?

A

D2, D3, D4

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6
Q

Which Dopamine receptors activate Adenylate Cyclase?

A

D1 and D5

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7
Q

What does Adenylate Cyclase do?

A

converts ATP to cAMP

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8
Q

What is the MoA of typical antipsychotics?

A

Dopamine D2 blockers

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9
Q

What type of symptoms are typicals good for treating?

A

Postive Symptoms

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10
Q

Which Dopamine receptors inhibit Adenylate Cyclase?

A

D2, D3, D4

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11
Q

Which Dopamine receptors activate Adenylate Cyclase?

A

D1 and D5

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12
Q

What is the relevance of high potency typicals? Why do they do this?

A

High potency have higher chance of EPS, and they offer less sedation. This is due to weak anticholinergic effect and autonomic SAs.

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13
Q

What is the MoA of typical antipsychotics?

A

Dopamine D2 blockers

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14
Q

What type of symptoms are typicals good for treating?

A

Postive Symptoms

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15
Q

What is the rank of potency of typicals?

A

Haloperidol>Fluphenazine=Perphenazine>Thiothixene>Chlorpromazine

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16
Q

What is the relevance of low potency typical? Why do they do this?

A

Low potency typicals have lower incidence of Extra Pyramidal Symptoms (EPS). This is because of their antimuscarinic effects

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17
Q

What is the relevance of high potency typicals? Why do they do this?

A

High potency have higher chance of EPS, and they offer less sedation. This is due to weak anticholinergic effect and autonomic SAs.

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18
Q

What type of symptoms are atypicals good for treating?

A

Negative Symptoms

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19
Q

What is the potency of Clozapine?

A

Low potency

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20
Q

What is the MoA of Risperidone?

A

5-HT2/D2 agonist

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21
Q

What is the only approved antipsychotic for children and teens?

A

Risperidone

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22
Q

What is the primary active metabolite of Risperidone?

A

Paliperidone

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23
Q

What is the MoA of Aripiprazole?

A

D2 partial agonist

5-HT2A antagonist, 5-HT1A partial agonist

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24
Q

What is the MoA of Ziprasidone?

A

5-HT2A, 5-HT1A, 5-HT2C/D2 antagonist

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25
Q

Which atypical antipsychotic acts as a D1, D2, 5-HT1, 5-HT2, alpha adrenergic and histamine receptor antagonist. With low affinity for muscarinic receptors?

A

Asenapine

26
Q

What is the MoA of Lurasidone?

A

D2 and 5-HT2A antagonist

Partial agonist of 5-HT1A

27
Q

Which atypical antipsychotic has the highest incidence of EPS?

A

Lurasidone

28
Q

What effects do antipsychotics have in the Cerebral Cortex?

A

They can lower the threshold for seizures. This most often occurs with low potency drugs like the phenothiazines (Chlorpromazine, Fluphenazine, and Perphenazine)

29
Q

What effects do antipsychotics have in the Basal Ganglia?

A

Decrease dopamine activity. This causes EPS.

Initially, they increase dopamine metabolism, synthesis, and firing rate, but this diminishes over time.

30
Q

At what site in the brain do antipsychotics have their antipsychotic effect?

A

Limbic System

31
Q

Which antipsychotic is an antidiuretic?

A

Chlorpromazine

32
Q

Which antipsychotics have the most increase in prolactin secretion?

A

All Typicals and Risperidone

33
Q

Which antipsychotics have no increase or decrease Prolactin secretion?

A

Quetiapine

Aripiprazole (may decrease secretion)

34
Q

What effects do antipsychotics have in the brain stem at low doses?

A

Decreased vasomotor reflexes

35
Q

What effects do antipsychotics have in the chemoreceptor trigger zone in low doses?

A

anti-nausea and vomiting elicited by activation of dopamine receptors

36
Q

Which antipsychotic is an antidiuretic?

A

Chlorpromazine

37
Q

What are the SAs of Chlorpromazine?

A 
antidiuretic
lowers glucose tolerance
lowers insulin release
orthostatic hypotension
causes jaundice
Urticaria in 5% of patients
38
Q

Which atypical antipsychotics increase the risk of DM2?

A

Atypicals: Clozapine and Olanzepine have highest risk

39
Q

Which atypical antipsychotics have the least risk of DM2

A

Aripiprazole and Ziprasidone

40
Q

Which EPS symptoms have the latest onset?

A

Perioral Tremor

Tardative Dyskinesia

41
Q

Which atypical antipsychotics have the least incidence of weight gain?

A

Ziprasidone (+/-) and Aripiprazole (+)

42
Q

Which atypical antipsychotic has the highest risk of causing EPS?

A

Risperidone

43
Q

Which atypical antipsychotics have the highest potential for CYP interactions?

A

Aripiprazole
Quietipine
Respiridone
Ziprasidone

44
Q

In a patient who develops Parkinsonian syndrome due to antipsychotic Rx, which two medications are contraindicated to treat this new problem? Why?

A

L-DOPA and Bromocriptine are contraindicated because they can induce agitation and enhance the psychosis

45
Q

Which EPS symptoms have a delayed onset?

A

Perioral Tremor

Tardative Dyskinesia

46
Q

Which EPS symptom can appear within the first 5 days of therapy?

A

Acute Dystonia

47
Q

Which EPS symptom can develop within 5-60 days of therapy?

A

Akathesia (There’s ants in my pants!!!)

48
Q

Which EPS symptom can develop within 5-30 days of therapy?

A

Parkinsonian syndrome

49
Q

In a patient who develops Parkinsonian syndrome due to antipsychotic Rx, which two medications are contraindicated to treat this new problem? Why?

A

L-DOPA and Bromocriptine are contraindicated because they can induce agitation and enhance the psychosis

50
Q

What are the symptoms of Neuroleptic Malignant Syndrome?

A 
Fever
Severe Parkinsonism with catatonia
Fluctuations in coarse tremor intensity
Autonomic instability
high creatine kinase
Myoglobinemia
51
Q

What is the mortality rate in NMS?

A

High (10%)

52
Q

How do you treat NMS?

A

STOP the antipsychotic

Dantrolene (muscle relaxant) or bromocriptine

53
Q

Which drug will require weekly white blood cell counts? Why?

A

Clozapine

Because this can cause agranulocytosis (can see leukopenia before onset)

54
Q

Which atypical antipsychotics have the highest incidence of metabolic syndrome?

A

Olanzapine

55
Q

Which atypical antipsychotics have the lowest risk of metabolic syndrome?

A

Zisprasidone and Aripiprazole

56
Q

Which side effect is caused seretonergic, muscarinic, noradrenergic, and D2 blockade?

A

Sexual side effects

57
Q

What type of tissues do antipsychotics accumulate in?

A

High blood supply tissues

58
Q

Should a pregnant woman take antipsychotics? Why?

A

Probably not.

Crosses placental barrier and enters beast milk.

59
Q

Which antipsychotics have active metabolites?

A

Chlorpromazine
Phenothiazines (chlorpromazine, Fluphenazine, Perphenazine)
Respiridone (*Paliperidone)
Aripiprazole

60
Q

Name the long acting depot antipsychotics

A

Prolixin Decanoate
Haldol Decanoate
Risperidal Consta

61
Q

What are some miscellaneous uses of antipsychotics?

A

Nausea and Vomiting (low dose)
Alcoholic hallucinosis
Neuropsychiatric disease with movement disorders: Tourette’s , Huntington’s, Intractable Hiccup

Psych Pharm (3 decks)

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