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Neuro/Psych Exam 1 > Antipsychotics > Flashcards

Antipsychotics Flashcards

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1
Q

What is an indication for Clozapine?

A

Recurrent suicidal behavior

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2
Q

What is an indication for Primavanserin?

A

hallucinations/delusions associated with parkinsons disease

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3
Q

Over-activation of which system causes positive symptoms i.e. hallucinations, voices etc…

A

Mesolimbic pathway

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4
Q

What are examples of positive symptoms?

A

hallucinations, delusions, disorganized speech/thinking, agitation, abnormal motor behavior

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5
Q

What causes negative and cognitive symptoms?

A

Mesocortical pathway dysfunction

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6
Q

What are examples of negative symptoms?

A

apathy, avolition (decreased motivation), alogia (cant speak), cognitive deficits (working memory), social withdrawal

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7
Q

What is the Nigrostriatal pathway physiologically useful for?

A

stimulation of purposeful movements

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8
Q

What Drugs can effect the Nigrostriatal pathway and can cause drug induced parkinsonism?

A

First generation antipsychotics > second generation antipsychotics

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9
Q

First generation antipsychotics can cause pseudoparkinsonism by antagonizing this receptor?

A

D2 receptor

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10
Q

What is the tuberoinfundibular pathway associated with?

A

Dopamine tonically inhibits prolactin release

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11
Q

If we antagonize the D2 receptor what is the effect on prolactin levels?

A

increase

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12
Q

What side effects are seen from disruption in the nigrostriatal pathway?

A

Extra Pyramidal Symptoms and Tardive Dyskinesia

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13
Q

Are we more likely to use first gen or second gen antipsychotics first line?

A

Second generations are usually first because they have less EPS

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14
Q

How long can it take to reach maximum benefit (remission) when using antipsychotics?

A

Several months - encourage patients to be compliant

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15
Q

What is the the ending for First gen antipsychotics?

A

“-Azine”

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16
Q

(star) What is the primary difference in Side effects of first generation in comparison to second gen antipsychotics?

A

SGA have less movement disorders

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17
Q

What are the muscarinic side effects of First gen Antipsychotics?

A

dry mouth, constipation, urinary retention, blurred vision, sedation

18
Q

What are the alpha-adrenergic side effects of FGAs?

A

orthostatic hypotension, dizziness

19
Q

What are the histamine side effects of FGAs?

A

Sedation

20
Q

What is a cardiac risk factor of FGAs?

A

QT prolongation, Torsades de Pointe, and seizure activity

21
Q

What is an endocrine (dopamine) side effect of FGAs?

A

Hyperprolactinemia

22
Q

What are the side effects of Hyperprolactinemia?

A

F - amenorrhea, galactorrhea. M - gynecomastia, decreased libido

23
Q

What are the dopamine side effects of FGAs specifically EPS?

A

Acute akathisia (involuntary movements), acute dystonia, parkinson like symptoms

24
Q

What are the low potency FGAs?

A

Chlorpromazine and Thioridazine

25
Q

What are the High potency FGAs?

A

Fluphenazine, Haloperidol

26
Q

(star) What are two treatments for Tardive Dyskinesia? and what is their MOA?

A

Valbenazine, deutetrabenazine

MOA - VMAT2 inhibitor

27
Q

(star) What are the two treatments for EPS specifically the anticholinergic agents?

A

Benztropine and Trihexyphenidyl

28
Q

(star) What is the treatment for EPS specifically the antihistamine agents?

A

Diphenhydramine

29
Q

SGAs like FGAs block the D2 receptor but they also block this receptor?

A

5HT2A receptor - stronger than their D2 effect

30
Q

What are common side effects of SGAs?

A

Weight gain, hyperglycemia, hyperlipidemia

31
Q

What is a rare but serious side effect associated with Clozapine?

A

Agranulocytosis

32
Q

What is a rare side effect of Olanzapine?

A

DRESS - Drug reaction w/ eosinophilia and systemic symptoms

33
Q

What is Neuroleptic malignant syndrome?

A

Rare but potentially fatal, severe parkinsons like movement disorder caused by FGAs > SGAs

34
Q

What are the side effects of NMS?

A

muscle rigidity (lead pipe), Rhabdomyolysis, increased muscle metabolism, hyperthermia, dehydration

35
Q

What is the treatment for NMS? hint: it is the same for malignant hyperthermia caused by anesthetics…

A

Dantrolene - Ryanodine receptor antagonist

36
Q

(star) What are the guidelines for all patients as it relates to baseline items we must get before giving an antipsychotic?

A

Serum glucose, lipids, weight (BMI), BP, Waist circumference, personal/Family history of metabolic and CV disease

37
Q

Which SGAs has a similar risk for prolactin elevation as high dose FGAs?

A

Risperidone

38
Q

Which antipsychotic agent has the highest risk for orthostatic hypotension?

A

Thioridazine

39
Q

(star) What drugs can be used to manage non-adherence/non-compiance of antipsychotics?

A

LAIAs - Long-Acting Injectable Agents

40
Q

(star) What are the LAIAs that we need to know for the exam?

A

Risperidone, Olanzapine, Aripiprazole lauroxil, (Paliperidone palmitate - dont need to know this one) but it makes the mnemonic ROAP

Neuro/Psych Exam 1 (21 decks)

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