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NMSP Exam 3 > Antipsychotics- Segars > Flashcards

Antipsychotics- Segars Flashcards

1
Q

what antipsychotic drug do you use for recurrent suicidal behavior

A

clozapine

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2
Q

what antipsychotic do you use for Parkinson disease psychosis

A

Pimavenserin

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3
Q

what is the Schizophrenia hypothesis

A

there is direct overstimulation go D2 leading to increased dopamine

there is indirect overstimulation of dopamine through increase serotonin

there is decreased NMDA and GABA which leads to increase Dopamine (usually GABA will inhibit dopamine)

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4
Q

positive symptoms of schizophrenia are associated with what pathway

A

mesolimbic pathway

VTA to the NA (nucleus accumbens)

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5
Q

negative symptoms of schizophrenia are associated with what pathway ?

A

mesocortical pathway

VTA to cortex

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6
Q

positive symptoms of schizophrenia

A

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

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7
Q

negative symptoms of schizophrenia

A

apathy, cognitive deficits, social withdrawal

*harder to treat

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8
Q

D1,5 “G protein”

A

stimulatory

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9
Q

D2,3,4. “G protein”

A

inhibitory

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10
Q

dopamine effects on the nigrostriatal pathways lead to?

A

stimulation of purposeful movement/EPS

antispychotics increase dopamine where it is lacking and also where it is already abundant (non selectivE)

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11
Q

dopamine effects in the tuberinfundibular pathway leads to

A

prolactin release

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12
Q

first generation antipsychotics

A

Chloropromazine
Fluphenanzine
Thioridazine
Trifluoperazine
Haloperidol
Loxapine
Molindone
Pimozide
Thiothiexene

-zine, Haloperidol and then the rest

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13
Q

what is the primary difference between 1st and 2nd generation antipsychotics

A

reduced movement disorders (EPS) in 2nd gens

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14
Q

the first generation antipsychotics primarily block the _ post synaptic receptors

A

dopamine D2

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15
Q

the first generation antipsychotics along with blocking the dopamine receptors also blocks what other receptors?

A

muscarinic (anticholinergic)

alpha adrenergic (a1)

histamine (H1)

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16
Q

muscarinic blockade effects from 1st gen antipsychotics

A

(anti cholingeric)

-dry mouth
-contipation
-urinary retention
-blurred vision
-sedation

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17
Q

alpha adrenergic blockade effects from 1st gen antipsychotics

A

orthostatic hypotension
dizziness/syncope

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18
Q

histamine blockade effects from 1st gen antipsychotics

A

sedation

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19
Q

what are some other side effects 1st generation antipsychotics can cause

A

QTc prolongation and seizure activity

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20
Q

EPS symptoms when taking 1st generation antipsychotics occurs when the D2 receptors have reach _ percent occupancy

A

78

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21
Q

low potency first generation antipsychotics cause more sedation, hypotension, tachycardia, and ECG changes

what are the low potency 1st gens?

A

chlorpromazine
thioridazine

22
Q

which low potent antipsychotic is associated with tornadoes de points and sudden death

A

thioridazine

23
Q

high potency 1st generation antipsychotics cause more movement EPS and prolactin disorder

which drugs are high potency

A

fluphenazine and haloperidol

24
Q

what are the dopamine associated side effects of first generation antipsychotics

A

Acute Extrapyramidal symptoms
Tardive dyskinesia

25
Q

what are the 3 EPS types

A

dystonia
akathisia
Parkinsonism

26
Q

what is dystonia and how can you treat it

A

sustained muscle contraction

Benztropine, diphenhydramine, trihexphenidyl (all anticholinergic)

27
Q

what is Akathisia and how cause you treat it

A

constant movements

with the 3 B’s

benztropine, beta blocker, benzodiazepam

28
Q

what is Parkinsonism and how can you treat it

A

tremor/rigidity/bradykinesia

Benzotropine or amantadine

29
Q

what is tardive dyskinesia and how can you treat it

A

repetitive uncontrollable movements

valbenazine, deutetrabenazine

30
Q

hypereprolcatinmia is a side effect of first generation antipsychotic drugs what is the presentation

A

amenorrhea, galactorrhea, gynecomastia, decreased libido

31
Q

second generation antipsychotics not only block dopamine type 2 receptors by they also block _

A

5HT2a (more blockage here at serotonin)

32
Q

5HT1,5 G proteins

A

Gi

33
Q

5HT2 g proteins

A

Gq

34
Q

5HT467

A

Gs

35
Q

what are the second generation antipsychotics

A

-idone
-piprazole
-apine
Primavanserin
Cariprazine
Lumateperone

36
Q

what are some of the side effects of 2nd gen antipsychotics

A

diabetes, weight gain, insulin resistance, hyperglycemia, CVD, dylipidemia

37
Q

what labs should you get at baseline and monitor when you put a patient on a second generation antipsychotic

A

weight/BMI
fasting/plasma glucose
lipids
blood pressure

38
Q

which antipsychotics cause the most weight gain

A

clozapine and olanzapine

39
Q

which antipsychotics causes the most metabolic effects

A

clozapine and olanzapine

40
Q

which antipsychotic causes the most QTc prolongation

A

ziprasidone

41
Q

there is a greater risk of _ in elderly patients with dementia that are put on antipsychotics

A

stroke

42
Q

what are some of the monitoring tools for measuring side effects in antipsychotic drugs

A

AIMS, GASS

(probably not on test)

43
Q

which second generation antipsychotic should you monitor WBC count because of its associated risk of agranulocytosis

A

clozapine (REMS)

44
Q

which second generation antipsychotic should you monitor for seizures

A

clozapine

45
Q

what is a rare but potentially fatal severe Parkinson likemovemtn disorder with wide spread muscle contraction caused by antipsychotics

A

neuroleptic malignant syndrome

46
Q

what is the progression of neuroleptic malignant syndrome

A

altered mental status (mesocortical)

muscle rigitdity

increased muscle metabolism and rhabdomyolysis (Nigro-striatal)

hyperthermia (hypothalamic)

dehydration (autonomic dysfunction)

47
Q

treatment of neuroleptic malignant syndrome

A

dantrolene

blocks ryanodine receptors and stops muscle contraction from stopping calcium from entering

diazepam peripherally*** fyi

48
Q

the goal of antipsychotic treatment is to get the patient into?

A

remission

49
Q

what antipsychotics are available in an injectable form immediate release and is used in an acute setting to clam down most, behavior, affect, violence etc.

A

haloperidol , ziprasidone, olanzapine, aripiprazole

50
Q

which antipsychotic do we use for multiple drug resistant schizophrenia

A

clozapine

51
Q

adherence is critical in taking antipsychotic medication

non-adherence can be managed with long acting injectable agents?

A

ROAP

risperidone
olanzapipne
aripriprazol
paliperidone

  • can last several months

NMSP Exam 3 (11 decks)

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