Antipsychotics Flashcards
What suffices are associated with first generation antipsychotics?
What are the 4 exceptions?
They are AKA what?
-azine
Haloperidol
Loxapine
Pimozide
Thiothixene
Conentional or Typical
What suffices are associated with second generation antipsychotics?
They are AKA what?
- idone
- azole
- apine
Novel or Atypical
What’s the primary difference between the first and second generation antipsychotics?
Reduced movement disorder side effects.
What is the MOA of FGA’s in general?
Blockage of D2 post-synaptic receptors
Which other receptors can FGAs block, thus producing side-effects?
Muscarinic receptors
Histamine receptors (H1)
a1-adrenergic
D2 receptors in the nigrostriatal pathway (EPS and movements) and tubulofundibular (prolactin) pathway
What are the typical side-effects noted in FGAs?
Hyperprolactinemia (tubulofundibular pathway)
-amenorrhea, galactorrhea, gynecomastia, decreased libido
EPS/TD (Acute akathisia/dystonia/Parkinsonism-like + Tardive dyskinesia) (nigrostriatal pathway)
What are the 2 low potency FGAs?
What side effects are more common in them?
Chlorpromazine + Thioridazine
More sedation, hypotension and seizure-threshold reduction.
What are the 2 high potency FGAs?
What side effects are more common in them?
Fluphenazine + Haloperidol
More movement (EPS) and endocrine effects (prolactin).
What 2 anticholinergic drugs can be given as a treatment for the EPS side-effects from FGAs?
What antihistamine drug can be given as a treatment for the EPS side-effects from FGAs?
Benztropine + Trihexyphenidyl
Diphenhydramine
What 2 drugs can be given to treat the tardive dyskinesia side-effects from FGAs? What is their class?
VMAT2 inhibitors: Valbenazine + Deutetrabenazine
In general, what is the MOA of second generation antipsychotics?
Blockage of D2 post-synaptic receptors and 5HT2A receptors.
What are the 4 broad categories of SGAs based on their MOA?
Which suffices are associated with each class?
- 5HT-2A/DA receptor antagonists: -idone
- Partial DA/5HT-1A receptor agonists: -piprazole
- Multi-acting receptor-target agents: -apine
- Inverse serotonin agonist/antagonist: Pimavanserin
Under what condition should you use Pimavanserin?
In a patient with Parkinson’s disease
Which 2 broad categories of SGAs can Cariprazine fit into?
5HT-2A/DA receptor antagonists + Partial DA/5HT-1A receptor agonists
What are side-effects of SGAs?
Weight gain
DM/insulin resistance
CVD/dyslipidemia
QTC prolongation/ECG changes (greater risk for women, elderly and those on anti-arrhythmics)
Stroke (class warning)
What is a unique and rare side-effect of Clozapine?
Agranulocytosis - monitor WBC; REMS program
What is a unique and rare side-effect of Olanzapine?
Drug reaction w/ eosinophilia and systemic symptoms (DRESS)
What is Neuroleptic Malignant Syndrome?
In which meds can it be seen?
What is the antidote for it?
Rare, but potentially-fatal, severe Parkinson’s-like movement disorder w/ widespread muscle contraction.
SGAs
Dantrolene
Baseline levels of which labs/vitals/etc. are monitored when taking SGAs? (5)
Serum Glc Lipids Weight (BMI) Waist circumference Personal/family history of metabolic and CV disease
What is the drug combo for treating Psychotic depression?
Olanzapine/Fluoxetine
What is the drug combo for Mania w/ psychotic features?
Li+/anticonvulsant
What is given in a patient with acute agitation?
Injectable (IR) and ODT or SL versions
Which drugs is used if there is multi-drug resistance and/or Psychotic with anti-suidical thoughts/behaviors?
Clozapine
With which meds can help manage adherence? (4)
Long-acting injectable agents (LAIAs) every 2-12 wks.
Risperidone
Olanzapine
Aripiprazole lauroxil
Paliperidone palmitate
