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Pharm I > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

The antipsychotic drugs fall into 2 major groups.. What are they?

A

First generation antipsychotics (FGAs)
-aka conventional antipsychotics

Second generation antipsychotics (SGAs)
-aka atpyical antipsychotics

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2
Q

Which group is better: FGA or SGA?

A

They are both equally effective

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3
Q

All of the FGAs produce strong blockade of receptors for ____ in the CNS. What does this result in?

A

Strong blockade of receptors for DOPAMINE in the CNS; this results in serious movement disorders

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4
Q

Extrapyramidial symptoms (EPS)

A

Serious movement disorders

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5
Q

What do the SGAs produce (like what blockade)?

A

Moderate blockade of receptors for dopamine; much stronger blockade of receptors for serotonin

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6
Q

Which has a lower risk for EPS: FGA or SGA?

A

SGA, since the blockade of receptors for dopamine is only moderate, whereas FGA has strong blockade of receptors for dopamine

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7
Q

Even thought the SGAs carry a lower risk for EPS, they cause significant risk for metabolic effects. What are some examples?

A
  • Weight gain
  • Diabetes
  • Dyslipidemia
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8
Q

Define: A chronic psychotic illness characterized by disordered thinking and a reduced ability to comprehend reality

A

Schizophrenia

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9
Q

When do symptoms of schizophrenia usually emerge?

A

During adolescence or early adulthood

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10
Q

What are the positive symptoms of schizophrenia?

*Positive symptoms are viewed as an exaggeration or distortion of normal function

A

Hallucinations
Delusions
Disorganized speech
Bizarre behavior

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11
Q

What are the negative symptoms of schizophrenia?

*Negative symptoms can be viewed as a loss or diminution of normal function

A

Blunted affect
Poverty of thought
Loss of motivation
Inability to experience pleasure

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12
Q

Do FGAs improve positive symptoms, negative symptoms, or both?

A

Positive symptoms only

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13
Q

What are the 4 examples of FGAs?

A

Chlorpromazine
Haloperidol
Thiothixene
Trifuperazine

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14
Q

Which is more potent? Haloperidol or chlorpromazine?

A

Haloperidol

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15
Q

What does it mean when we say a drug is more potent?

A

The dose of the more potent drug (ex: haloperidol) required to believe psychotic symptoms is smaller than the required dose of the less potent drug (ex: chlorpromazine)

It DOES NOT mean that the more potent drug will produce greater effects.

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16
Q

If low potency and high potency neuroleptics (another name for FGAs) are equally effective, why do we distinguish between them?

A

These agents produce identical antipsychotic effects, but they differ SIGNIFICANTLY in their side effects

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17
Q

What is the primary indication for antipsychotic drugs?

A

Schizophrenia

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18
Q

FGA agents are equally effective, but individual patients may respond differently from one FGA to another. So how is selection on an FGA based?

A

It’s side effects

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19
Q

Do FGAs have many or few side effects?

A

Many

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20
Q

Of the many side effects that FGAs may produce, what is the most troubling?

A

Extrapyramidal reactions–especially tardive dyskinesia (TD)

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21
Q

What are 4 types of EPS?

A

Acute dystonia
Parkinsonism
Akathisia
Tardive dyskinesia

22
Q

Three of the 4 types of EPS occurs early in therapy. What are they? Can they be managed?

A

Acute dystonia
Parkinsonism
Akathisia
Yes, they can be managed with a variety of drugs

*The early reactions occur LESS FREQUENTLY with LOW-POTENCY agents than with high potency agents

23
Q

What is the type of EPS that occurs late in therapy? Does it have satisfactory treatment?

A

Tardive dyskinesia; No satisfactory treatment

*The risk of TD is equal with ALL FGAs

24
Q

Describe what happens in acute dystonia

A
  • Muscle tightening (spasms) usually of the neck and shoulders
  • Can involve the tongue and eyes
  • Occur early in therapy
25
Q

Describe what happens in akathisia

A
  • Literally means “can’t sit”
  • A motor restlessness–> constant drive to move
  • Occurs early in therapy
26
Q

Describe what happens in Parkinsonism

A
  • Exact same presentation as Parkinson’s disease (tremor, shuffling gait, decreased arm swing, and mask-like facies)
  • Occurs early in therapy
27
Q

Describe what happens in Tardive dyskinesia

A
  • Means “late movement disorder”
  • Occurs late in therapy
  • Usually permanent
  • Involuntary movement of tongue, eyes, lips, and face
28
Q

If a schizophrenia patient has been on FGAs for 2 years and begins showing symptoms of involuntary movement of the tongue and eyes, what kind of EPS would she have?

A

Tardive dyskinesia

*Even though acute dystonia has these same characteristics, the key word of the patient having been taking the drug for 2 years already lets you know that this is TD.

29
Q

Which FGA drugs are used more often: low or high potency?

A

High; because they produce fewer side effects

30
Q

High potency FGAs causes more ____, but less ____, ____, ____.

A

More early EPS, but less sedation, orthostatic hypotension, and anticholinergic effects

31
Q

FGA: Is haloperidol low or high potency?

A

High

32
Q

FGA: What is haloperidol a preferred agent for?

A

Tourette’s syndrome

  • It can also be used to control severe behavior problems in children
  • It is used more than other FGAs
33
Q

FGA: Haloperidol is a high potency drug. Based on what we know, what kind of effects may we see?

A 
Early EPS;
As well as:
-less sedation
-less orthostatic hypotension
-less anticholinergic effects
34
Q

FGA: Is trifluoperazine low or high potency?

A

High potency

35
Q

FGA: is thiothixene low or high potency?

A

High potency

36
Q

FGA: is haloperidol low or high potency?

A

High potency

37
Q

FGA: is chlorpromazine low or high potency?

A

Low potency

38
Q

FGA: Chlorpromazine is a low potency drug. What sort of adverse effects may be seen here?

A

(the opposite of a high potency drug)

  • Sedation
  • Orthostatic hypotension
  • Anticholinergic effects
39
Q

Which antipsychotic drug class is less likely to cause EPS effects, including TD?

A

SGAs

40
Q

SGAs may have less of a risk for getting EPS, but what do SGAs carry a serious risk for?

A

Metabolic effects

  • Weight gain
  • Diabetes
  • Dyslipidemia (can lead to cardiovascular events and premature death)

*Can also cause sedation, orthostatic hypotension, and can increase the risk of death when used to treat demential-related psychosis in older adults

41
Q

So even though SGAs and FGAs are similar in effectiveness, which one costs 10-20x more than the other

A

SGAs cost 10-20x more than FGAs

42
Q

What is the MOA of SGAs?

A

Block dopamine and serotonin

43
Q

What are the 4 types of SGAs?

A

clozapine
rrisperidone
olanzapine
quetipine

44
Q

Do SGAs treat both positive and negative effects, or only one?

A

They treat both!

45
Q

What is the most effective SGA for schizophrenia?

A

clozapine

46
Q

What problem does clozapine cause that makes it a drug only given to patients who have not responded to safer alternatives?

A

It causes agranulocytosis

47
Q

What is agranulocytosis

A

An increased deficiency in granulocytes in the blood causing an increased vulnerability to infection

48
Q

What is NMS?

A

Neuroleptic malignant syndrome

49
Q

Is NMS more likely to occur with FGA or SGA drugs?

A

FGA

50
Q

Is NMS more likely to occur with high or low potency FGAs?

A

High potency

51
Q

What are the symptoms of NMS?

A 
"lead pipe rigidity"
Fever
Encephalitis
VS instability
Elevated WBC & CPK
Rigidity
Sweating

Pharm I (30 decks)

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