Antipsychotics Flashcards
Extrapyramidal Symptoms
Akathisia
Acute dystonic reactions
Parkinsonism
Akathisia
Sense of restlessness , agitation, SI
onset = days to weeks
Akathisia treatment
Propanolol - 10mg BID, up to 30-90mg daily
Inderal - 60-80mg daily
Benzos - any of them will work
reduce dose of antipsychotic or switch
Dystonia
torticollis, laryngospasm, occular crisis
occurs in minutes to hours
Dystonia treatment
Benzotropine 1-2mg 1-2x/day
Diphenhydramine 50mg daily
if severe, stop antipsychotic and give above agents IM or IV once or twice to stop the dystonia, then give PO
Parkinsonism
bradykinesia, rigidity, tremors, shuffling
onset = 1-2 months
Parkinsonism treatment
Benzotropine 1-2mg 1-2x/day
Trihexyphenidyl 2-5mg 1-2x/day
Diphenhydramine 50mg daily
can start benzotropine at the same time as the antipsychotic if they are high risk
Tardive Dyskinesia
repetitive, involuntary movements. chewing, rolling tongue, smacking lips
can be permanent
clozapine is only antipsychotic that does not cause this
Tardive Dyskinesia treatment
Deutetrabenazine (austedo) 6mg bid for 1 week, than increase by 3mg bid, max 24 mg. take with food
-prolongs qtc, SI, insomnia
valbenazine (ingrezza) 40mg x 1 week, then 80mg
-prolongs qtc, SI, sedation
Neuroleptic malignant syndrome
-reduced consciousness
-increased muscle tone
-autonomic dysfunction (HTN, ST, hyperpyrexia, diaphoresis, drooling)
**life threatening emergency
Typical Antipsychotics adverse effects
S - sedation, sun sensitivity, sexual side effects
T - tardive dyskinesia
A - anticholinergic, agranulocytosis
N - neuroleptic malignant syndrome
C - cardiac arrhythmias
E - extrapyramidal effects, endocrine effects (^ prolactin levels)
Alogia
poverty of speech
Affective blunting
reduced range of emotions
Asociality
reduced social drive and interaction
Anhedonia
reduced ability to feel pleasure
Avolition
reduced desire, motivation to complete daily tasks
Positive symptoms come from
mesolimbic
Negative symptoms come from
mesocortical/prefrontal cortex
Affective symptoms come from
Ventromedical prefrontal cortex
Aggressive symptoms come from
amygdala & orbitofrontal cortex
Cognitive symptoms come from
Dorsolateral prefrontal cortex
High Potency FGA
Haldol, fluphenazine
Mid Potency FGA
perphenazine, loxapine
Low potency FGA
chlorpromazine
Haloperidal (Haldol)
FGA
PO 1-15mg/day MAX 100mg
usual = 1-40mg/day
Decanoate
Fluphenazine (Prolixin)
FGA
PO 0.5 - 10mg/day MAX 40mg
usual = 1-20mg/day
decanoate
Chlorpromazine (Thorazine)
FGA
200-800mg/day
Loxapine (Loxitane)
FGA
20mg/day in 2 doses, titrate over 7-10 days to 60-100mg, max 250mg
Perphenazine (Trilafon)
FGA
intial = 4-8mg TID
12-24mg/day
16-64mg/day if hospitalized
Trifluoperazine (stelazine)
FGA
intial = 2-5 mg BID
normal = 15-20 mg/day
FGA contraindications
-allergic
-ingestion of substances that will interact ex etoh
-severe cardiac abnormality
-high risk for seizure
- narrow angle glaucoma
-history of tardive dyskinesia
caution in liver disease
Most sedating antipsychotics
olanzapine
clozapine
seroquel
Atypical Antipsychotics that cause EKG changes
ziprasidone
Atypical Antipsychotics that cause EPS
risperidone
(Haldol and fluphenazine for 1st gen)
Aytpical antipsychotic that causes akathsia
ariprazole
brexipiprazole
antipsychotics that must be taken with food
geodon - 500 cals
lurasidone - 350 cals
atypical psychotics that are high risk for metabolic syndrome
clozapine
olanzapine
atypical psychotics that are medium risk for metabolic syndrome
risperidone, paliperidone, seroquel
atypical psychotics that are low risk for metabolic syndrome
ziprasidone
ariprazole
lurasidone
what drug increases prolactin
risperidone
what drugs come in IV/IM formulation
haldol
fluphenazine
aripiprazole
risperidone
what drugs come in sublingual formulation
olanzapine
asenapine
