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Psychiatry > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

First antipsychotic

A

Chlorpromazine (Thorazine)

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2
Q

How are typical antipsychotics divided?

A

High vs Low Potency

Correlates to D2 receptor binding affinity

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3
Q

What is Haldol?

A

Typical Antipsychotic

Used for agitated patients and Tourette’s Syndrome

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4
Q

Formulation of Haldol

A

PO, IM, IV

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5
Q

What medications can be used to counteract EPS SE?

A

Anticholinergics:
Trihexyphenidyl (artane)
Benztropine (Cogetin)
Diphenydramine (Benadryl)

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6
Q

Which FGA antipsychotics are available in a long acting injectable form? What is this used for

A

Haldol
Fluphenazine (Prolixin)
Given IM q2-4wks to treat chronic schizophrenia

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7
Q

Properties of Chlorpromazine (Thorazine)

A

Typical Low Potency Antipsychotic
Anticholinergic
Antihistamine
a1-adrenergic antagonist

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8
Q

What is Prochlorperazine (Compazine) commonly used for?

A

Antiemetic (via D2 blockade)

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9
Q

Besides as an antipsychotic, what can Chlorpromazine (Thorazine) also be used for?

A

Intractable Hiccups

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10
Q

What is a serious SE of Thioridazine (Mellaril)?

A

Dose dependent QTc prolongation
Torsades
Cardiotoxicity

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11
Q

Why is Clozapine (Clozaril) not used despite being a very efficacious antipsychotic?

A

Bad SE profile prevents it from being 1st line

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12
Q

What antipsychotic is used to treat psychosis in Lewy Body Dementia and Parkinson’s? Why?

A

Quetiapine (Seroquel): atypical

Due to low likelihood of EPS

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13
Q

Which atypical antipsychotics have highest risk of hyperprolactinemia?

A

Risperidone (Risperidal)

Paliperidone (Invega)

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14
Q

Which atypical antipsychotics are available in a long acting injectable form?

A

Risperidone (Risperidal)

Paliperidone (Invega)

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15
Q

Which atypical antipsychotic causes most signfiicant sedation and metabolic syndrome?

A

Olanzapine(Zyprexa)

Clozapine (Clozaril)

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16
Q

Which SGA (second generation antipsychotic) has the highest risk of causing QTc prolongation?

A

Ziprasidone (Geodon)

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17
Q

Which SGA causes akathisia commonly?

A

Aripiprazole (Abilify)

Partial dopamine agonist

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18
Q

Which atypical antipsychotic is FDA approved for adjunct treatment in major depression?

A

Aripiprazole (Abilify)

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19
Q

Which atypical antipsychotic requires slow dose titration and why?

A

Clozapine (Clozaril)

Due to risk of seizure induction

20
Q

Which SGAs are most metabolically neutral?

A

Lurasidone (Latuda)
Asenapine (Saphris)
Ziprasidone (Geodone)
Aripiprazole (Abilify)

21
Q

What is Tardive Dyskinesia and what is it caused by?

A

Repetitive, involuntary, purposeless movements

Caused more commonly by TYPICAL antipsychotics

22
Q

Patient on clozapine(clozaril) with WBC<2000 or ANC<1000

A

Do ABRUPT STOP

23
Q

Why is gradual taper preferred over abrupt stop with antipsychotics?

A

Abrupt stop -> rebound psychosis

EXCEPT when patient has WBC<2000 or ANC<1000

24
Q

What should be monitored in patients on atypical antipsychotics and why?

A

Weight, Waist Circumference, Glucose, Lipids

Due to metabolic syndrome

25
Q

Whicih antipsychotics can cause dose dependent orthostatic hypotension and via what?

A 
a1-Adrenergic Antagonism
Clozapine(Clozaril)
Quetiapine (Seroquel)
Iloperidone (Fanapt)
Risperidone (Risperdal)
Paliperidone (Invega)

*Problem in elderly and those at fall risk

26
Q

Why is there a blackbox warning when using antipsychotics in elderly dementia patients?

A

Risk of sudden CV death

27
Q

Which atypical antipsychotic may cause both dry mouth or excess salivation?

A

Clozapine (Clozaril)

28
Q

MOA of SGA

A

Block D2 and 5HT2A receptors

29
Q

What are positive symptoms of schizophrenia due to?

A

Hyperactivity of dopamine Mesolimbic Pathway

30
Q

Blockade of the dopamine tubuloinfundibular pathway leads to what?

A

Infertility
Galactorrhea
Osteopenia

31
Q

What needs to be done when switching from an antipsychotic to Aripiprazole (Abilify)? Why?

A

Need to switch slowly or have washout period

Abilify will initially act as dopamine AGONIST

32
Q

What % of D2 receptors need to be occupied for antipsychotic effect?

A

60%

33
Q

What % of D2 receptors need to be occupied to see elevated prolactin or EPS?

A

80%

34
Q

What causes NMS with antipsychotics?

A

Dopamine Antagonism

35
Q

What is though to be associated with development of negative symptoms?

A

Hypoactivity of Dopamine Mesocortical Pathway

36
Q

Which SGA has MOA of partial dopamine agonism?

A

Aripiprazole (Abilify)

37
Q

Which of the following antiemetic medicaitons are D2 blockers leading to possible EPS or Tardive Dyskinesia?

Prochlorperazine (Compazine)
Metoclopramide(Reglan)
Droperidol (Inapsine)
Promethazine (Phenergan)

A

All of them

38
Q

What does cigarette smoking in schizophrenia patients imply?

A

Smoking induces increased metabolism of antipsychotic medicaitons

39
Q

What lab finding correlates with disease severity and prognosis of NMS?

A

Creatine Kinase

NOT DIAGNOSTIC THOUGH

40
Q

Which antipsychotics are approved for treatment of Bipolar Depression?

A

Olanzapine/Fluoxetine (Symbyax)
Lurasidone(Latuda)
Quetiapine (Seroquel)

41
Q

What is Paliperidone(Invega)

A

Active Metabolite of Risperidone (Risperdal)
Signfiicant risk of hyperprolactinemia
Needs to be taken with food

42
Q

Which SGAs are available in long acting injections

A

Risperidone (Risperdal)
Olanzapine (Zyprexa)
Paliperidone (Invega)
Airpiprazole (Abilify)

43
Q

Antipsychotic SE of sedation and weight gain are due to what?

A

Antaognism of H1 receptors

44
Q

Which demographic is at greatest risk of dystonia with antipsychotics?

A

Young Males

45
Q

What symptom of NMS most commonly present first? What are the other sx?

A 
MENTAL STATUS CHANGE
Other Sx:
Hyperthermia
Muscle Rigidity
Autonomic Instability

Psychiatry (7 decks)

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