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Psychopharmacology > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What common property do all antipsychotics share?

A

they all reduce dopaminergic neurotransmission

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2
Q

How do typical anti-Ps work?

A

ability to block dopamine (D2) receptors.

They also have in, varying degrees, M1, Alpha-1 and H1 receptor blockade.

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3
Q

How do atypical anti-Ps work?

A

Combination of the relatively lower D2 antagonism with the 5HT2A antagonism.

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4
Q

How does 5HT2A antagonism reduces EPSE

A

by increasing Dopamine in the nigrostriatal areas.

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5
Q

How does 5HT2A antagonism reduce negative symptoms

A

by improving Dopamine in the prefrontal cortex

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6
Q

How does 5HT2A antagonism have antidepressant effect

A

by increasing dopamine in the ventromedial prefrontal cortex.

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7
Q

What does 5HT2A antagonism do to hyperprolactinaemia

A

reduce it

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8
Q

Which phenothiazine has an aliphatic side chain

A

Chlorpromazine

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9
Q

Which Phenothiazines have a PiperiDine side chain

A

Thioridazine, pipothiazine

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10
Q

Which Phenothiazines have a PiperiZine side chain

A

Trifluoperazine, fluphenazine

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11
Q

Name a Butyrophenone

A

Haloperidol

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12
Q

Name a Thioxanthenes

A

Flupenthixol, zuclupenthixol

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13
Q

Example of DiphenylbutylPiperidines

A

Pimozide

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14
Q

Example of Dibenzodiazepines

A

Clozapine

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15
Q

Example of Benzoxasoles

A

Risperidone

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16
Q

Thienobenzodiazepines example?

A

Olanzapine

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17
Q

Dibenzothiazepines example?

A

Quetiapine

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18
Q

Examples of Substituted benzamides

A

Sulpiride, amisulpride

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19
Q

Example of Arylpiperidylindole (quinolone)

A

Aripiprazole

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20
Q

Which three atypicals are available in depot form

A

Risperidone (available as Risperdal Consta or Paliperidone)
Olanzapine
Aripiprazole (approved in the UK in Jan 2014)

21
Q

Which depot may be more effective in preventing relapses than others

A

zuclopenthixol

22
Q

When may post injection syndrome happen and what is risk of this

A

from accidental entry into a blood vessel on administration.The incidence of this is < 0.1% and almost all reactions occur within 1 hour of injection.

23
Q

Which depot must be given under supervision for three hours after the injection is given.

A

Olanzapine depots

24
Q

Symptoms of post injection syndrome

A

Sedation
Confusion, disorientation
Agitation, anxiety, aggression
Extrapyramidal symptoms, dysarthria, ataxia
Dizziness, weakness
Hypertension
Convulsion

25
Q

AntiPs with highest associated risk of diabetes?

A

Clozapine and olanzapine

26
Q

AntiPs recommended for patients with or with risk of developing diabetes?

A

Amisulpride, aripiprazole, and ziprasidone

27
Q

Half life and steady state of aripiprazole?

A

75 hours, 2 weeks

28
Q

Half life and steady state of olanzapine?

A

30 hours 1 week

29
Q

Half life and steady state of risperidone?

A

Risperidone 20 hours 2-3 days (oral)

30
Q

Half life and steady state of both amisulpride and clozapine?

A

12 hours 2-3 days

31
Q

Half life and steady state of zuprasidone and quetiapine?

A

6 hours 2-3 days

32
Q

Which antipsychotic shows most change to EEG of patients on it

A

Clozapine (47.1%)

33
Q

What is the term for the point at which the amount of drug administered each day is exactly counterbalanced by the amount eliminated.

A

steady state

34
Q

Which antipsychotics are least likely to cause postural hypotension?

A

Amisulpride
Aripiprazole
Haloperidol
Sulpiride
Trifluoperazine

35
Q

What scale can be used to ask about sexual symptoms prior to commencing AntiP

A

Arizona Sexual Experiences Scale (ASEX)

36
Q

What is propensity for antiPs to cause sexual side effects related to?

A

effect on prolactin

37
Q

Which antiP causes most sexual side effects and effect on prolactin

A

Risperidone, haloperidol

38
Q

Which antiP causes sexual side effects but not related to prolactin

A

clozapine

39
Q

Which antiP Causes a temporary increase in prolactin which then returns to normal within 6 weeks

A

olanzapine

40
Q

If sexual side effects can consider adding 5-10 mg of what as can normalise prolactin level?

A

aripiprazole

41
Q

The following are which type of side effects:
Galactorrhoea, gynecomastia, menstrual disturbance, lowered sperm count, reduced libido, Parkinsonism, dystonia, akathisia, tardive dyskinesia

A

Antidopaminergic effects/antimuscarinic

42
Q

What type of SEs are Dry mouth, blurred vision, urinary retention, constipation

A

anticholinergic

43
Q

Which type of SEs are Postural hypotension, ejaculatory failure

A

Antiadrenergic effects

44
Q

What type of SE is Drowsiness

A

Histaminergic effects

45
Q

Which antiP has highest risk of sudden death and why

A

Thioridazine has pronounced effects on K+ channels and materially prolongs the QTc interval

46
Q

Which antiPs have moderate risk of weight gain

A

Chlorpromazine
Quetiapine
Risperidone
Paliperidone

47
Q

Which antiPs have high risk of weight gain

A

clozapine, olanzapine

48
Q

Apart from switching antiP if weight gain present, which additional measures may be taken?

A

Aripiprazole augmentation (for clozapine and olanzapine induced weight gain)
Metformin
Orlistat
Liraglutide (for clozapine induced weight gain)
Topiramate

Psychopharmacology (19 decks)

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