antipsychotics Flashcards
Which SGA has the highest sedation, ACH effects, and orthostasis?
clozapine
common suffix for FGA
“azine”
what is risk of iloperidone?
severe orthostasis
why is loxapine rarely used?
lots of DDI
goal level of lithium and what must patient do when they take it?
0.6 - 1
drink adequate water
three injectable SGA that are long acting
risperidone microspheres, paliperidone palmitate, aripiprazole
4 mechanisms of action of SGA
serotonin dopamine antagonist, D2 antagonist with rapid dissociation, D2 partial agonist, serotonin partial agonist at 5HT 1A & antagonist at 5HT 2A
which drug is not indicated for bipolar disorder but is often used in mood disorders?
oxcarbazepine
Which FGA is best for treating refractory schizophrenia?
thioridazine
Which lipid changes are you most likely to see in a patient on an antipsychotic?
triglyceride
Common DDI with VPA
carbapenem antibiotics, lamotrigine, phenytoin, warfarin
Which SGA do you have to closely monitor CrCl with and adjust the dose accordingly?
paliperidone
receptor involved in anticholinergic effects
muscarine
receptors that provide sedative side effects
histamine and alpha-1
generalized slowing of voluntary movement with reduction in arm movements; most noticeable signs are rigidity and tremor at rest; may see pill rolling movements of the hands, stooped posture and shuffling gait
pseudoparkinsonism
strong subjective feeling of distress or discomfort; motor restlessness, inability to sit or stand still; sometimes mistaken as agitation or increased psychosis!
akathisia
bizarre, involuntary tonic contractions of skeletal muscle; most common dystonia as buccal spasms, facial grimacing and tics; can involve back, arms, and legs
acute dystonic reaction
IF you give olazapine and benzo via IM simultaneous what can you cause in your patient?
respiratory depression
which SGA has a long half life so they can take it once daily?
cariprazine
Two SGA most likely to cause weight gain
clozapine and olanzapine
When lithium levels are > 4 or the level is >2.5 and the patient is showing cardiac/neruologic symptoms - how do you treat?
hemodialysis
how long do you have to wait to draw levels of carbamazepine?
7-10 days → have to wait for it to autoinduce it’s own metabolism
which SGA has the most EPS side effects?
risperidone
what causes NMS?
sudden reduction in dopamine activity
Which FGA have the highest anticholinergic effects?
low potency FGA
why do you want to avoid giving carbamazepine with clozapine?
agranulocytosis
treatment for NMS
discontinue the agent and provide supportive care
Mid potency FGA are only used in treating
schizophrenia
central anticholinergic effects
delirium, psychosis, hyperthermia
haloperidol, fluphenazine, thiothixene, trifluoperazine, pimozide
high potency FGA
This SGA is used in treating schizophrenia, BPD I, and adjunct MDD
aripiprazole
why do you want to slowly titrate up lamotrigine?
decreases risk of Stevens Johnson Syndrome/Toxic Epidermal Necrolysis
90% of akithisia cases develop in
first 2.5 months of treatment
These two SGA have high sedative effects and moderate ACH effects?
olanzapine and quetiapine
dopamine 2 antagonism can lead to…
hyperprolactinemia
Common DDI with lithium
NSAID, ACEi/ARB, diuretics, theophylline
what high potency FGA is only used in treating Tourette’s Syndrome?
pimozide
how long does the onset of pseudoparkinsonism take?
develops several days to weeks after treatment initiation
MOA of first generation antipsychotics
blockade of D2 receptors
Which FGA can shorten QTc?
perphenazine
side effects of clozapine
dry mouth, constipation, blurred vision, urinary retion
mad as a hatter, blind as a bat, hot as a hare, red as a beet, dry as a bone
why should you be cautious in using injectable haloperidol over PO?
injectable is 2x more potent
older high potency FGA that isn’t really prescribed much?
thiothixene
which SGA acts like a mood light?
aripiprazole
which SGA can also help with treating Tourettes?
risperidone
what symptoms will you see in newborn whose mother received FGA treatment in the third trimester?
EPS and withdrawal symptoms
which high potency FGA do you give to a patient who is resistant to taking their meds and is likely to cheek their meds?
liquid fluphenzine
Two SGA most likely to cause diabetes
clozapine and olanzapine
what type of symptoms are FGA better at treating?
positive symptoms
FGA have higher risk of →
SGA have higher risk of →
neurological side effects
metabolic side effects
Which SGA do you have to take with 500 calories → must take BID so all together need 1000 calories?
ziprasidone
how long does it take tardive dyskinesia to develop?
months to years after treatment initiation
What is the difference betwee low potency and high potency FGA?
low → more sedating
high → greater risk of EPS
what lab value will be elevated in NMS
serum creatinine kinase → rhabdomyolysis
Two SGA least likely to cause weight gain
ziprasidone and aripiprazole
receptor that causes orthostatic hypotension
alpha-1
two long acting injectable FGA
fluphenzine decanoate, haloperidol decanoate
perphenzine and loxapine are both
mid potency FGA
If your patient has hepatitis or cirrhosis what high potency FGA do you want to absolutely avoid?
trifluoperazine
three immediate release injectable FGA
chlorpromazine, fluphenazine, haloperidol
Clozapine and lithium both decrease
suicide ideality
What method do you use when injecting FGA?
Z tracking method
All SGA can lengthen QTc except which two?
aripiprazole and lurasidone
treatment for akathisia
propranolol
what can hyperprolactinemia cause?
galactorrhea, sexual dysfunction, amenorrhea, gynecomastia
two injectable SGA with immediate release
olanzapine and ziprasidone
This drug is only used for the MAINTENANCE of BPD1 and epilepsy
lamotrigine
What effect with antipsychotics have in the elderly?
increased mortality with dementia related psychosis
Which SGA has the lowest risk of metabolic effects?
ziprasidone
patient presents with muscle rigidity, hyperthermia, altered consciousness, and autonomic dysfunction
neuroleptic malignant syndrome (NMS)
treatment for acute dystonic reaction
diphenhydramine or benzotropine
If the patient is taking high doses of haloperidol what you monitor for?
QTc prolongation
peripheral anticholinergic effects
dry mouth/eyes/throat, blurred vision, mydriasis, tachycardia, constipation, urinary retention
How does a patient need to take lurasidone?
with 350 calories
This SGA has rapid binding and dissociation with the D2 receptor and thus has a good side effect profile
quetiapine
treatments for tardive dyskinesia
valbenazine or vitamin E
presence of HLA B*1502 allele puts patients taking carbamazepine at 10 fold increased risk for
steven johnson syndrome
What lab value will become elevated in the first 3 months of an antipsychotic?
LFTs
VPA will cause elevated levels of ___ in the blood
ammonia
In order to get the antipsychotic effect from quetiapine you must?
prescribe at very high dose (600-800) or else it is just expensive benedryl
with which SGA does a patient need to swallow the drug as well as their saliva in order to get the full dose?
olanzapine
Black box warnings for clozapine?
myocarditis, reduces seizure threshold, significant orthostasis, agranulocytosis
How long does the onset of acute dystonic reaction take?
within 24-96 hours of drug initiation or dose change
what do you monitor for in a patient on thioridazine?
QTc prolongation
three antipsychotics least likely to cause dyslipidemia
ziprasidone, aripiprazole, lurasidone
chlorpromazine and thioridazine are both
low potency FGA
two SGA with partial agonist/antagonist actions
brexipiprazole and cariprazine
why do you need lifelong blood monitoring in a patient on clozapine?
risk of agranulocytosis
Two SGA least likely to cause diabetes
ziprasidone and aripiprazole
classic mood stabilizer used in manic episodes of bipolar disorder and as maintenance
lithium
treatment for pseudoparkinsonism
benzotropine, trihexyphenidyl, diphenhydramine, amantadine
stereotypical involuntary movements including sucking/smacking of lips, lateral jaw movements and fly catching dartings of the tonuge - may be irreversible
tardive dyskinesia
agent used in treating acute manic or mixed episodes of bipolar disorder, epilepsy, and migraine prophylaxis?
valproic acid (VPA)
