Antipsychotics Jeopardy Flashcards
Not only was this drug the first antipsychotic, it was the first psychotropic medication of any kind.
Chlorpromazine (Thorazine)
Typical antipsychotics are divided into these two categories which also correlates to their D2 receptor’s binding affinity
High potency and low potency
This typical antipsychotic is available PO, IM, and IV, is commonly used to treat agitated patients in hospitals/ER’s, and can be used to treat Tourette’s syndrome.
Haloperidol (Haldol)
Three anticholinergic meds commonly used to counter extrapyramidal side-effects (EPS) are: trihexyphenidyl (Artane), benztropine (Cogentin), & this medication
Diphenhydramine (Benadryl)
When used in their long-acting injectable form, these 2 FGA’s are given IM every 2-4 weeks to treat pts w/ chronic schizophrenia.
- Haloperidol (Haldol)
- Fluphenazine (Prolixin)
This type of typical antipsychotic is anti-cholinergic, anti-histaminic, & an α1 adrenergic antagonist.
Low potency antipsychotic
- Chlorpromazine (thorazine)
While prochlorperazine (Compazine) is a D2 blocker, it is more commonly used for this than its antipsychotic properties.
Antiemetic properties
This antipsychotic can also be used to treat intractable hiccups.
Chlorpromazine (Thorazine)
This typical antipsychotic has the greatest risk of any antipsychotic for dose dependent QTc prolongation, torsades de pointes, and cardiotoxicity
Thioridazine (Mellaril)
Even though its the most efficacious antipsychotic, its side effect profile prevents this drug from consideration for first line use.
Clozapine (Clozaril)
This atypical antipsychotic is used to treat psychosis in Lewy Body Dementia & Parkinson’s Disease due to its low likelihood of EPS.
Quetiapine (Seroquel)
These 2 atypicals are available in a long acting injectable form and have the highest risk among atypicals of causing prolactin elevation.
- Risperidone (Risperdal)
- Paliperidone (Invega)
These two atypicals are most likely to cause side effects of significant sedation and the metabolic syndrome.
- Olanzapine (Zyprexa)
- Clozapine (Clozaril)
Of all the SGA’s, this med has the highest risk of causing
QTc prolongation.
Ziprasidone (Geodon)
This SGA is a partial dopamine agonist & commonly has the side effect akathisia.
Aripiprazole (Abilify)
This atypical is FDA approved for adjunct treatment of MDD.
Aripiprazole (Abilify)
Due to the risk of seizure induction, slow dose titration must be done for this atypical antipsychotic.
Clozapine (Clozaril)
Lurasidone (Latuda), asenapine (Saphris) & these two SGA’s are the most metabolically “neutral”.
- Ziprasidone (Geodon)
- Aripiprazole (Abilify)
More common with typical antipsychotics, this side effect is characterized by repetitive, involuntary, purposeless
movements.
Tardive dyskinesia
For a pt taking Clozapine (Clozaril), this is done when the WBC is <2,000 or the ANC is <1,000.
Abrupt stop (abrupt stop → rebound psychosis; do gradual taper when possible)
Due to the risk of metabolic syndrome, pts on atypicals should have their weight, waist circumference, and these 2 labs monitored regularly.
- Glucose
- Lipids
The picture shows a pt experiencing this EPS side
effect. (Neck tilted towards shoulder)
Dystonia
Clozapine (Clozaril), quetiapine (Seroquel), iloperidone (Fanapt), risperidone (Risperdal) paliperidone (Invega)
may all cause dose dependent orthostatic hypotension due to this.
α1 adrenergic antagonism
- Undesirable in elderly pts & pts at risk for falls
There is a blackbox warning for the use of antipsychotics in elderly dementia patients due to increased risk of this.
Sudden death (CV cause)
The antipsychotic side effect seen in this pt is this (eyes looking upward and towards midline, asymmetrically)
Oculogyric crisis
What is the MoA behind gynecomastia in pts taking D2-receptor blockers?
Hyperprolactinemia
This atypical may cause dry mouth due to its anticholinergic properties, but ironically it may also cause excess salivation.
Clozapine (Clozaril)
SGA’s work primary by blocking these 2 receptors.
D2 receptor
5HT2A receptor
The positive sx of schizophrenia are due to hyperactivity of what dopamine tract?
Mesolimbic pathway
Excess blockade of this dopamine tract may cause infertility, galactorrhea, and osteopenia.
Tubuloinfundibular pathway
When switching to aripiprazole (Abilify) from a different antipsychotic, before the other antipsychotic has washed out, the aripiprazole (abilify)—at least in theory— initially does this at the D2 receptors.
Act as a dopamine agonist
- When switching to abilify, need to switch slowly or
have a washout period
The % of D2 occupancy necessary for the antipsychotic effect is this.
60%
This % of occupancy at D2 is believed to be associated with elevated prolactin and/or EPS.
80%
While NMS is uncommon to rare (incident rate 0.02-3%), its
cause is this.
Dopamine antagonism
Hypoactivity of this dopamine tract is believed to be a/w the development of negative sx.
Mesocortical pathway
The SGA with the unique MoA of partial dopamine agonism is this.
Aripiprazole (Abilify)
Prochlorperazine (Compazine) Metoclopramide (Reglan)
Droperidol (Inapsine) Promethazine (Phenergan)
This antiemetic medication(s) is/are a D2 blocker(s) and may cause EPS or tardive dyskinesia (TD).
All
About 75% of pts with schizophrenia do this unhealthy activity which also induces increased metabolism of antipsychotic meds.
Cigarette smoking
While not diagnostic for NMS
(it may be nl if there is not clearly well developed rigidity), this lab’s degree of abnormality correlates with the disease severity and prognosis.
Creatine kinase
Antipsychotics approved for the treatment of bipolar depression are olanzapine/fluoxetine (Symbyax), lurasidone (Latuda), and this.
Quetiapine (Seroquel)
This atypical has a significant risk of causing hyperprolactinemia, is the active metabolite of risperidone (Risperdal), and needs to be
taken with food.
Paliperidone (Invega)
The 4 SGA’s that are available in long acting injectable preparations are: risperidone (Risperidal Consta), olanzapine (Zyprexa Relprevv), and these two meds.
- Paliperidone (Invega Sustenna)
- Aripiprazole (Abilify Maintena)
Antipsychotic side effects of sedation and weight gain are likely due to antagonist activity at this receptor.
Histamine (H1)
Young or Elderly
Males or Females
This demographic is at the greatest risk for dystonia from antipsychotics.
Young males
While muscular rigidity, hyperthermia, and autonomic instability are all common sx of NMS, most often this symptom presents first.
Mental status changes
