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Block 8; Week 6-M > Antipsychotics-Kirkpatrick > Flashcards

Antipsychotics-Kirkpatrick Flashcards

1
Q

What are the appropriate uses of antipsychotics?

A 
psychosis
non-psychotic mania
autism
adjunct to antidepressants
sometimes dementia w/ mood & behavioral issues (2nd or 3rd line)
delirium (2nd or 3rd line)
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2
Q

What is the MOA of antipsychotics used to treat schizophrenia?

A

dopamine antagonists
one partial dopamine agonist–works same way tho
variable responses for patients

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3
Q

In double-blind studies, psychotic symptoms have a transient increase with infusion of low doses of:

A

Ketamine (an NMDA antagonist)
MCPP (a sertonin antagonist)
Cannabis

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4
Q

What are some important dopamine pathways?

A

Mesocorticolimbic
**Antipsychotic efficacy
Nigrostrital
**Extrapyramidal side effects

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5
Q

What are commonly used 1st gen antipsychotics? aka typical antipsychotics aka neuroleptics

A

fluphenazine–Prolixin
perphenazine–Trilafon
trifluoperazine–stelazine
haloperiodol–haldol

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6
Q

What are the 2nd gen drugs aka atypical antipsychotics?

A 
aripiprazole 		(Abilify *)
olanzapine		(Zyprexa *)
quetiapine 		(Seroquel) 
risperidone		(Risperdal *)
ziprasidone 		(Geodon) 
iloperidone		(Fanapt)
asenapine 		(Saphris)
Paliperidone 		(Invega *)
Lurasidone		(Latuda)
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7
Q

Which of the 2nd gen drugs are a dopamine partial agonist?

A

aripiprazole–abilify!

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8
Q

What are the most commonly used 2nd gen antipsychotics?

A

aripiprazole-abilify
olanzapine-zyprexa
quetiapine-Seroquel
risperidone-risperdal
ziprasidone-geodon
**depot formulation & have to monitor in clinic for several hours
exists for ability, zyprexa, risperdal, invega

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9
Q

T/FAll of the 2nd generation drugs have superior efficacy, especially for negative symptoms

A

False

No established superiority for negative symptoms
Improvement in neg sx is due to improvement in other psychiatric symptoms and/or motor side effects

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10
Q

T/F 2nd generation drugs have no risk of extrapyramidal side effects.

A

False.

varies by drug & dose-related

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11
Q

T/F If a patient’s psychotic symptoms haven’t responded you should raise the dose
If a patient has particularly severe psychotic symptoms, he or she needs a higher dose

A

False

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12
Q

T/F If a patient has symptoms in the grey zone between odd experiences and clearcut psychosis, you should give a lower dose than usual

A

False.

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13
Q

What is an important thing to keep in mind w/ the shared dose-response curve for antipsychotics?

A

they all plateau!

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14
Q

What are the 3 efficacy groups for antipsychotics?

A
  1. clozapine
  2. risperidone & olanzapine
  3. all other antipsychotics
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15
Q

If clozapine is in the #1 efficacy group, why don’t more people prescribe it?

A

b/c it has greater side effects

& many people it does nothing for them.

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16
Q

What are the side effects of 1st gen drugs?

A

extrapyramidal side effects
orthostatic hypotension
liver problems
neuroleptic malignant syndrome

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17
Q

What are the side effects of 2nd gen drugs?

A

Primary: weight gain, diabetes

sometimes–extrapyramidal side effects

18
Q

Which drugs have extrapyramidal side effects sometimes–2nd gen?

A

risperidone
geodon–akathisia
abilify-akathisia

19
Q

What is the side effect profile of clozapine?

A 
agranulocytosis--get blood drawn to check, reversible
sustained tachycardia
weight gain
orthostatic hypotension
hypersalivation
sedation
20
Q

What are extrapyramidal side effects?

A 
Rigidity 
Tremor 
Bradykinesia 
Hypersalivation
Neuroleptic malignant syndrome 
Akathisia
21
Q

How do you treat extrapyramidal side effects? Except akathisia

A

decrease dose
change medication
anticholinergic drugs: diphenhydramine (benadryl), trihexiphenidyl (artane), benzotropine (cogentin)
amantadine

22
Q

How do you treat akathisia?

A

beta blockers-propranolol
high doses of VIt B6
maybe clonazepam
anticholinergics don’t help

23
Q

What’s the deal with discontinuation of antipsychotics?

A

74% discontinued w/i 18 mo

b/c of side effects, inadequate symptoms control, or other reasons

24
Q

Although olanzapine is in class 2 efficacy, what is a bad thing about it?

A

weight gain! 2nd most weight-gain causing drug.
**efficacy-weight gain trade off with 2nd gen antipsychotics
1st gen-EPS trade off!

25
Q

What is the extrapyramidal side effect of tar dive dyskinesia?

A

writhing or jerky movements
syndrome of involuntary choreo-athetoid movements
1st ten drugs have more likelihood of causing this, also dose-related
akathesia may be a precursor to this
male & African American risk factors

26
Q

Why are many people with schizophrenia overweight?

A

iatrogenic b/c of antipsychotic side effects

naturally thin

27
Q

What do you do with treatment of weight gain w/ antipsychotic meds?

A

exercise
nutritional counseling
metformin
consider decreasing dose or changing medication

28
Q

Weight gain is probably caused by lack of specificity of antipsychotics, binding which receptor?

A

histamine-H1

**also causes sedation & dizziness

29
Q

When D2 is bound…what are the side effects?

A

EPS

prolactin elevation

30
Q

When M1 is bound…what are the side effects?

A 
cognitive deficits
dry mouth
constipation
increased heart rate
urinary retention
blurred vision
31
Q

IF alpha 1 is bound…SE?

A

hypotension

32
Q

What is a QT prolongation?

A

Electrical depolarization & repolarization of the ventricles

Increased interval a risk factor for
ventricular tachyarrhythmias
especially torsades de pointes (“twisting of the spikes”)
sudden death

**a side effect of some antipsychotics

33
Q

QT interval is normal based off of heart rate. Normal is roughly ____. What is considered a risk for sudden death in males & females?

A 
Normal: ≤400 ms (some disagreement) 
Risk of sudden death: 
Borderline for males:     431-450
Abnormal for males:      < 450 
Borderline for females:  451 – 470 
Abnormal for females:   > 470
34
Q

What are some additional risk factors or increased QTc?

A 
Hypokalemia 
Hypomagnesemia 
Hypocalcemia 
Hypothermia 
Hep C 
HIV 
Myocardial ischemia 
Post-cardiac arrest
Increased intracranial pressure 
Congenital long QT syndrome
Medications
35
Q

What are some medications that can cause increased QT interval?

A 
Amisulpride
Clozapine
Fluphenazine
Haloperidol
Olanzapine
Perphenazine
Quetiapine
Risperidone 
Thioridazine 
Ziprasidone

4 ms for risperidone
30 ms for thioridazine

36
Q

What can be some difficult features of dementia?

A

psychosis, agitation, suspiciousness, irritability are common
**frequently treated with antipsychotics & benzos
Good treatment: psychosocial intervention

37
Q

If you treat dementia with benzos…what might happen?

A

increased confusion

falls! b/c of sedation. could lead to death in an older person.

38
Q

What is the black box warning of every antipsychotic?

A

increased mortality in elderly patients with dementia related psychosis

39
Q

what is an alternative to antipsychotics to treat dementia patients?

A

citalopram

**may not work in patients with vascular dementia

40
Q

Focus on which drugs?

A

haloperidol (haldol)
top 5 2nd gen
abilify-different MOA partial dopamine agonist. still stops dopaminergic transmission
know EPS symptoms
weight gain w/ clozapine & olanzapine
keep in mind agranulocytosis possible w/ clozapine

41
Q

What is the categorization of clozapine?

A

2nd gen antipsychotics

Block 8; Week 6-M (13 decks)

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