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cmt-tres > Antipsychotic meds > Flashcards

Antipsychotic meds Flashcards

1
Q

Typical (1st Generation)

A

Decrease dopamine
Works best on positive symptoms
EPS and Anti-HAM side effects

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2
Q

Atypical (2nd Generation)

A

Decrease dopamine AND increase serotonin
Works on positive and negative symptoms
Metabolic side effects

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3
Q

antipsych meds

Class warnings

A

Black box warning- higher mortality rate in geriatric pts with dementia-related psychosis

Adverse cerebrovascular events
Neuroleptic malignant syndrome
Tardive dyskinesia
Weight gain, hyperglycemia, new-onset or worsening diabetes, hyperlipidemias (especially for kids)

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4
Q

Antipsychotic Side Effects

A

Metabolic Dysfunction
Anti-HAM
Neuromalignant Syndrome

Extrapyramidal Syndrome
Dystonia
Akathisia
Parkinsonian Syndrome
Tardive Dyskinesia

1st Generation Antipsychotics- think EPS and ANTI-HAM side effects

2nd Generation Antipsychotics- think more metabolic side effects

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5
Q

Extrapyramidal Syndrome
Sx

A

Dystonia
Akathisia
Parkinsonian Syndrome
Tardive Dyskinesia

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6
Q

Metabolic Dysfunction

A

Weight gain
Hyperglycemia
hyperlipidemia
More common with second generation antipsychotics
Need to check labs every 6-12 months (Lipids, weight, BP, A1C)
Tx: treat dysfunction respectively or consider changing antipsychotics if severe

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7
Q

Anti-HAM

A

Antihistamine - weight gain and sedation

Antiadrenergic - orthostatic hypotension, cardiac abnormalities, sexual dysfunction

Antimuscarinic (anticholinergic effects) - (dry mouth, tachycardia, urinary retention, blurry vision, constipation, precipitation of narrow-angle glaucoma

Hyperprolactinemia - low libido, galactorrhea, gynecomastia, impotence, amenorrhea

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8
Q

Neuromalignant Syndrome (NMS)
and tx

A

Occurs in up to 3% of patients taking neuroleptics
Extreme rigidity, AMS, fever, unstable BP, myoglobinemia
Can be FATAL

Tx: STOP medication, dantrolene and bromocriptine, supportive care

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9
Q

Extrapyramidal Symptoms (EPS) - MC 1st Gen

A

Akathisia
inner restlessness, can’t sit still
Not anxiety
Tx: reduce dose or change meds
Propranolol
Clonazepam

Parkinsonian syndrome
tremor, mask-like facies, rigidity, shuffling gait, bradykinesia
Typically starts within 1 month of starting medication
Elderly more at risk
Tx: change or reduce drug
Levodopa and other antiparkinsonian drugs
https://www.youtube.com/watch?v=f6yxH2bgkSY

Dystonia
Acute!
Typically starts within days of initiating drug
involuntary contractions of major muscle groups
Commonly tongue, face, neck, back
Tx: anticholinergics (benztropine), antiparkinsonian drugs
Diagnostic and curative!
https://www.youtube.com/watch?v=y2D5HAWPVC4

Tardive Dyskinesia
Involuntary movements - facial grimacing, tongue protrusion, lateral jaw movements, lip smacking, choreiform movements of the limbs (rarely)
Months to years to develop
Can develop at any time while on medication, 5% increase risk each year on FGA
Can be permanent
Tx: STOP agent once early symptoms arise.
VMAT2 Inhibitors - valbenazine and deutrabenazine
https://www.tardiveimpact.com/what-is-td

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10
Q

Tardive Dyskinesia

A

Involuntary movements - facial grimacing, tongue protrusion, lateral jaw movements, lip smacking, choreiform movements of the limbs (rarely)
Months to years to develop
Can develop at any time while on medication, 5% increase risk each year on FGA
Can be permanent
Tx: STOP agent once early symptoms arise.
VMAT2 Inhibitors - valbenazine and deutrabenazine
https://www.tardiveimpact.com/what-is-td

EPS Sx

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11
Q

Dystonia

A

Acute!
Typically starts within days of initiating drug
involuntary contractions of major muscle groups
Commonly tongue, face, neck, back
Tx: anticholinergics (benztropine), antiparkinsonian drugs
Diagnostic and curative!
https://www.youtube.com/watch?v=y2D5HAWPVC4

EPS sx

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12
Q

Akathisia

A

inner restlessness, can’t sit still
Not anxiety
Tx: reduce dose or change meds
Propranolol
Clonazepam

EPS Sx

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13
Q

AIMS

A

Screening for TD
Provider rates patient
Score of 2 indicates presence of TD
Performed every 6 months

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14
Q

Chlorpromazine (Thorazine)

A

typical

First antipsychotic developed, not commonly used

Effective Dose: 60mg - 800mg
FDA indications- Psychosis, mania, nausea and vomiting, intractable hiccups
Off label- bipolar disorder, behavioral disturbances, impulse control
Route: PO or IM
Monitoring- ECG if cardiac disease
Cost- pretty expensive

Side Effects- sedation, orthostasis, tachycardia, drowsiness, dry mouth, constipation, blurred vision, prolactin elevation, skin pigmentation, ocular changes, jaundice, photosensitivity

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15
Q

Fluphenazine (Prolixin)

A

typical

Effective Dose: 3 - 45mg
FDA indications- psychosis, schizophrenia
Off label- dementia associated psychosis or agitation
Route- PO and IM
Cost- cheap
Side Effects- EPS, headache, drowsiness, dry mouth

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16
Q

Haloperidol (Haldol)

A

typical

Effective Dose: 1-40mg
FDA indications- psychosis, Tourette’s disorder
Off label- bipolar disorder, behavioral disturbances, impulse control disorders, delirium
Route: PO, IM short acting and long acting
Cost- cheap
Side Effects- EPS, headache, drowsiness, dry mouth, prolactin elevation

17
Q

Quetiapine (Seroquel)

A

atypical

Effective Dose: 300 - 800mg
FDA indications- Schizophrenia (13+yo), bipolar manic/mixed (10+), bipolar depression, maintenance for bipolar, major depression (as adjunct)
Off label- insomnia, anxiety disorders, behavioral disturbances, impulse control disorders
Monitoring- fasting glucose, lipids
Cost- cheap

Side Effects- somnolence, hypotension, dry mouth, dizziness, constipation, weight gain, fatigue, orthostatic hypotension

18
Q

Ziprasidone (Geodon)

A

atypical

Effective Dose: 120 - 160mg
FDA indications- Schizophrenia, bipolar disorder (acute tx of mania/mixed episodes, Bipolar maintenance as adjunct, acute agitation in schizophrenia (IM only)
Off label- bipolar disorder, behavioral disturbances, impulse control disorders
Monitoring- fasting glucose, lipids, ECG if cardiac disease
Route: PO or IM
Cost- cheap

Side Effects- somnolence, dizziness, akathisia, rash, QT prolongation, DRESS
Need to take with 500 cals
Less weight gain than clozapine, olanzapine, quetiapine, and risperidone
More QT prolongation than any other atypical antipsychotic

19
Q

Lurasidone (Latuda)

A

atypical

Effective Dose: 40mg to 120mg
FDA indications- Schizophrenia (adults and adolescents 13-17), bipolar depression (as monotherapy and adjunct in adults and children 10-17)
Off label- mixed depression, treatment resistant depression, manic episodes, impulse control disorders
Monitoring- fasting glucose, lipids
Cost- expensive

Side Effects- sedation, akathisia, nausea, parkinsonism, agitation, orthostatic hypotension, syncope
Administer with at least 350 calories to increase absorption
Appears relatively weight neutral

20
Q

Aripiprazole (Abilify)

A

atypical

Effective Dose: 10 - 30mg
FDA indications- schizophrenia (13-17, adults), bipolar disorder (acute mania: adults and 13-17, maintenance: adults), major depression as adjunct (adults), irritability in autism (children 6-17), Tourette’s disorder (children 6-17)
Off label- bipolar depression, behavioral disturbances
Monitoring- fasting glucose, lipids
Route- PO and IM
Cost- cheap

Side Effects- akathisia, anxiety, insomnia, sedation, tremors
Minimal weight and metabolic side effects but risk of akathisia

21
Q

Olanzapine (Zyprexa)

A

atypical

Effective dose: 5 - 20mg
FDA indications- schizophrenia (13+), acute or mixed bipolar 1 manic episodes (13+), maintenance tx of bipolar, bipolar depression (as Symbyax, 13+), treatment resistant depression (as Symbyax), acute agitation in schizophrenia and bipolar mania (injectable form)
Off label- behavioral disturbances, impulse control disorders
Monitoring- fasting glucose, lipids
Route - PO and IM
Cost- cheap

Side Effects- somnolence, dry mouth, constipation, weight gain (10-30lb is common), increased appetite, EPS
High prevalence of weight gain and metabolic side effects
Symbyax is an expensive combination of olanzapine and fluoxetine (just write as separate generic medications)

22
Q

Paliperidone (Invega)

A

atypical

MOA- dopamine D2 and serotonin 5-HT2A receptor antagonist
FDA indications- Schizophrenia (13+), schizoaffective disorder

Monitoring- fasting glucose, lipids, prolactin if symptoms
Cost- expensive

Side Effects- akathisia, EPS, tremor, tachycardia, insomnia, somnolence, weight gain, orthostatic hypotension, headache, elevated prolactin
”Ghost pills” osmotic delivery system
Not highly effective in acute mania
Along with risperidone, **causes the most EPS and hyperprolactinemia of all atypicals **

23
Q

Risperidone (Risperdal)

A

atypical

Effective Dose: 4 - 16mg
FDA indications- schizophrenia (13+), bipolar disorder (manic/mixed 10+), irritability in autism (children 5+)

Monitoring- fasting glucose, lipids, prolactin if symptoms
Cost- cheap
Route: PO and IM

Side Effects- EPS, somnolence, anxiety, constipation, nausea, dyspepsia, dizziness, prolactin elevation, weight gain, orthostatic hypotension
Along with paliperidone, causes most EPS and hyperprolactinemia of all atypicals

24
Q

Asenapine (Saphris)

A

Atypical

Effective Dose: 10 - 20mg
FDA indications- Schizophrenia, bipolar disorder (acute and maintenance of manic/mixed episodes in adults and kids 10-17)
Off label- bipolar maintenance, bipolar depression, behavioral disturbances, impulse control disorders
Monitoring- fasting glucose, lipids
Cost- expensive

Side Effects- akathisia, oral hypoesthesia, somnolence, dizziness, EPS, weight gain
Sublingual and patch formulation, good if swallowing pills is an issue

25
Q

Cariprazine (Vraylar)

A

atypical

Effective Dose: 3 - 6mg
FDA indications- Schizophrenia, bipolar I depression, Major depressive disorder

Cost- expensive

Side Effects- GI upset, dizziness, insomnia, increased appetite. Typically very well tolerated and effective

26
Q

Clozapine (Clozaril)

A

atypical

Dose: 300 - 600mg
FDA indications- treatment resistant schizophrenia, reduction in risk of suicide in schizophrenia and schizoaffective disorders

Monitoring- fasting glucose, lipids, baseline ANC (>1000) then weekly for 6 months, then biweekly for another 6-12 months, then monthly after 12 months
Cost- pretty cheap

Side Effects- sedation, orthostatic hypotension, hypersalivation, weight gain, constipation, tachycardia, potentially life-threatening neutropenia (1-2%)

Must be in risk evaluation and mitigation strategy program (REMS) in order to prescribe

cmt-tres (53 decks)

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