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Block 8 Week 6 > Antipsychotic drugs-Kirkpatrick > Flashcards

Antipsychotic drugs-Kirkpatrick Flashcards

1
Q

What are appropriate uses for antipsychotics?

A

Psychosis
Non-psychotic mania
Autism
Adjunct to antidepressants

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2
Q

What are other common uses for antipsychotics?

A

Behavioral problems in patients with dementia (2nd or 3rd line only)
Delirium ((2nd or 3rd line only)

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3
Q

What is the dopamine theory of schizophrenia?

A

Psychosis=schizophrenia=dopamine dysregulation

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4
Q

Antipsychotic meds are all dopamine (blank) or (blank) and dopamine receptor binding has a strong correlation with (blank).

A

anatagonists
partial agonists
clinical dose

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5
Q

T or F

Patients’ responses to antipsychotics are highly variable; some don’t respond at all

A

T

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6
Q

Psychotic symptoms have a transient increase with infusion of low doses of what three things?

A

Ketamine (an NMDA antagonist)
MCPP (a sertonin agonist)
Cannabis

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7
Q

What are the 2 dopamine pathways?

When you give block dopamine receptors how does it effect these pathways?

A

mesocorticolimbic-antipsychotic efficacy

nigrostrital- extrapyramidal side effects

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8
Q

what are the functions of the dopamine pathway?

A
  • reward (motivation)
  • pleasure, euphoria
  • motor function (fine tuning)
  • compulsion
  • Perservation
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9
Q

What are the functions of the serotonin pathways?

A
  • mood
  • memory processing
  • sleep
  • cognition
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10
Q

What are the commonly use first generation drugs antipsychotics?
Which ones have a depot formulation?

A
  • fluphenazine
  • perphenazine
  • trifluoperazine
  • haloperidol (haldol)

Haloperidol and fluphenazine

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11
Q

What are the five most commonly used 2nd generation antipsychotics?
Which ones have a depot formulation?

A 
Aripiprazole
Olanzapine
Quetiapine
Risperidone
Ziprasidone

-aripiprazole olanzapine, risperidone

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12
Q

What is the mechanism of action of all antispychotics except for one? Which one is the exception and how does it work?

A

They are all dopamine antagonists

Aripiprazole (abilify)-> partial dopamine agonist

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13
Q

Why dont you use the depot formulation of olanzapine?

A

Because it causes hypotension

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14
Q

Which 2 antipsychotics cause the most weight gain?

A

Clozapine and olanzapine

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15
Q

T or F

all of the 2nd generation drugs have superior efficacy, especially for negative symptoms

A

FALSE

-improvement in neg sx is due to improvement in other psychiatric symptoms and/or motor side effects

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16
Q

T or F

2nd generation drugs have no risk of EPS

A

False!!

it varies by drug and is dose related

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17
Q

T or F

If a patient’s psychotic symptoms havent responed you should raise the dose

A

F

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18
Q

T or F

if a patient has particularly severe psychotic symptoms, he or she needs a higher dose

A

F

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19
Q

T or F
If a patient has symptoms in the grey zone b/w odd experiences and clearcut psychosis, you should give a lower dose than usual

A

F

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20
Q

How do all antipsychotics look on a dose-response curve?

A

they have an exponential increase and then plateau (efficacy does not increase past this point, in fact it drops)

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21
Q

What antipsychotic is th e most effective but has the most side effects?

A

Clozapine

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22
Q

What is the class I antipsychotic?

A

Clozapine

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23
Q

What is the class II antipsychotic?

A

Risperidone and Olanzapine

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24
Q

What is the class III antipsychotic?

A 
Everything else
(zotepine, amisulpride, aripiprazole, sertindole, quietiapine, ziprasidone, remoxipride)
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25
Q

What is the major side effect of clozapine? Is this reversible? When will it most likely occur? How do you keep an eye out for it?

A

Agranulocytosis (bone marrow suppression)
Yes
in the first year (about 1%)
Blood draws

26
Q

What are all the SEs of clozapine?

A
  • agranylocytosis
  • sustained tachycardia
  • weight gain
  • orthostatic hypotension
  • hypersalivation
  • sedation
27
Q

What are extrapyramidal side effects?

A
  • Rigidity
  • Tremor
  • Bradykinesia
  • Hypersalivation
  • Neuroleptic Malignant Syndrome
  • Akathisia
28
Q

What is the treatment for EPS?

A 
decrease dose, change medication
Anticholinergic drug:
-diphenydramine (benadryl)
-trihexiphenidyl (artane)
-benzotropine (cogentin)
Amantadine

These will remedy everything except for akathisia

29
Q

What is the only symptom of EPS that cannot be remedied by amantadine or anticholinergic drugs?

A

akathisia

30
Q

How do you treat akathisia?

A

-change meds
-beta blockers (propranolol)
-maybe high doses of B6
-maybe clonazepam
NOT ANTICHOLINERGICS

31
Q

A study was done comparing the rate of antipsychotic medication discontinuation with 1st generation vs 2nd generation antipsychotics, which class was discontinued more and why?

A

both were discontinued equally due to SEs

32
Q

What is this:

syndrome of involuntary choreo-athethoid movements, not just the mouth and face

A

tardive dyskinesia

33
Q

Tardive dyskinesia is a SE of (blank) generation antipsychotics and is (blank and blank)-related

A

first

dose and time

34
Q

What ethinicity and gender is most susceptible to tardive dyskinesia?

A

Male gender, AA

35
Q

If you stop the medication that is inducing tardive dyskinesia what will happen?

A

you will get transient worsening and then you may or may not get improvement

36
Q

What movement disorder may be a risk factor for tardive dyskinesia?

A

Akathesia

37
Q

Which is drug puts you at higher risk of developing tardive dyskinesia; haloperidol or olanzapine?

A

Haloperidol

38
Q

What is the only antipsychotic drug that caused weight loss?

A

Olindone (moban)

39
Q

Weight gain in schizophrenics is iatrogenic (caused by physicians) cuz that antipsychotics make you gain weight! How do we know this?

A

cuz schizophrenia is associated with smaller BMI, shorter and skinner people w/out tx

40
Q

How do you treat weight gain?

A
  • change meds
  • decrease dose
  • exercise
  • nutritional counseling
  • metformin
41
Q

If you block D2 receptors, what are the side effects?

A

EPS, prolactin elevation

42
Q

If you block M1 receptors, what are the side effects?

A

Cognitive deficits, dry mouth, constipation, increased heart rate urinary retention, blurred vision

43
Q

If you block H1 receptors what are the side effects?

A

sedation, weight gain, dizziness

44
Q

If you block the alpha 1 receptors what are the side effects?

A

hypotension

45
Q

If you block the 5-HT2A receptors what are the side effects?

A

anti-EPS

46
Q

If you block the 5-HT2c receptors what are the side effects?

A

satiety blockade

47
Q

Why are secondary generation drugs considered better than first generation drugss?

A

cuz they block the 5-HT2A receptor thus inducing ANTI-EPS side effects YAY

48
Q

What is the QT interval?

What happens if the interval is increased?

A

measure of the time between the start of the Q wave and the end of the T wave in EKG
-the electrical depolarization and repolarization of the ventricles

-its a risk factor for ventricular tachyarrhytmias (especially torsades de pointes) AND sudden death

49
Q

A normal QT wave depends on a (blank). How do you correct a QT wave for differences in heart rate?
What is a normal QTc?

A
  • heart rate
  • The QTC (estimates QT interval at a heart rate of 60bpm)
  • less than 400 ms
50
Q 
There is a risk of sudden death with a QTc of....
Borderline for males?
Abnormal for males?
Borderline for females?
Abnormal for females?
A

431-450
>450
451-470
>470

51
Q

What are risk factors for increased QTc?

A
  • hypokalemia
  • hypomagnesemia
  • hypocalcemia
  • medications
52
Q

What 2 antipsychotics can cause increased QTC and by how much?

A

4 ms for risperidone

30 ms for thioridazine

53
Q

In dementia what are some behavioral problems associated with it?

A

psychosis, agitation, suspiciousness, irritability

54
Q

How do you treat dementia often times?

How well does this work?

A

-antipsychotics and benzodiazepines
short term-> may work
Long term-> danger and ineffective

55
Q

Treating dementia with Benzos can result in what two serious side effects?
How should you treat dementia instead?

A

increased confusion
falls

-psychosocial interventions, especially managing environmental cues (including social interactions) should be the first step

56
Q

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of (blank). (blank) is not approved for the tx of patients with dementia-related psychosis

A

death.

Olanzapine (zyprexa)

57
Q

What is a drug you should use instead of a antipsychotic in the treatment of dementia related psychosis and why? When cant you use this

A

citalopram -> has equal efficacy to risperidone

May not work in vascular dementia

58
Q

IV Haloperidol increases the risk of (blank).

A

QTc prolongation

59
Q

Drug-induced long QT and arrhythmia propensity substantially increase when specific psychotropic drugs are administered to patients with (blank X 4)

A

hypokalemia, abnormal T wave morphology, HCV infection, and HIV infection.

60
Q

What atypical antipsychotic results in a lot of sedation and how is this drug taken?

A

asenapine-> sublingually

61
Q

does lurasidone effect the QT interval?

A

no

62
Q

Among antipsychotics, (blank) remains the agent most associated with QTc prolongation; intravenous (blank) also appears to carry an increased risk. Of the atypical antipsychotics, (blank) appears most likely to prolong the QTc interval.
Which SSRI causes prolonged QTc?

A

thioridazine
haloperidol
ziprasidone
Citalopram

Block 8 Week 6 (13 decks)

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