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SMUSPG-Behavioral > Antipsychotics > Flashcards

Antipsychotics Flashcards

1
Q

Mesolimbic Dopamine Hyperactivity

A

over activity in nucleus accumbens

Positive Symptoms

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2
Q

Mesocortical Dopamine Underactivity

A

Negative/Cognitive Symptoms:

negative, cognitive and affective sx of schixo

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3
Q

Dopamine

Serotonin

A

Dec Postivive sx

Dec post and neg sx

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4
Q

Neuroleptics (Antipsychotics):Dopamine Pathways (MOA)

Mesolimbic:

A

DA overactivity l/t positive sx for schizophrenia and psychosis with mania, depression and dementia

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5
Q

Mesocortical:

A

negative sx and cognitive dysfunction (DA underactivity in schizophrenia d/t overactivity of N-methyl-D-aspartate (NMDA) or glutamate system)

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6
Q

Nigrostriatal:

A

controls motor movements; blockade of dopamine by drugs here causes EPS

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7
Q

Tuberoinfundibular:

A

hypothalamus to anterior pituitary – DA blockade leads to elevated prolactin levels l/t galactorrhea, amenorrhea, sexual dysfunction

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8
Q

Typical antipsychotics (First generation) FGA

A

TARGETS POSTIVE SX OF SCHIZO
Blockade of DA2-receptors in mesolimbic dopamine pathway

block in mesocortical, nigrostriatal, and tuberoinfundibular leading to ADE

blockade- histamine, cholinergic , alpha blockade

EFFICACY SAME

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9
Q

Atypical antipsychotics (Second generation)

A 
TARGETS NEG SX OF SCHIZO
Block serotonin (5-HT2A) receptors more than DA receptor blockade, mesocortical

less EPS and less TD

Less hyperprolactinemia (except risperidone*)

EFFICACY SAME
Primarily Targets-cognitive deficits, but also can have positive symptom relief

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10
Q

HIGH POTENCY FGA-

-ol, xene, razine, nazine, ide

A

High EPS
Haloperidol (Haldol)-*has long acting IM form
LESS CV

Fluphenazine (Prolixin)*has long acting IM form

Thiothixene (Navane)- QT
Trifluperazine (Stelazine)
Pimozide (Orap)

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11
Q

LOW POTENCY FGA- AZINE

A

Have HIGH anticholinergic SE’s

  • Orthostatic Hypotension
  • Sedation

Chlorpromazine (Thorazine)
Thioridazine (Mellaril)

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12
Q

Mid Potency

A

Loxapine (Loxitane)

Perphenazine (Trilaphon)

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13
Q

Typical Antipsychotics, FGA Side Effects

A

Cardiovascular: QTc tosardes de pointes

Anticholinergic
Blurred vision, constipation, dry mouth, urinary retention

Antihistamine effect  Sedation

Anti alpha 1 effect  Orthostatic hypotension

Endocrine: hyperprolactinemia, osteoporosis, amenorrhea, galactorrhea, gynecomastia, sexual SEs

HIGH Extrapyramidal Symptoms EPS

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14
Q

EPS Extrapyramidal Symptoms EPS

A

D2 blockage on nigrostriatal pathway
*worse with 1st generation antipsychotics

Tx w/ lower dose or change of antipsychotic or diphenhydramine or benztropine (Cogentin), trihexyphenidyl (Artane)

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15
Q

A.D.A.P.T. EPS SE

A

ACUTE
DYSTONIA- Hours to days: muscle contraction, commonly affecting facial area
AKATHISIA-Days to weeks: restlessness)
PAKRINSOMISM Weeks to months: Cogwheel rigid
TARDIVE-Months to Years: irreversible
TX CLOZAPINE

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16
Q

Clozapine-SGA

A

Black box- myocarditis, seizures, agranulocytosis

Plasma monitoring: 300-420 ng/ml best; > 1000 ng/ml = seizure and Ach toxicity

Dose: start 12.5-25mg daily, incr by 25-50mg daily over 2 weeks to minimize low BP, sedation, resp depression, seizure risk

Agranulocytosis
Check WBC/ANC (must be > 3000/1500) qwk x6months, if okay, q2wks x6mon; then q4wks if stable

Concerns if active infectious process, immunosuppressed
Monitor sore throat, fever, cold/flu sx, unhealing sores

17
Q

Clozapine-SGA ADR

A 
inc salivation
sedation tachycardia dizzy
DRUG interactions- fluvoxamine, ciprofloxcin, 
smoking lower levels
Carbamezapine_ agranulcyttosis
Bupropion- seizures
18
Q

Risperidone- SGA ADR

A

priapism, hyperprolactinemia, hypotension

Paliperidone *active metabolite of risperidone
Primarily renal elimination, CRCL
Tachycardia inc.

19
Q

Olanzapine- SGA ADR

A

Smoking increases metabolism

FDA report: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

20
Q

Quetiapine- SGA ADR

A

titrate due to orthostasis, sedation

21
Q

Ziprasidone - SGA ADR

A

take with food, increases absorption
rash and/or urticaria
QTc prolongation

22
Q

Aripiprazole- SGA ADR

A

urges for gambling, shopping, binge eating and sexual behavior

23
Q

Lurasidone- SGA ADR

A

Newer -once daily dosing bipolar depression
Well tolerated,
does not affect QT, hypotension
somnolence, akathisia, Parkinsonian sx, agitation
Alcohol enhances sedation

24
Q

Cardiometabolic

A

Weight gain- higher with low potency
12 month wt gain: Cloz, olanz:

Metabolic syndrome: clozapine and olanzapine worst, least with aripiprazole, ziprasidone

Glucose dysregulation: worst with olanz, cloz;

Monitor w/ SGA
Baselin, 12 wk, annual biometrics

Worse- clozapine, olanzipine, quetiapine
Leaset apriprazole

25
Q

ALL Neuroleptics

A

AntiCACh- SE low potent FGA, cloz, olanzo SGA

Sedation- low potency FGA, cloz, olanzo SGA

Seizues- CLOZAPINE, low potent
Higher rate w/ Low potenty FGA vs high

26
Q

BPH closed anlge AVOID

A

FGAs

27
Q

Endocrine Adverse Effects

A

FGAs-Dopamine inhibits release of prolactin; blocking DA would then Prolactin is increased- reverisle
W- menstrual, infertil
M- dec libido, ED,
LT- osteoporisis,

SGA- Respirodone more than FGA

28
Q

Neuroleptic Malignant Syndrome (NMS)

A

Rare, Medical Emergency

Mortality = 10%, if kidney failure = 50%
HIGH potency FGA

Idiosyncratic reaction presenting with confusion, autonomic instability, hyperpyrexia, rhabdomyolysis, renal failure, CV collapse
Fever
Encephalopathy
Vitals unstable
Enzyme increase
Rigidity of muscles

Treatment: DC neuroleptic, supportive care, can use dantrolene or bromocriptine

29
Q

Drug interatcion

A

Smoking decrease serum neuroleptic (esp clozapine, olanzapine)

Antidepressants – increased sx and EPS

Lithium, Carbamazepine – confusion/disorientation, increased EPSE

Antihypertensives – increased hypotensive effects

Ziprasidone – medications that prolong the QT interval

SMUSPG-Behavioral (11 decks)

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