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pharm 2 2 > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

What are positive symptoms?

A

Delusions, paranoia, hallucinations

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2
Q

What are negative symptoms?

A

Residual symptoms, apathy, withdrawal, blunt affect

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3
Q

What are the 4 dopamine pathways?

A

1) Mesolimbic (pleasure/reward)
2) Mesocortical (worsens negative sx)
3) Nigrostriatal (balance of DA/Ach
4) Tuberoinfundibular (DA & prolactin)

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4
Q

What happens when you treat schizophrenia?

A

Decrease DA = Increase ACh

produces parkinsonism like symptoms (EPS) that can be treated with anticholinergics.

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5
Q

What is Tardive Dyskinesia?

A

Can not be fixed neuroleptic malignant syndrome

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6
Q

What is the father of typical antipsychotics?

A

Chlorpromazine, an antihistamine found to have anti psychotic properties

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7
Q

First generation agents have what capability?

A

Alpha 1 blocking and may cause orthostatic hypotension

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8
Q

M1 binding affinities cause what?

A

antisludge properties - dry mouth, constipation

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9
Q

How do you treat first dose phenomenon?

A

IV Benztopine (highly anticholinergic)

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10
Q

What is NMS?

A

hyperpyrexia, rigid, increases in CPK (leads to rhabdo)

TX: stop drug, give dantrolene / bromocriptine

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11
Q

All antipsychotics carry what precaution?

A

QT interval prolongation (TORSADES!)

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12
Q

Major CON of first generations?

A

EPS, negative symptoms not well treated, tardive dyskinesia but CHEAPER

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13
Q

What is Haloperidol? Risks?

A

High potency sedative TYPICAL antipsychotic. risk of hypotension and may lower seizure threshold

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14
Q

How do atypical antipsychotics work

A

Block DA & 5HT2A

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15
Q

What concerns with the atypicals?

A

Metabolic effects– weight gain, DM, dyslipidemia

also more expensive

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16
Q

Pros of atypicals?

A

Adherence improved, reduced EPC, better with negative symptoms

17
Q

What are the atypicals?

A
  • Risperidone
  • Paliperidone
  • Olanzapine
  • Quetiapine
  • Clozapine
  • Ziprasidone
  • Aripiprazole
  • Asenapine
  • Lurasidone
18
Q

Quetiapine is approved for treatment of what?

A

Schizophrenia, acute bipolar mania, bipolar depressoion

19
Q

Quetiapine side effects?

A

weight gain, DM, lipid abnormalities

Very low risk of EPS & hyperprolactinemia

20
Q

What is Olanzapine?

A

Son of Clozapine

Equal or superior to Haldol for treating negative symptoms

Metabolic issues present but no agranulocytosis

21
Q

What is Clozapine?

A

First Atypical

Low incidence of EPS, tardive, and good for negative symptoms

22
Q

What is risk with Clozapine?

A

Agranulocytosis, usually older females at start of therapy

23
Q

5 BBW for Clozapine?

A
  • Agranulocytosis
  • Orthostatic hypotension
  • Sizures
  • Myocarditis / cardiomyopathy
  • Mortality increased in dementia elderly
24
Q

What is Risperidone advantage & disadvantage?

A
  • EPS (higher doses) but significant hyperprolactinemia
25
Q

Paliperidone is what? Risk?

A

Metabolite of Risperidone so risk of hyperprolactinemia

26
Q

Benefit of Lurasidone? Risk

A

Low metabolic risk, less sedating

Anticholinergic

HIGHER RISK OF EPS

27
Q

Benefit of Aripiprazole?

A

Lower incidence of EPS, weight gain, prolactinemia, sedation, dyslipdemia

28
Q

Other use for Aripiprazole?

A

Antidepressant for augmenting SSRI / SNRI

29
Q

What is Lithium?

A

Mood stabilizer for bipolar, low therapeutic index (easily becomes toxic) so you must adjust for renal insufficiency

30
Q

Lithium has an inverse relationship with what?

A

Sodium- so Na wasting increases Li levels

31
Q

A/E of lithium?

A
  • Fine tremor
  • Polyuria
  • Polydipsia
  • Hypothyroidism
  • Weight gain
  • Metallic taste
  • Rash
32
Q

What indicates lithium toxicity?

A

tremor, so check levels

If toxicity can’t give charcoal!! (metal)

33
Q

What is another mood stabilizer?

A

Valproic acid (also anti epileptic) for agitation

hepatotoxic so follow LFT

34
Q

Antipsychotics & pregnancy?

A

Avoid, especially 3rd trimester

35
Q

PEARL with antipsychotics & dementia?

A

> 65 increased mortality due to cardiovascular incidents

pharm 2 2 (8 decks)

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