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Psychiatry > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

MOA of first and 2nd generation antipsychotics:

A

First: Block D2 Receptors

Second: Block D2 and 5HT-2A Receptors

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2
Q

Efficacy differences in 1st and 2nd generation antipsychotics =

A

They both treat positive symptoms to the same degree but atypical antipsychotics treat negative symptoms better.

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3
Q

Which are the low potency antipsychotics?

A
  • Chlorpromazine

- Thioridazine

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4
Q

Which are the mid-potency antipsychotics?

A
  • Loxapine
  • Thiothixene
  • Trifluoperazine
  • Perphenazine
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5
Q

Which are the High Potency antipsychotics?

A
  • Haloperidol
  • Fluphenazine
  • Pimozide
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6
Q

What differentiates a low from a high potency antipsychotic =

A

affinity for the D2 receptor–the lower the affinity, the lower the potency

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7
Q

Difference in terms of side effects between lower and higher potency antipsychotics =

A

Low potency antipsychotics:

  • more likely cause anticholinergic & antihistaminic s/e.
  • more likely to cause QTc prolongation
  • more likely to cause seizures
  • more likely to cause agranulocytosis

High potency antipsychotics:

  • more likely to cause EPS and NMS.
  • More likely to cause tardive dyskinesia
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8
Q

Chlorpromazine:

  • Class =
  • Common side effects =
  • Indications =
A
  • Class =
    • Low potency typical antipsychotic
- Common side effects =
   • Orthostatic Hyptotension
   • Bluish Skin
   • Photosensitivity
   • Obstructive Jaundice
- Indications =
   • Intractable hiccups
   • Nausea
   • Vomiting
   • Antipsychotic
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9
Q

Thioridazine

  • Class =
  • Common side effects =
A
  • Class =
    • Low potency typical antipsychotic
  • Common side effects =
    • Retinitis Pigmentosa
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10
Q

Loxapine

  • Class =
  • Common side effects =
  • Metabolite acts as a…
A
  • Class =
    • Mid potency typical antipsychotic
  • Common side effects =
    • Higher risk of seizure
  • Metabolite =
    • Antidepressant properties
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11
Q

Thiothixene

  • Class =
  • Common side effects =
A
  • Class =
    • Mid potency typical antipsychotic
  • Common side effects =
    • Ocular pigment changes
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12
Q

Trifluoperazine

  • Class =
  • Indications other than anti psychosis =
A
  • Class =
    • Mid potency typical antipsychotic
  • Indications =
    • Anxiolytic
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13
Q

Perphenazine

  • Class =
A
  • Class =

• Mid potency typical antipsychotic

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14
Q

Antipsychotics with decanoate forms available =

A
  • Fluphenazine

- Haldol

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15
Q

Pimozide

  • Class =
  • Common side effects =
A
  • Class =
    • High potency typical antipsychotic
  • Common side effects =
    • Heart Block
    • V-Tach
    • Other cardiac effects
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16
Q

Fluphenazine

  • Class =
A
  • Class =

• High potency typical antipsychotic

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17
Q

Brain pathway associated with the positive symptoms of schizophrenia =

A

Mesolimbic Dopamine Pathway

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18
Q

Structures within the mesolimbic pathway =

A
  • Nucleus accumbens
  • Fornix
  • Amygdala
  • Hippocampus
19
Q

Brain pathway associated with the negative symptoms of schizophrenia =

A

Mesocortical dopamine pathway

20
Q

Brain pathway associated with the EPS of antipsychotics =

A

Nigrostriatal pathways

21
Q

NMS symptoms =

A

“FALTERED”

  • Fever (most common sx)
  • Autonomic Instability
  • Leukocytosis
  • Tremor
  • Elevated CPK
  • Rigidity
  • Excessive sweating (diaphoresis)
  • Delirium
22
Q

“Blue-gray skin discoloration” from…

A

Chlorpromazine

23
Q

Clozapine

  • Class =
  • Indications =
  • Side effects =
  • Effect on Suicide =
A

Class:
- Atypical Antipsychotic

Indications:

  • Treatment refractory Psychosis
  • Psychosis + suicidality

Side Effects:

  • Agranulocytosis
  • Tachycardia
  • Hypersalivation
  • Anticholinergics
  • Myocarditis
    • Seizures

Suicide
- Only antipsychotic which reduces the risk of suicide

24
Q

When to stop clozapine in the case of agranulocytosis =

A

When PMN count drops below 1500/µL

25
Q

Risperidone

  • Class =
  • MOA
  • Side effects =
A

Class:
- Atypical Antipsychotic

MOA:
- Blocks 5HT2a, alpha-1, and D2 receptors

Side Effects:

  • Hyperprolactinemia
  • Orthostatic hypotension
  • Reflex tachycardia
  • Weight GAIN
26
Q

Quetiapine

  • Class =
  • Indications =
  • Side effects =
A

Class:
- Atypical Antipsychotic

Indications:

  • Psychosis
  • Insomnia

Side Effects:

  • Sedation
  • Orthostatic hypotension
27
Q

Olanzapine

  • Class =
  • Indications =
  • Side effects =
A

Class:
- Atypical Antipsychotic

Indications:

  • Psychosis
  • Mood stabilization (later line)

Side Effects:

  • Weight Gain
  • Metabolic Syndrome
  • Sedation
28
Q

Ziprasidone

  • Class =
  • Effect on weight =
A

Class:
- Atypical Antipsychotic

Effect on Weight:
- Less likely to cause weight gain

29
Q

Aripiprazole

  • Class =
  • MOA =
  • Side effects =
A

Class:
- Atypical Antipsychotic

MOA
- Partial D2 agonism

Side Effects:

  • Akathisia
  • Less potential for weight gain
  • Less Sedating
30
Q

Paliperidone =

A

Metabolite of risperidone

More expensive

Also comes in a long acting form

31
Q

Best drug to use in delirious, elderly patients and why:

A

Haloperidol.

This is the strongest antipsychotic there is, and therefore small doses can be used while avoiding the side effects of the antipsychotics, such as the orthostatics, anti-histaminergic, and anti-cholinergic side effects.

Haloperidol also has the lowest risk of falls in these patients because it has less anti-adrenergic properties.

32
Q

Reason you cannot use risperidone in elderly, delirious patients =

A

It only comes in oral formulations–which typically doesn’t bode well in delirious patients.

33
Q

How often long-acting depot form of risperidone needs to be administered =

A

Bi-monthly (twice per month)

34
Q

Which antipsychotics will cause EPS?

A

All of them, at high enough doses–except for clozapine.

35
Q

Antipsychotics which come in a long-acting injectable form =

A

Haloperidol

Risperidone

36
Q

Sialorrhea =

  • What causes it?
A

Excessive salivation / drooling

Commonly caused by clozapine

37
Q

Best treatment for sialorrhea =

A

Clonipine

38
Q

How to deal with the persistent sinus tachycardia seen in some patients on clozapine:

A
  • Usually you can wait and it will go away on its own.

- However, if it just will not go away then you should add a ß-blocker like propanolol.

39
Q

Role of antipsychotics in bipolar disorder =

A
  • Antipsychotics are most commonly used during the first manic episode–which is much more intense than the rest of the episodes.
  • They are not commonly used for maintenance therapy due to the high risk of side effects.
40
Q

Which atypical antipsychotics are the least likely to cause metabolic syndrome?

A

Ziprasidone > Ariprazole > Risperidone > Quetiapine

41
Q

Which are the atypical antipsychotics most likely to cause metabolic syndrome?

A
  • Olanzapine

- Clozapine

42
Q

Rabbit Syndrome and what causes it =

A

Quivering of the mouth without involvement of the tongue. This is commonly caused by high potency antipsychotics like haldol.

43
Q

Signs of pseudoparkinsonism =

A
  • Bradykinesia
  • Flexed posture
  • Festinating gait
  • Resting tremor

Psychiatry (14 decks)

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