Antipsychotics Flashcards
Not only was this drug the first antipsychotic, it was the first psychotropic medication of any kind
chlorpromazine (Thorazine)
Typical antipsychotics are divided into these two categories which also correlates to their D2 receptor’s binding affinity
high potency & low potency
This typical antipsychotic is available PO, IM, & IV; is commonly used to treat agitated patients in hospitals/ER’s; & can be used to treat Tourette’s syndromes
haloperidol (Haldol)
Name 3 anticholinergic medications commonly used to counter EPS side effects:
trihexyphenidyl (artane), benztropine (cogentin), & diphenhydramine (Benadryl)
When used in their long acting injectable form, these 2 FGA’s are given IM every 2-4 weeks to treat patients with chronic schizophrenia
haloperidol (Haldol) & fluphenazine (Prolixin)
This type of typical antipsychotic is anti-cholinergic, anti-histaminic, & an α1 adrenergic antagonist
low potency antipsychotics Chlorpromazine (thorazine)
While prochlorperazine (Compazine) is a D2 blocker it is more commonly used for this than its antipsychotic properties
antiemetic properties
This antipsychotic can also be used to treat intractable hiccups
chlorpromazine (Thorazine)
This typical antipsychotic has the greatest risk of any antipsychotic for dose dependent QTc prolongation, torsades de pointes, and cardiotoxicity
thioridazine (Mellaril)
Even though its the most efficacious antipsychotic, its side effect profile prevents this drug from consideration for first line use
Clozapine (Clozaril)
This atypical antipsychotic is used to treat psychosis in Lewy Body Dementia & Parkinson’s Disease due to its low likelihood of EPS
quetiapine (Seroquel)
These 2 atypical antipsychotics are available in a long acting injectable form & have the highest risk among atypicals of causing prolactin elevation
risperidone (Risperdal) & paliperidone (Invega)
These two atypicals are most likely to cause side effects of significant sedation and the metabolic syndrome
olanzapine (Zyprexa) and clozapine (Clozaril)
Of all the SGA’s, this medication has the highest risk of causing QTc prolongation
ziprasidone (Geodon)
This SGA is a partial dopamine agonist & commonly has the side effect akathisia
aripiprazole (Abilify)
This atypical antipsychotic is FDA approved for adjunct treatment of major depression
aripiprazole (Abilify)
Due to the risk of seizure induction, slow dose titration must be done for this atypical antipsychotic
clozapine (Clozaril)
Name the most metabolically “neutral” antipsychotics
Lurasidone (latuda), asenapine (saphris), ziprasidone (geodone), aripiprazole (abilify)
More common with typical antipsychotics, this side effect is characterized by repetitive, involuntary, purposeless movements
Tardive Dyskinesia
For a patient taking Clozapine (Clozaril) this is done when the WBC is < 2,000 or the absolute neutrophil count is < 1,000
abrupt stop (abrupt stop → rebound psychosis; do gradual taper when possible)
Due to the risk of metabolic syndrome, patients on atypical antipsychotics should have their weight, waist circumference and these 2 labs monitored regularly
glucose & lipids
Clozapine (clozaril), Quetiapine (seroquel), Iloperidone (fanapt), Risperidone (risperdal) Paliperidone (invega) ——————————————– All may cause dose dependent orthostatic hypotension due to this
α1 adrenergic antagonism (undesirable in elderly pts & pts at risk for falls)
There is a blackbox warning for the use of antipsychotics in elderly dementia patients due to increased risk of this
sudden death (cardiovascular cause)
This atypical antipsychotic may cause dry mouth due to its anticholinergic properties, but ironically it may also cause excess salivation
clozapine (Clozaril)
SGA’s work primary by blocking these 2 receptors
D2 & 5HT2A receptor
The positive symptoms of schizophrenia are due to hyperactivity of what dopamine tract?
The Mesolimbic Pathway
Excess blockade of this dopamine tract may cause infertility, galactorrhea, & osteopenia
The Tubuloinfundibular Pathway
When switching to aripiprazole (abilify) from a different antipsychotic, before the other antipsychotic has washed out, the aripiprazole (abilify)—at least in theory— initially does this at the D2 receptors
acts as a dopamine agonist (When switching to abilify, need to switch slowly or have a washout period)
The percentage of D2 occupancy necessary for the antipsychotic effect is this
60%
This percentage of occupancy at D2 is believed to be associated with elevated prolactin and/or EPS
~80%
While NMS is uncommon to rare (incident rate 0.02-3%), its cause is this
dopamine antagonism
Hypoactivity of this dopamine tract is believed to be associated with the development of negative symptoms
The mesocortical pathway
The SGA with the unique mechanism of action of partial dopamine agonism is this
aripiprazole (Abilify)
Which antiemetic medications are D2 blockers and may cause EPS or TD
Prochlorperazine (Compazine) Metoclopramide (Reglan) Droperidol (Inapsine) Promethazine (Phenergan)
About 75% of pts with schizophrenia do this unhealthy activity which also induces an increased metabolic rate of antipsychotic medications
cigarette smoking
While not diagnostic for NMS (it may be normal if there is not clearly well developed rigidity), this lab’s degree of abnormality correlates with the disease severity & prognosis
creatine kinase
Antipsychotics approved for the treatment of bipolar depression are olanzapine/fluoxetine (symbyax), lurasidone (latuda), and this
quetiapine (Seroquel)
This atypical has a significant risk of causing hyperprolactinemia, is the active metabolite of risperidone (Risperdal), and needs to be taken with food
paliperidone (Invega)
The 4 SGA’s that are available in long acting injectable preparations are:
risperidone (Risperidal Consta) olanzapine (Zyprexa Relprevv) paliperidone (Invega Sustenna) aripiprazole (Abilify Maintena)
Antipsychotic side effects of sedation & weight gain are likely due to antagonist activity at this receptor
Histamine (H1)
This demographic is at the greatest risk for dystonia from antipsychotics
young males
While muscular rigidity, hyperthermia, & autonomic stability are all common symptoms of NMS, most often this symptom presents first
mental status changes
The picture showsa pt experiencing this EPS side effect
Dystonia
The antipsychotic side effect seen in this patient is this
oculogyric crisis
The picture shows a patient with this D2 blocking medication side effect
gynecomasitia (From hyperprolactinemia)
