Antipsychotics (Segars) Flashcards
main difference between 1st gen agents (conventional/typical) vs 2nd gen agents (novel/atypical)? BIG STAR
Reduction in movement-disorder Side effects
chlorpromazine, fluphenazine, haloperidol, thioridazine, and thiothexine are __ antipsychotics
1st gen/conventional/typical
aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone are __ antipsychotics
2nd gen/novel/atypical
if an antipsychotic end in -AZINE, it is a __ generation
if an antipsychotic ends in -PIPRAZOLE, -APINE, or -IDONE, it is a __ generation
1st
2nd
recurrent suicidal behavior can be tx with __
clozapine (2nd gen)
__ antagonists reduce positive symptoms of schizophrenia (hallucinations, delusions, disorganized speech/thinking, agitation, abnormal motor behavior)
D2
2 dopamine pathways relevant to schizophrenia symptoms?
Mesolimbic –> overactivity –> positive symptoms
Mesocortical –> dysfunction –> negative and cognitive symptoms
D2 antagonism of Nigrostriatal pathway induces __ symptoms
extrapyramidal
D2 antagonism effects on prolactin levels?
increases prolactin levels
the FGA’s primarily block __ receptors
D2 post-synaptic
block D2»_space; 5HT2
other receptors that FGAs also block (with varying potencies)?
Muscarinic –> anti-cholinergic SE’s
H1 receptors –> Sedation SE
a1 receptors –> Orthostatic hypotension, dizziness/syncope SE’s
D2 in nigrostriatal (movements) and tuberoinfundibular (prolactin)
can get risk of QTc prolongation and seizure activity
Treatment for acute dystonia/akathisia/dyskinesia/parkinsonism-like SEs from using FGA’s? BIG STAR
Anticholingeric agents: Diphenhydramine (benadryl), benztropine (cogentin), and trihexyphenidyl
what are the high potency FGAs that cause more movement (EPS) and endocrine effects (prolactin)?
Fluphenazine
Haloperidol
Thiothixene
SGA’s block what receptors?
D2 post-synaptic AND 5HT2a
5-HT2a»_space; D2
what is the dual 5-HT2a/D2 theory?
5-HT2a antagonism increases DA transmission in nigrostriatal pathway –> may contribute to improved negative and cognitive symptoms via increased DA release in PFC, reduced EP SE’s
This SGA is a D2 partial agonist, aids in dysregulation in mesocortical pathway
Aripiprazole
common SEs of SGAs?
Common:
weight gain
metabolic –> hyperglycemia/insulin resistance, hyperlipidemia
Rare: QTc prolongation Stroke --> greater risk in elderly w/dementia (class warning)
which gen more associated with +++ weight gain? which drugs?
2nd gen –> Clozapine and Olanzapine
Aripiprazole and Ziprasidone not associated with weight gain as 2nd gen drugs
which gen more associated with hypercholesterolemia? which drugs?
2nd gen –> Clozapine, Olanzapine
Aripiprazole and Ziprasidone less associated with hypercholesteremia as 2nd gen drugs
which gen more associated with EPS/tardive dyskinesia? drugs?
1st gen –> fluphenazine, haloperidol, and thiothixene
chlorpromazine and thioridazine less associated as 1st ten drugs
which gen more associated with prolactin elevation? drugs?
1st gen –> fluphenazine, haloperidol, thioridazine
which gen more associated with sedation?
1st gen –> chlorpromazine and thioridazine
which gen more associated with anticholinergic side effects? drugs?
1st gen –> Thioridazine and chlorpromazine
which gen more associated with orthostatic hypotension? drugs?
more so 1st gen –> thioridazine and chlorpromazine
2nd gen –> clozapine
which 1st gen associated with QTc prolongation? 2nd gen?
1st –> thioridazine
2nd –> ziprasidone
which 2nd gen drug to avoid weight gain and DM?
Ziprasidone and then aripiprazole
which 2nd gen drug to avoid hypercholesterolemia?
Ziprasidone and then aripiprazole
which 1st gen drug less likely to cause EPS/tardive dyskinesia?
chlorpromazine
which 2nd gen drug likely to have anticholinergic side effects?
clozapine
which 1st gen drugs to avoid orthostatic hypotension?
fluphenazine and haloperidol
which SGA do you want to monitor WBC and REMS program d/t agranulocytosis?
Clozapine
tx for neuroleptic malignant syndrome (rare but severe antipsychotic drug SE)?
dantrolene
what assessment parameter to monitor in ALL pts on SGA’s? BIG STAR
Serum glucose lipids weight (BMI) BP When possible --> waist circumference, personal hx, FH of metabolic and CV disease
which agents more commonly recommended and utilized at 1st line, initial therapy?
atypical agents (2nd gen)
how to manage non-adherence tx of psychotic disorders? BIG STAR
long-acting injectable agents (LAIAs) every 2-12 wks, depending on agent, dose, pt factors
1st gen –> haloperidol decanoate and fluphenazine decanoate
2nd gen –> risperidone, olanzapine, aripiprazole lauroxil, and paliperidone palmitate
which drug to use for multi-drug resistant disease and/or psychotic with anti-suicidal thoughts/behaviors?
clozapine
which 2nd gen drug to use to avoid galactorrhea?
aripiprazole
avoid risperidone
