Antipsychotic drugs Flashcards
What antipsychotic would you prescribe for a patient who has been treatment resistive and is a suicide risk?
Clozapine (2nd gen)
What would you prescribe for a patient with parkinson’s who is in the late stages showing signs of psychosis?
Pimavanserin (5HT inverse agonist)
What are the 2 Dopamine pathways most involved in the symptoms of Schizophrenia?
Mesolimbic
Mesocortical
What are positive symptoms?
Symptoms that are additional to a person/overactive.
Hallucinations, delusions, disorganized speech, agitation
What are negative symptoms?
“Hypoactive” symptoms
Apathy, Alogia, Cognitive deficits, social withdrawal
Which pathway is responsible for the EPS/TD side effects of antipsychotics?
Nigrostriatal Pathway
What suffix do Typical (1st gen) agents share?
- azine
* not all of them, but about half
What suffix to Atypical (2nd gen) agents share?
- idone
- piprazole
- apine
What is the main difference between typical and atypical antipsychotics?
atypical (2nd gen) have decreased EPS/TD side effects
What neurotransmitter does first gen’s primarily block?
D2
What neurotransmitter does second gen’s primarily block?
5HT2
What are 3 other neurotransmitter receptors that typical agents block (and accounts for side effects)?
Muscarinic
Histaminic
a1 adrenergic
What side effects are associated with a1-adrenergic blockage by typicals?
Orthostatic Hypotension
Dizziness/Syncope
Remember: a1= 1 Heart= blood pressure issues
What are some presenting symptoms for hyperprolactinemia caused by typical antipsychotics?
Amenorrhea
Galactorrhea
Gynecomastia
Decreased Libido
What are the 1st line treatments for EPS symptoms?
Benztropine (anticholinergic)
Trihexyphenidyl
What are the side effects associated with histamine blockade by typical?
Sedation
What can be given to offset the histamine-mediated EPS symptoms?
Diphenhydramine
Treatments for Tardive Dyskinesia
VMAT2 inhibitors- “-benazines”
Valbenazine
Deutetrabenazine
“-idone” mechanism of action
5HT-2A/DA Antagonists
Which 2nd gen’s work by being partial agonists at DA/5HT1A receptors?
-piprazoles
Which 2nd gen’s are considered multi-acting agents?
-apines
What side effects are more common in 2nd gen compared to 1st gen?
Metabolic problems: Weight gain, Hyperlipidemia, Hyperglycemia
QTc prolongation
Which 1st gen’s have the highest risk for EPS and TD?
High Potency:
Fluphenazine
Haloperidol
“HAL FLIES HIGH”
Which 1st gen’s have the highest risk for anti-histamine/cholinergic/a1 side effects?
Chlorpromazine
Thioridazine
“Cheating Thieves are LOW”- These have low potential for EPS/TD side effects
Which 2nd gens have the highest risk for metabolic side effects?
ClOzapine
Olanzapnie
O’s for Obesity
Overall, which 2nd gen’s has the lowest risk of side effects?
Ziprasidone
Risperidone
What is the GASS used for?
Generalized survey to evaluate side effects of antipsychotics
What is the AIMS used for?
Evaluates Movement side effects
What is a side effect specifically related to Clozapine?
Agranulocytosis
A patient who is taking antipsychotics presents with muscle rigidity, rhabdomyolysis, hyperthermia, and dehydration. What could they be suffering from?
Neuroleptic Malignant Syndrome (NMS)
What is the antidote to NMS?
Dantrolene
What are the Long-Acting Injectable Agents?
ROAP Risperidone Olanzapine Aripiprazole Paliperidone (don't need to know this one)
