Antipsychotics- Segars Flashcards
what antipsychotic drug do you use for recurrent suicidal behavior
clozapine
what antipsychotic do you use for Parkinson disease psychosis
Pimavenserin
what is the Schizophrenia hypothesis
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)
positive symptoms of schizophrenia are associated with what pathway
mesolimbic pathway
VTA to the NA (nucleus accumbens)
negative symptoms of schizophrenia are associated with what pathway ?
mesocortical pathway
VTA to cortex
positive symptoms of schizophrenia
hallucinations, delusions, disorganized speech/thinking, abnormal motor behavior, agitation
negative symptoms of schizophrenia
apathy, cognitive deficits, social withdrawal
*harder to treat
D1,5 “G protein”
stimulatory
D2,3,4. “G protein”
inhibitory
dopamine effects on the nigrostriatal pathways lead to?
stimulation of purposeful movement/EPS
antispychotics increase dopamine where it is lacking and also where it is already abundant (non selectivE)
dopamine effects in the tuberinfundibular pathway leads to
prolactin release
first generation antipsychotics
Chloropromazine
Fluphenanzine
Thioridazine
Trifluoperazine
Haloperidol
Loxapine
Molindone
Pimozide
Thiothiexene
-zine, Haloperidol and then the rest
what is the primary difference between 1st and 2nd generation antipsychotics
reduced movement disorders (EPS) in 2nd gens
the first generation antipsychotics primarily block the _ post synaptic receptors
dopamine D2
the first generation antipsychotics along with blocking the dopamine receptors also blocks what other receptors?
muscarinic (anticholinergic)
alpha adrenergic (a1)
histamine (H1)
muscarinic blockade effects from 1st gen antipsychotics
(anti cholingeric)
-dry mouth
-contipation
-urinary retention
-blurred vision
-sedation
alpha adrenergic blockade effects from 1st gen antipsychotics
orthostatic hypotension
dizziness/syncope
histamine blockade effects from 1st gen antipsychotics
sedation
what are some other side effects 1st generation antipsychotics can cause
QTc prolongation and seizure activity
EPS symptoms when taking 1st generation antipsychotics occurs when the D2 receptors have reach _ percent occupancy
78
low potency first generation antipsychotics cause more sedation, hypotension, tachycardia, and ECG changes
what are the low potency 1st gens?
chlorpromazine
thioridazine
which low potent antipsychotic is associated with tornadoes de points and sudden death
thioridazine
high potency 1st generation antipsychotics cause more movement EPS and prolactin disorder
which drugs are high potency
fluphenazine and haloperidol
what are the dopamine associated side effects of first generation antipsychotics
Acute Extrapyramidal symptoms
Tardive dyskinesia
what are the 3 EPS types
dystonia
akathisia
Parkinsonism
what is dystonia and how can you treat it
sustained muscle contraction
Benztropine, diphenhydramine, trihexphenidyl (all anticholinergic)
what is Akathisia and how cause you treat it
constant movements
with the 3 B’s
benztropine, beta blocker, benzodiazepam
what is Parkinsonism and how can you treat it
tremor/rigidity/bradykinesia
Benzotropine or amantadine
what is tardive dyskinesia and how can you treat it
repetitive uncontrollable movements
valbenazine, deutetrabenazine
hypereprolcatinmia is a side effect of first generation antipsychotic drugs what is the presentation
amenorrhea, galactorrhea, gynecomastia, decreased libido
second generation antipsychotics not only block dopamine type 2 receptors by they also block _
5HT2a (more blockage here at serotonin)
5HT1,5 G proteins
Gi
5HT2 g proteins
Gq
5HT467
Gs
what are the second generation antipsychotics
-idone
-piprazole
-apine
Primavanserin
Cariprazine
Lumateperone
what are some of the side effects of 2nd gen antipsychotics
diabetes, weight gain, insulin resistance, hyperglycemia, CVD, dylipidemia
what labs should you get at baseline and monitor when you put a patient on a second generation antipsychotic
weight/BMI
fasting/plasma glucose
lipids
blood pressure
which antipsychotics cause the most weight gain
clozapine and olanzapine
which antipsychotics causes the most metabolic effects
clozapine and olanzapine
which antipsychotic causes the most QTc prolongation
ziprasidone
there is a greater risk of _ in elderly patients with dementia that are put on antipsychotics
stroke
what are some of the monitoring tools for measuring side effects in antipsychotic drugs
AIMS, GASS
(probably not on test)
which second generation antipsychotic should you monitor WBC count because of its associated risk of agranulocytosis
clozapine (REMS)
which second generation antipsychotic should you monitor for seizures
clozapine
what is a rare but potentially fatal severe Parkinson likemovemtn disorder with wide spread muscle contraction caused by antipsychotics
neuroleptic malignant syndrome
what is the progression of neuroleptic malignant syndrome
altered mental status (mesocortical)
muscle rigitdity
increased muscle metabolism and rhabdomyolysis (Nigro-striatal)
hyperthermia (hypothalamic)
dehydration (autonomic dysfunction)
treatment of neuroleptic malignant syndrome
dantrolene
blocks ryanodine receptors and stops muscle contraction from stopping calcium from entering
diazepam peripherally*** fyi
the goal of antipsychotic treatment is to get the patient into?
remission
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.
haloperidol , ziprasidone, olanzapine, aripiprazole
which antipsychotic do we use for multiple drug resistant schizophrenia
clozapine
adherence is critical in taking antipsychotic medication
non-adherence can be managed with long acting injectable agents?
ROAP
risperidone
olanzapipne
aripriprazol
paliperidone
- can last several months
