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Psychiatry > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

Benztropine- what is it?

A

Anti-cholinergic

treats EPS effects of antipsychotics

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2
Q

Chlorpromazine- what is it?

A

Phenothiazine
Competitive antagonist at:
- Dopamine D2 (primary antipsychotic effect)
- Muscarinic cholinergic (anti-ACh AEs)
- Histamine H1
- alpha-adrenergic (orthostatic hypotension)
- 5-HT2

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3
Q

Clozapine- what is it?

A

Atypical antipsychotic

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4
Q

Diphenhydramine- what is it?

A

histamine H1 antagonist
- Also anti-cholinergic
(treats EPS effects of antipsychotics)

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5
Q

Droperidol- what is it?

A

Pharmacologically very similar to haloperidol, but used as anti-emetic

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6
Q

Fluphenazine- what is it?

A

Phenothiazine
Competitive antagonist at:
- Dopamine D2 (primary antipsychotic effect)
- Muscarinic cholinergic (anti-ACh AEs)
- Histamine H1
- alpha-adrenergic (orthostatic hypotension)
- 5-HT2

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7
Q

Haloperidol- what is it?

A

High-potency (typical) Antipsychotic
Butyrophenone class

  • D2-antagonist
    little antagonist activity at muscarinic or alpha-adrenoceptors (therefore little hypotension or sedation)
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8
Q

Olanzapine- what is it?

A

Atypical antipsychotic

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9
Q

Prochlorperazine- what is it?

A

Same as chlorpromazine, but used as anti-emetic so normal ppl don’t have to “take antipsychotics”

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10
Q

Risperidone- what is it?

A

Atypical antipsychotic

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11
Q

Thioridazine- what is it?

A

Phenothiazine
Competitive antagonist at:
- Dopamine D2 (primary antipsychotic effect)
- Muscarinic cholinergic (anti-ACh AEs)
- Histamine H1
- alpha-adrenergic (orthostatic hypotension)
- 5-HT2

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12
Q

Trihexyphenidyl- what is it?

A

Anti-cholinergic

treats EPS effects of antipsychotics

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13
Q

Trifluoperazine- what is it?

A

Phenothiazine
Competitive antagonist at:
- Dopamine D2 (primary antipsychotic effect)
- Muscarinic cholinergic (anti-ACh AEs)
- Histamine H1
- alpha-adrenergic (orthostatic hypotension)
- 5-HT2

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14
Q

Quetiapine- what is it?

A

Atypical antipsychotic

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15
Q

Ziprasidone- what is it?

A

Atypical antipsychotic

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16
Q

Aripiprazole- what is it?

A

Atypical antipsychotic

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17
Q

Why are atypical antidepressants described as “atypical”?

A

They have less (or no) antagonistic

activity at dopaminergic & cholinergic receptors

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18
Q

What are “Neuroleptics”?

A

Another term for antipsychotics

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19
Q

Chlorpromazine’s antipsychotic effect is thought to result from dopaminergic blockade in the _____ & _____.

A

prefrontal & limbic cortices

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20
Q

Blockade of dopamine receptors in the basal ganglia leads to extrapyramidal effects, which are…? (4)

A
  • Akathisia
  • Dystonia
  • Rigidity
  • Tardive dyskinesia
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21
Q

What is “Akathisia”?

A

An uncomfortable inability to sit still

22
Q

Acute dystonic signs are usually manifested how?

A

As uncomfortable (and embarrassing) contractions of the muscles of the face and neck

23
Q

The rigidity that occurs in antipsychotics may be clinically indistinguishable from that of _____.

A

Parkinson disease

24
Q

How are the Extrapyramidal effects of antipsychotics treated?

A

Anticholinergics such as trihexyphenidyl, benztropine, or diphenhydramine

25
Q

______ is characterized by involuntary, repetitive,

stereotyped movements usually of the face such as lip smacking, eye blinking, grimacing, or tongue protruding.

A

Tardive Dyskinesia

26
Q

How often does Tardive Dyskinesia become permanent?

A

In up to half of the cases

27
Q

What is Neuroleptic malignant syndrome?

A

A rare complication of chlorpromazine therapy and is characterized by hyperthermia (due to generalized muscle contracture), stupor, and such metabolic abnormalities as myoglobinemia and elevation of creatine kinase

28
Q

Does tolerance develop to chlorpromazine?

A

No (nor to any of the antipsychotic agents)

29
Q

(Antipsychotics)
In general, those medications with a greater anticholinergic effect are __(a)__ sedating and __(b)__ likely to cause extrapyramidal effects.

A

a) more
b) less

(also tend to cause more orthostatic hypotension due to alpha-adrenergic blockade)

30
Q

Thioridazine has __(a)__ sedating and hypotensive effects as compared with chlorpromazine while causing many __(b)__ extrapyramidal reactions.

A

a) greater

b) fewer

31
Q

Trifluoperazine and fluphenazine are __(a)__ sedating, cause __(b)__ hypotensive effects, and are __(c)__ likely to cause extrapyramidal reactions than chlorpromazine

A

a) less
b) fewer
c) more

32
Q

Which of the antipsychotics may cause QT prolongation?

A

Trifluoperazine

33
Q

Does Haloperidol or have anticholinergic or anti-alpha-adrenergic activity?

A

No (or very little)

34
Q

______ is commonly used for inpatients whose primary diagnosis is not psychosis but who require antipsychotic therapy (e.g., ICU-associated
psychosis)

A

Haloperidol

35
Q

What is the antipsychotic activity in atypical antipsychotics thought to be due to?

A

5HT2 blockade

36
Q

Atypical antipsychotics: AEs? (that they all share)

A
  • Orthostatic Hypotension (b/c they are potent alpha-antagonists)
37
Q

Extrapyramidal effects of atypical antipsychotics?

A

EPS are much rarer in atypical antipsychotics than w/ older antipsychotics

38
Q

Orthostatic hypotension in atypical antipsychotics?

A

This is a common problem due to their alpha-adrenergic antagonistic effects

39
Q

Which of the atypical antipsychotics is a partial agonist at both dopaminergic D2 and 5-HT1A receptors.

A

Aripiprazole

40
Q

_____ may cause weight gain, diabetes, seizures, & agranulocytosis

A

Clozapine

41
Q

Clozapine: AEs?

A
  • Orthostatic hypotension
  • weight gain
  • diabetes
  • seizures
  • agranulocytosis
42
Q

______, although very closely related to clozapine in structure, does not cause seizures nor agranulocytosis; it may cause weight gain and diabetes.

A

Olanzapine

43
Q

Olanzapine: AEs?

A
  • Orthostatic hypotension
  • weight gain
  • diabetes
44
Q

Which of the atypical antipsychotics may cause extrapyramidal effects at high doses & weight gain?

A

Risperidone

45
Q

Which of the atypical antipsychotics may rarely cause extrapyramidal effects and QT prolongation (that may predispose some persons to cardiac dysrhythmias)?

A

Ziprasidone

46
Q

Name the 3 atypical antipsychotics that don’t cause weight gain.

A

Quetiapine, Ziprasidone, & Aripiprazole

47
Q

Amongst all the antipsychotics, which is the most effective & which is the most toxic?

A

Clozapine is both

48
Q

Behind Clozapine, which are the most effective antipsychotics?

A

Risperidone and olanzapine are the next best

& are superior to the phenothiazines and butyrophenones

49
Q

Which of the antipsychotics are orally effective?

A

All of them

that we’ve learned about

50
Q

For the emergency management of acute psychosis, __(a)__ may be given intravenously or intramuscularly
b) What other 3 may also be given intramuscularly?

A

a) Haloperidol

b) Chlorpromazine, Ziprasidone, or Olanzapine

51
Q

_____ should rarely be given intravenously because of its profound vasodilatory effect.

A

Chlorpromazine

52
Q

For long-term management of patients that are non-compliant w/ oral therapy, which 3 antipsychotics may be prepared as a formula to be given as an intramuscular injection every few weeks?

A

Haloperidol, Fluphenazine, & Risperidone

Psychiatry (7 decks)

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