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Antipsychotics Flashcards

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1
Q

typical antipsychotics moa

A

dopamine D2 blockers; decrease positive symptoms (hallucinations, disorganization of thought and behavior)

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2
Q

atypical antipsychotics moa

A

D2 and 5-HT2A antagonism

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3
Q

haloperidol moa/potency

A

D2 block; high potency

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4
Q

butyrophenones

A

haloperidol

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5
Q

only approved agent for children and teens

A

risperidone

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6
Q

aripiprazole moa

A

D2 partial agonist, 5-HT2a antagonist; 5-HT1a partial agonist (lower incidence of side effects)

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7
Q

asenapine moa

A

D1, D2, 5-HT2, alpha adrenergic and histamine receptor antagonist (low muscarinic affinity)

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8
Q

anti-psychotic extrapyramidal side effects

A

acute dystonia, akathesia, parkinsonian syndrome, neuroleptic malignant syndrome, perioral tremor, tardive dyskinesia

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9
Q

acute dystonia symptoms and treatment

A

symptoms: muscle spasms, facial grimacind, stiff neck, oculogyric crisis
Tx: anticholinergic antiparkinsonian agents

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10
Q

akathesia symptoms and treatment

A

symptoms: strong subjective feelings of distress or discomfort often referred to the legs
Tx: decrease dose, add antiparkinsonian agent, anti anxiety agent or propranolol

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11
Q

neuroleptic malignant syndrome symptoms and treatment

A

Symptoms: fever, severe parkinsonism with catatonia, fluctuations in coarse tremor intensity, autonomic instability, elevated creatinine kinase, myoglobinemia, high mortality
Tx: cessation of antipsychotic, supportive care, dantrolene or bromocriptine

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12
Q

antipsychotic effects on the brainstem

A

decreased vasomotor reflexes at low doses

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13
Q

antipsychotic effects on the CTZ

A

protect against N./V at low doses

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14
Q

drugs that cause increased PRL

A

all typical and risperidone

little increase: clozapine, olanzapine, and ziprasidone

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15
Q

likely to increase risk of type 2 DM

A

clozapine and olanzapine

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16
Q

may cause jaundice

A

chlorpromazine

17
Q

agranulocytosis

A

clozapine (weekly blood counts necessary)

18
Q

cause skin reactions - urticaria, photosensitivity or dermatitis

A

phenothiazines - chlorpromazine, fluphenazine, perphenazine

19
Q

most likely to cause weight gain

A

clozapine and olanzapine

20
Q

main route of metabolism

A

hepatic microsomal oxidases and conjugation; most metabolites are inactive
typical: cyp 2D6 and 3A4 (inhibit)

21
Q

paliperidone

A

active metabolite of risperidone available for therapeutic use

22
Q

treatment of catatonia

A

benzos seem to help, if not ECT

do not give antipsychotics

23
Q

if a patient is on haliperidol for 1 week and comes back complaining of agitation and trouble sitting still (akisthesia) what should you do?

A

decrease the dose

24
Q

why do low potency typical antipsychotics have fewer EPSs?

A

they have greater antimuscarinic effects

-e.g. chlorpromazine and thiothixine

25
Q

what antipsychotic should you use in an Alzheimer’s patient?

A

typical antipsychotics

26
Q

what atypical is best to prevent weight gain?

A

ziprasidone

27
Q

atypicals are most effective in treating…

A

positive symptoms

28
Q

which antipsychotic is most effective in preventing suicide and may be effective in patient who have not responded to other antipsychotics?

A

clozapine

29
Q

course of action when a patient develops an acute dystonia

A

give an injectable anticholinergic (e.g. benztropine) to counteract the DA block on the basal ganglia

30
Q

trifluoperazine side effects

A

constipation, orthostatic hypotension, mydriadasis, decreased libido

31
Q

high potency typical antipsychotics

A

haloperidol, fluphenazine, perphenazine

32
Q

low potency typical antipsychotics

A

chlorpromazine and thiothixane

33
Q

acute dystonia

A

muscle spasms, torticollis, oculogyric crisis

34
Q

antipsychotics that cause QT prolongation

A

chlorpromazine (typical), and ziprasidone (atypical)

35
Q

side effect that caused by all typicals

A

PRL release; results in sexual dysfunction, amenorrhea, gynecomastia, galactorrhea, and hypoestrogenism

36
Q

risperidone adverse effects

A

PRL secretion

weight gain, esp. in children and teens

37
Q

increase the risk of type 2 DM

A

clozapine and olanzapine and chlorpromazine

38
Q

chlorpromazine adverse effects

A 
Anticholinergic effects and increased PRL release (same as other low-potency typicals)
impaired glucose tolerance
QT prolongation
Jaundice
Urticaria
39
Q

clozapine adverse effects

A

agranulocytosis
increased risk for type 2 DM
lowers seizure threshold

psych (12 decks)

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