Antipsychotics Flashcards
First antipsychotic
Chlorpromazine (Thorazine)
How are typical antipsychotics divided?
High vs Low Potency
Correlates to D2 receptor binding affinity
What is Haldol?
Typical Antipsychotic
Used for agitated patients and Tourette’s Syndrome
Formulation of Haldol
PO, IM, IV
What medications can be used to counteract EPS SE?
Anticholinergics:
Trihexyphenidyl (artane)
Benztropine (Cogetin)
Diphenydramine (Benadryl)
Which FGA antipsychotics are available in a long acting injectable form? What is this used for
Haldol
Fluphenazine (Prolixin)
Given IM q2-4wks to treat chronic schizophrenia
Properties of Chlorpromazine (Thorazine)
Typical Low Potency Antipsychotic
Anticholinergic
Antihistamine
a1-adrenergic antagonist
What is Prochlorperazine (Compazine) commonly used for?
Antiemetic (via D2 blockade)
Besides as an antipsychotic, what can Chlorpromazine (Thorazine) also be used for?
Intractable Hiccups
What is a serious SE of Thioridazine (Mellaril)?
Dose dependent QTc prolongation
Torsades
Cardiotoxicity
Why is Clozapine (Clozaril) not used despite being a very efficacious antipsychotic?
Bad SE profile prevents it from being 1st line
What antipsychotic is used to treat psychosis in Lewy Body Dementia and Parkinson’s? Why?
Quetiapine (Seroquel): atypical
Due to low likelihood of EPS
Which atypical antipsychotics have highest risk of hyperprolactinemia?
Risperidone (Risperidal)
Paliperidone (Invega)
Which atypical antipsychotics are available in a long acting injectable form?
Risperidone (Risperidal)
Paliperidone (Invega)
Which atypical antipsychotic causes most signfiicant sedation and metabolic syndrome?
Olanzapine(Zyprexa)
Clozapine (Clozaril)
Which SGA (second generation antipsychotic) has the highest risk of causing QTc prolongation?
Ziprasidone (Geodon)
Which SGA causes akathisia commonly?
Aripiprazole (Abilify)
Partial dopamine agonist
Which atypical antipsychotic is FDA approved for adjunct treatment in major depression?
Aripiprazole (Abilify)
Which atypical antipsychotic requires slow dose titration and why?
Clozapine (Clozaril)
Due to risk of seizure induction
Which SGAs are most metabolically neutral?
Lurasidone (Latuda)
Asenapine (Saphris)
Ziprasidone (Geodone)
Aripiprazole (Abilify)
What is Tardive Dyskinesia and what is it caused by?
Repetitive, involuntary, purposeless movements
Caused more commonly by TYPICAL antipsychotics
Patient on clozapine(clozaril) with WBC<2000 or ANC<1000
Do ABRUPT STOP
Why is gradual taper preferred over abrupt stop with antipsychotics?
Abrupt stop -> rebound psychosis
EXCEPT when patient has WBC<2000 or ANC<1000
What should be monitored in patients on atypical antipsychotics and why?
Weight, Waist Circumference, Glucose, Lipids
Due to metabolic syndrome
Whicih antipsychotics can cause dose dependent orthostatic hypotension and via what?
a1-Adrenergic Antagonism Clozapine(Clozaril) Quetiapine (Seroquel) Iloperidone (Fanapt) Risperidone (Risperdal) Paliperidone (Invega)
*Problem in elderly and those at fall risk
Why is there a blackbox warning when using antipsychotics in elderly dementia patients?
Risk of sudden CV death
Which atypical antipsychotic may cause both dry mouth or excess salivation?
Clozapine (Clozaril)
MOA of SGA
Block D2 and 5HT2A receptors
What are positive symptoms of schizophrenia due to?
Hyperactivity of dopamine Mesolimbic Pathway
Blockade of the dopamine tubuloinfundibular pathway leads to what?
Infertility
Galactorrhea
Osteopenia
What needs to be done when switching from an antipsychotic to Aripiprazole (Abilify)? Why?
Need to switch slowly or have washout period
Abilify will initially act as dopamine AGONIST
What % of D2 receptors need to be occupied for antipsychotic effect?
60%
What % of D2 receptors need to be occupied to see elevated prolactin or EPS?
80%
What causes NMS with antipsychotics?
Dopamine Antagonism
What is though to be associated with development of negative symptoms?
Hypoactivity of Dopamine Mesocortical Pathway
Which SGA has MOA of partial dopamine agonism?
Aripiprazole (Abilify)
Which of the following antiemetic medicaitons are D2 blockers leading to possible EPS or Tardive Dyskinesia?
Prochlorperazine (Compazine)
Metoclopramide(Reglan)
Droperidol (Inapsine)
Promethazine (Phenergan)
All of them
What does cigarette smoking in schizophrenia patients imply?
Smoking induces increased metabolism of antipsychotic medicaitons
What lab finding correlates with disease severity and prognosis of NMS?
Creatine Kinase
NOT DIAGNOSTIC THOUGH
Which antipsychotics are approved for treatment of Bipolar Depression?
Olanzapine/Fluoxetine (Symbyax)
Lurasidone(Latuda)
Quetiapine (Seroquel)
What is Paliperidone(Invega)
Active Metabolite of Risperidone (Risperdal)
Signfiicant risk of hyperprolactinemia
Needs to be taken with food
Which SGAs are available in long acting injections
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Paliperidone (Invega)
Airpiprazole (Abilify)
Antipsychotic SE of sedation and weight gain are due to what?
Antaognism of H1 receptors
Which demographic is at greatest risk of dystonia with antipsychotics?
Young Males
What symptom of NMS most commonly present first? What are the other sx?
MENTAL STATUS CHANGE Other Sx: Hyperthermia Muscle Rigidity Autonomic Instability
