Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BSP Exam II > Antipsychotic Pharmacology > Flashcards

Antipsychotic Pharmacology Flashcards

1
Q

Antipsychotics are separated into first generation and second generation. What is the major difference between the generations?

A

Reduction in movement disorder AEs from first to second gen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MOA of first generation antipsychotics (aka “conventional” or “typical”)

A

Primarily block dopamine type 2 (D2) postsynaptic receptors

[D2&raquo_space; 5HT2]

Also block one or more other receptors with varying potencies — primarily inducing AEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

First gen antipsychotics may increase risk of _____ prolongation and ______ activity

A

QTc; seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Many AEs of first gen antipsychotics are based on their inhibition of various other receptors, including muscarinic, histamine, alpha-adrenergic (primarily alpha 1), and D2 receptors in nigrostriatal and tuberoinfundibular pathways.

What AEs are associated with first gen antipsychotic-induced inhibition at muscarinic receptors?

A 
Dry mouth
Constipation
Urinary retention
Blurry vision
Sedation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Many AEs of first gen antipsychotics are based on their inhibition of various other receptors, including muscarinic, histamine, alpha-adrenergic (primarily alpha 1), and D2 receptors in nigrostriatal and tuberoinfundibular pathways.

What AEs are associated with first gen antipsychotic-induced inhibition at histamine receptors (primarily H1)?

A

Sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Many AEs of first gen antipsychotics are based on their inhibition of various other receptors, including muscarinic, histamine, alpha-adrenergic (primarily alpha 1), and D2 receptors in nigrostriatal and tuberoinfundibular pathways.

What AEs are associated with first gen antipsychotic-induced inhibition at alpha-adrenergic receptors?

A

Orthostatic hypotension

Dizziness/syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Many AEs of first gen antipsychotics are based on their inhibition of various other receptors, including muscarinic, histamine, alpha-adrenergic (primarily alpha 1), and D2 receptors in nigrostriatal and tuberoinfundibular pathways.

What AEs are associated with first gen antipsychotic-induced inhibition at D2 receptors in nigrostriatal pathway?

A

Extrapyramidal symptoms (EPS) — acute akathisia/dystonia/parkinsonism-like

Tardive dyskinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Many AEs of first gen antipsychotics are based on their inhibition of various other receptors, including muscarinic, histamine, alpha-adrenergic (primarily alpha 1), and D2 receptors in nigrostriatal and tuberoinfundibular pathways.

What AEs are associated with first gen antipsychotic-induced inhibition at D2 receptors in tuberoinfundibular pathway?

A

Hyperprolactinemia —> amenorrhea, galactorrhea, gynecomastia, decreased libido

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment options for EPS adverse effects of first gen antipsychotics (akasthesia, dystonia, parkinsonism-like syndrome)

A

Anticholinergic agents — benzotropine and trihexyphenidyl

Antihistamines — diphenhydramine

[these are both used for acute tx and maintenance]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment for tardive dyskinesia induced by first gen antipsychotic’s activity at nigrostriatal pathway

A

Valbenazine
Deutetrabenazine

[Selective vesicular monoamine transporter 2 (VMAT2) inhibitors]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The first gen antipsychotics are separated into low potency and high potency agents. What is the difference between the two categorizations?

A

Low potency cause more sedation, hypotension, and reduction of seizure threshold

High potency cause more movement (EPS) and endocrine (prolactin) effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List the 5 first gen antipsychotics based on their categorization as either low potency or high potency agents

A

Low potency agents:

  • Chlorpromazine
  • Thioridazine

High potency agents:

  • Fluphenazine
  • Haloperidol
  • Thiothixene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Second generation antipsychotics are also referred to as “Novel” or “atypical” antipsychotics. What 6 drugs are in this category?

A 
Aripiprazole
Clozapine
Olanzapine
Quetiapine
Risperidone
Ziprasidone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What second generation antipsychotic is used in the treatment for recurrent suicidal behavior?

A

Clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MOA of second generation antipsychotics

A

Block both D2 postsynaptic receptors and 5HT-2A

[5HT-2A&raquo_space; D2]

Note: some block one or more other DA receptors (1, 3-5) and also have greater propensity to be an agonist/antagonist on one or more other 5HT receptors (other than 5HT2A blockade)

_______________________

[5HT2A antagonism in PFC theorized to increase DA transmission in mesocortical pathway — May contribut to improved negative and cognitive symptoms and reduced EP adverse effects]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Adverse effects of second gen antipsychotics

A

Weight gain

Metabolic effects — hyperglycemia/insulin resistance, hyperlipidemia

Other rare side effects: QTc prolongation, stroke, agranulocytosis, drug reaction w/eosinophilia and systemic symptoms (DRESS), neuroleptic malignant syndrome (NMS)

17
Q

Second gen antipsychotics may cause QTc prolongation/ECG changes due to ______ ionotropic actions; there is greater risk of this in women, elderly, and those on _______

A

Negative; antiarrhythmics

18
Q

The risk of stroke with second gen antipsychotics is greater in what pt population?

A

Elderly pts with dementia

19
Q

T/F: all antipsychotics carry an increase in risk of all-cause mortality

A

True

20
Q

Which second gen antipsychotic is most associated with AE of agranulocytosis, and thus requires WBC monitoring via REMs program

A

Clozapine

21
Q

Clinical features of Drug reaction with Eosinophilia and Systemic Symptoms (DRESS) that may occur with second generation antipsychotics

A

Very rare, potentially life-threatening drug-induced hypersensitivity reaction

Includes skin eruption, hematologic abnormalities (eosinophilia, atypical lymphocytosis), LAD, and internal organ involvement (liver, kidney, lung)

Long latency (2-8 wks) between drug exposure and onset; Prolonged course with frequent relapses despite discontinuing culprit drug

Frequent association with reactivation of latent HHV infection

22
Q

Drug reaction with Eosinophilia and Systemic Symptoms (DRESS) is most commonly associated with which second gen antipsychotic?

A

Olanzapine

23
Q

Neuroleptic Malignant Syndrome (NMS) is an AE of second gen antipsychotics. What are the clinical features?

A

Rare potentially fatal severe parkinson-like movement disorder with widespread muscle contraction

Mesocortical effects (AMS), nigrostriatal effects (rigidity, rhabdomyolysis), hypothalamic effects (hyperthermia), autonomic dysfunction (dehydration)

24
Q

Treatment for neuroleptic malignant syndrome (NMS) if it occurs as an AE of second gen antipsychotics

A

Dantrolene — inhibits Ca release at ryanodine receptor in SR —> peripheral mm. relaxation

25
Q

Guidelines recommend determining in ALL pts a few baseline items before starting an antipsychotic. What are they?

A

Serum glucose
Lipids
Weight (BMI)
Blood pressure

Waist circumference

Personal and/or family hx of metabolic and CV disease

26
Q

Monitoring tools for pts on antipsychotics

A

Glasgow antipsychotic side-effect scale (GASS)

Abnormal Involuntary Movement Scale (AIMS)

Others:

  • Barnes Akathisia Rating Scale (BARS)
  • Simpson-Angus Scale for EPS (SAS)
27
Q

Non-adherence to antipsychotic therapy regimen can be managed with Long-Acting Injectable Agents (LAIA’s). What are they?

A

Haloperidol decanoate
Fluphenazine decanoate

[ROAP mnemonic]:
Risperidone
Olanzapine
Aripiprazole
Paliperidone
28
Q

Considerations regarding initial therapy for psychoses

A

Selected agent may take 2-3 weeks necessary to evaluate a response

Maximum benefit (remission) may take several months

High doses are NOT correlated with more rapid response

Adjunctive pharmacotherapies useful for multiple comorbidities

Nonpharmacotherapy adjunctive tx also helpful — psychological, social, rehab, supportive, etc

29
Q

In terms of treatment-resistant psychoses (i.e., after dose escalation or switching agents), combo anti-psychotic therapy may be necessary. What combination is useful for psychotic depression?

A

Olanzapine

Fluoxetine

30
Q

In terms of treatment-resistant psychoses (i.e., after dose escalation or switching agents), combo anti-psychotic therapy may be necessary. What combination is useful for mania with psychotic features?

A

Lithium

Anticonvulsant

31
Q

Which antipsychotic is useful in multi-drug resistant disease?

A

Clozapine

32
Q

What antipsychotic is useful in psychotic pts with antisuicidal thoughts/behaviors?

A

Clozapine

BSP Exam II (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions