Antipsychotics Flashcards
What is an indication for Clozapine?
Recurrent suicidal behavior
What is an indication for Primavanserin?
hallucinations/delusions associated with parkinsons disease
Over-activation of which system causes positive symptoms i.e. hallucinations, voices etc…
Mesolimbic pathway
What are examples of positive symptoms?
hallucinations, delusions, disorganized speech/thinking, agitation, abnormal motor behavior
What causes negative and cognitive symptoms?
Mesocortical pathway dysfunction
What are examples of negative symptoms?
apathy, avolition (decreased motivation), alogia (cant speak), cognitive deficits (working memory), social withdrawal
What is the Nigrostriatal pathway physiologically useful for?
stimulation of purposeful movements
What Drugs can effect the Nigrostriatal pathway and can cause drug induced parkinsonism?
First generation antipsychotics > second generation antipsychotics
First generation antipsychotics can cause pseudoparkinsonism by antagonizing this receptor?
D2 receptor
What is the tuberoinfundibular pathway associated with?
Dopamine tonically inhibits prolactin release
If we antagonize the D2 receptor what is the effect on prolactin levels?
increase
What side effects are seen from disruption in the nigrostriatal pathway?
Extra Pyramidal Symptoms and Tardive Dyskinesia
Are we more likely to use first gen or second gen antipsychotics first line?
Second generations are usually first because they have less EPS
How long can it take to reach maximum benefit (remission) when using antipsychotics?
Several months - encourage patients to be compliant
What is the the ending for First gen antipsychotics?
“-Azine”
(star) What is the primary difference in Side effects of first generation in comparison to second gen antipsychotics?
SGA have less movement disorders
What are the muscarinic side effects of First gen Antipsychotics?
dry mouth, constipation, urinary retention, blurred vision, sedation
What are the alpha-adrenergic side effects of FGAs?
orthostatic hypotension, dizziness
What are the histamine side effects of FGAs?
Sedation
What is a cardiac risk factor of FGAs?
QT prolongation, Torsades de Pointe, and seizure activity
What is an endocrine (dopamine) side effect of FGAs?
Hyperprolactinemia
What are the side effects of Hyperprolactinemia?
F - amenorrhea, galactorrhea. M - gynecomastia, decreased libido
What are the dopamine side effects of FGAs specifically EPS?
Acute akathisia (involuntary movements), acute dystonia, parkinson like symptoms
What are the low potency FGAs?
Chlorpromazine and Thioridazine
What are the High potency FGAs?
Fluphenazine, Haloperidol
(star) What are two treatments for Tardive Dyskinesia? and what is their MOA?
Valbenazine, deutetrabenazine
MOA - VMAT2 inhibitor
(star) What are the two treatments for EPS specifically the anticholinergic agents?
Benztropine and Trihexyphenidyl
(star) What is the treatment for EPS specifically the antihistamine agents?
Diphenhydramine
SGAs like FGAs block the D2 receptor but they also block this receptor?
5HT2A receptor - stronger than their D2 effect
What are common side effects of SGAs?
Weight gain, hyperglycemia, hyperlipidemia
What is a rare but serious side effect associated with Clozapine?
Agranulocytosis
What is a rare side effect of Olanzapine?
DRESS - Drug reaction w/ eosinophilia and systemic symptoms
What is Neuroleptic malignant syndrome?
Rare but potentially fatal, severe parkinsons like movement disorder caused by FGAs > SGAs
What are the side effects of NMS?
muscle rigidity (lead pipe), Rhabdomyolysis, increased muscle metabolism, hyperthermia, dehydration
What is the treatment for NMS? hint: it is the same for malignant hyperthermia caused by anesthetics…
Dantrolene - Ryanodine receptor antagonist
(star) What are the guidelines for all patients as it relates to baseline items we must get before giving an antipsychotic?
Serum glucose, lipids, weight (BMI), BP, Waist circumference, personal/Family history of metabolic and CV disease
Which SGAs has a similar risk for prolactin elevation as high dose FGAs?
Risperidone
Which antipsychotic agent has the highest risk for orthostatic hypotension?
Thioridazine
(star) What drugs can be used to manage non-adherence/non-compiance of antipsychotics?
LAIAs - Long-Acting Injectable Agents
(star) What are the LAIAs that we need to know for the exam?
Risperidone, Olanzapine, Aripiprazole lauroxil, (Paliperidone palmitate - dont need to know this one) but it makes the mnemonic ROAP
