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IPAP 21-2 Soph Semester > Antipsychotics BLOCK III > Flashcards

Antipsychotics BLOCK III Flashcards

1
Q

What is psychosis

A

general term that describes several mental disorders characterized by a defect of lost contact with reality often with hallucinations or delusions

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2
Q

What defines schizophrenia

A

Schizophrenia: thought disorder characterized by a mix of symptoms such as:

  • Hallucinations
  • Ideation
  • Reality (e.g. delusion)
  • Cognition (e.g. loose association)
  • Emotions (e.g. flat affect)
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3
Q

What is alogia

A

Inability to carry on conversation

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4
Q

What is Catatonia

A

the predominant clinical features involve disturbances in a person’s movement; may exhibit a dramatic reduction in activity, to the point that voluntary movement stops

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5
Q

What is hebephrenia

A

Disorganized

is thought to be an extreme expression of disorganization syndrome that has been hypothesized to be one feature of a 3-factor model of schizophrenia symptoms, the other factors being; 
Delusions/hallucinations (reality distortion) 
Psychomotor poverty (poor speech, lack of spontaneous movement, and blunting emotion)
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6
Q

How do 5-HT blockers effect schizophrenia

A

Increase the release of DA to alleviate negative symptoms

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7
Q

How do D2 blockers like haloperidol effect schizophrenia

A

Inhibit DA action and alleviate positive symptoms (hallucinations/ .delusions)

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8
Q

What are the primary NTs involved in Schizo DO

A

Dopamine
5-hydroxtryptamine (5HT; serotonin)
Glutamate

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9
Q

Is polypharm or monopharm preferred for schizo DOs

A

Monopharm

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10
Q

What is the APA recommendation for 1* vs 2* gen antipsychotics

A

Use an atypical antipsychotic first (less risk for EPS)

Patients who prefer or have a history of response to typical antipsychotics may first use typical antipsychotics

Response to medications is NOT immediate, maximal treatment response may take 6 months or longer to be observed

After treatment response observed; maintain current therapy for a minimum of 6 months

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11
Q

What are the 7 clinical uses of Antipsychotics

A

Antiemetic (Typicals)

Stop Hiccups (Chlorpromazine)

Adjunct Pain Control (off label)

Depression (off label)

Rapid acting Formulations
( acute agitated and disruptive behavior)

Long acting Formulations ( used in pts that lack compliance)

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12
Q

Define EPS

A

-Dystonia: abnormal tonicity; severe muscle spasm of the head, neck and tongue

-Tardive Dyskinesia (may not be reversible)
Syndrome of involuntary movements of the face, mouth, tongue, trunk and limbs
Occurs in prolonged therapy with drugs that have a high affinity for the D2 receptor (i.e. haloperidol)

-Akathesia (most common EPS)
Desire to be in constant motion (inability to sit still, pacing).
May include feeling of fright, rage, suicide.
Can be confused with anxiety or exacerbation of psychosis

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13
Q

How do we tx EPS

A

Low dose propranolol and reduce dose of antipsychotics

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14
Q

What is the black box label for antipsychotics

A

Black Box Warning: increase mortality in elderly patients with dementia-related psychosis

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15
Q

What is the MOA of 1* gen Antipsychotics

A

Competitive blockers of dopamine receptors D2 in the mesolimbic pathway

Also have activity at histamine, muscarinic, and alpha-receptors

Relatively less effective at controlling the negative symptoms of schizophrenia

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16
Q

How do we treat psuedo Parkinson’s ( drug induced)

A

Reduce dose
Use an Atypical (2* gen)
Anticholinergic: Trihexyphenidyl or Benzotropine
Antihistamine: diphenhydramine

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17
Q

What are the ADE of 1* gen antipsychotics

A 
QT prolongation 
Negative/ cognitive s/s 
Weight gain 
Postural HOTN 
Anticholinergic Fx 
Sedation
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18
Q

What is the most severe ADE of 1* gen antipsychotics

A

Nueroleptic Malignant Syndrome

Occurs in all agents, but more common with high-potency typical drugs

Symptoms: agitation, confusion, changing levels of consciousness, fever, tachycardia, hypertension, and sweating

Most severe adverse drug event; mortality rate is high and it should be taken seriously

Discontinue the offending agent and provide supportive therapy

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19
Q

What is the relationship of dopamine to prolactin

A

Dopamine is the major prolactin inhibiting factor so blocking dopamine results in prolactin elevation

Symptoms:
Women: galactorrhea and menstrual irregularities
Men: gynecomastia, sexual dysfunction and decreased fertility

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20
Q

What are the low potency 1* gen antipsychotics

A

Chlorpromazine and Thioridazine

Lower affinity for dopamine receptors; thus less risk of causing EPS

Possess anticholinergic, antihistaminic, and α-adrenergic blocking properties

Higher rates of sedative, anticholinergic and autonomic adverse effects

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21
Q

What are the high potency 1* gen antipsychotics

A

Trifluoperazine
Fluphenazine
Haloperidol

High affinity for the dopamine receptors; thus higher rates of extrapyramidal symptoms (EPS)

Less potency at the other receptors

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22
Q

What antipsychotic Tx hiccups

A

Chlorpromazine

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23
Q

When using chlorpromazine for hiccups, what is the ADE associated with this drug

A

May cause pigment deposits on the retina and corneal opacity

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24
Q

What are the ADE of Thioridazine

A

High anti-cholinergic side effects

Highest occurrence of sedation

Black Box Warning: Torsade’s de pointes and sudden death

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25
Q

What is the preferred agent for non-psychotic anxiety

A

BZDs

26
Q

What is the clin use of Trifluoperazine

A

Generalized non-psychotic anxiety

27
Q

For psychotic patients refusing oral medications what 1* gen med has a clinical indiaction for use

A

Fluphenazine (IM long acting)

28
Q

What is the clinical use of Haloperidol

A

Acute agitation, and Tourette’s

29
Q

What is the ADE of haloperidol

A

IV- torsades

EPS and QT elongation

30
Q

What pts can not receive haloperidol

A

Parkinson’s Disease

Severe toxic central nervous system depression

comatose states

31
Q

What is the advantage of 2* gen antipsychotics

A

Developed to reduce EPS, tardive dyskinesia and improve efficacy

32
Q

What is metabolic syndrome

A

Occurs with 2* gen antipsychotics

Weight Gain: check waist circumference at baseline and periodically

Hypertension

Hyperglycemia and/or diabetes mellitus

Lipid abnormalities

33
Q

How do antipsychotics effect the SZR threshold

A

Lowers the SZR threshold

Increases risk of SZR

34
Q

Which 2* gen antipsychotic has the most wt gain, which has the least

A

Clozapine and Olanzapine have the most

Lurasidone has the least

35
Q

Which 2* gen antipsychotics have the most hyperglycemia and DM S/s

A

Clozapine and olanzapine have the most

Lurasidone has the least

36
Q

Which 2* gen antipsychotics have the most Lipid abnormalities S/s, which have the least

A

Clozapine and Olanzapine have the most

Lurasidone has the least s

37
Q

What is the oldest atypical agent, the most effective and is reserved for pts who are resistant to other antipsychotics

A

Clozapine

38
Q

What is the only atypical agent indicated to reduce RSK of SI

A

Clozapine

39
Q

What is the ADE of Clozapine

A

Black Box Warning: Agranulocytosis

A reduction in WBC and it increases the risk of serious or fatal infections

Contraindicated if the WBC is <3,500/mm3

Highest during the first 4-6 months of therapy

Monitoring: weekly CBC for first 6 months then every 2 weeks after that while taking the drug

40
Q

Does Clozapine effect prolactin levels

A

NO

41
Q

What is the difference between Olanzapine and clozapine

A

Olazpaine:
Structurally similar to clozapine and has similar pharmacology
Not associated with agranulocytosis

42
Q

Olanzapine can be used as an adjunct with what SSRI in the Tx of depression

A

Fluoxetine

43
Q

What is the ADE of Olanzapine

A

Excessive weight gain, sedation, and hypotension compared to the other atypical agents

44
Q

IV/IM formulations of olanzapine have what risk

A

IV/IM formulations have a significant risk for respiratory depression; monitor for at least 3 hours post dose

45
Q

What is the clinical use of Risperidone

A

Schizophrenia acute psychosis and prevention

Bipolar mania and maintenance therapy

More effective at combating the positive symptoms

Commonly used in children 10-17yo for psychiatric and behavioral disorders

46
Q

What 2* gen antipsychotics is commonly used in children 10-17 y/o for psych and behavior DO

A

Risperidone

47
Q

What 2* gen antipsychotics has the most interacting with prolactin levels

A

Risperidone

48
Q

Which 2* gen antipsychotic has the highest EPS RSK

A

Risperidone

49
Q

What is paliperidone

A

Active metabolite of Risperidone

Efficacy is comparable to risperdone

50
Q

Compared to risperidone, how is paliperidone better of worse with prolactin and EPS

A

Increased risk of hyperprolactinemia

Compared to risperdone, lower risk of EPS

51
Q

What is the 2* gen antipsychotic that is a good choice for psychosis with Parkinson’s Dz

A

Quetiapine

52
Q

What is the ADE of quetiapine

A

Very sedating (quetiapine makes you quiet)

Signifigant ortho HOTN,
May causes cataracts

53
Q

What is the clincal use of Ziprasidone

A

Tx of Bipolar disorder as monotherapy or adjunct to lithium or valproate

54
Q

What are the ADE of Iloperidone, a drug used to treat schizophrenia only

A

Higher risk of orthostatic hypotension and QTc prolongation

Esophageal dysmotility/aspiration

55
Q

What can you use Lurasidone for

A

Schizophrenia and bipolar only

56
Q

What is the route for admin for lurasidone

A

Oral

57
Q

How should pts in acute agitation and psychosis be handled

A

Perform the least offensive or least aggressive things possible to terminate the emergency
Talk the patient down, offer them food or drink, or offer them oral medication (lurasidone)

58
Q

How should parenteral pharmolocolgy be managed

A

When very rapid control of agitation is required

Oral treatment is not tolerable

IM or IV injections, then transition patient to oral medication with 24hrs if feasible

59
Q

Are antipsychotics contraindicated in pregnancy

A

NO

60
Q

What is the risk of antipsychotics to mothers/ newborns

A

Potential risk for EPS signs and withdrawal symptoms in newborns whose mothers were treated with antipsychotics during the 3rd trimester

IPAP 21-2 Soph Semester (20 decks)

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