Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

First Aid for Psych Clerkship > Chapter 18: Psychopharm part 2 > Flashcards

Chapter 18: Psychopharm part 2 Flashcards

1
Q

Antipsychotics- typicals vs atypicals

A

Used to treat psychotic disorders as well as psychotic symptoms associated with other psychiatric and medical illnesses

Typical/ first-gen = neuroleptics. Classified according to potency and treat psychosis by blocking dopamine (D2) receptors.
Atypicals/ 2nd gen: block both D2 and serotonin (2A) receptors

Most have a number of actions and receptor interactions –> varied efficacy and side-effect profiles.
Both typical and atypical- similar efficacies in treating POSITIVE psychotic sympoms (hallucinations, delusions)
Atypcals- maybe better at negative symptoms
Atypicals- better side-effect profile. However, metabolic syndrome and expensive –> both classes used equally

Choice: base on pt’s presentation, past response, side-effects, patient preference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Typical (first gen) antipsychotics: low-potency

A

lower affinity for dopamine receptors; higher dose is required. Higher antiadrenergic, anticholinergic, antihistaminic side effects compared to high-potencies

lower incidence of EPS and (possibly) neuroleptic malignant syndrome
more lthality in overdose due to QTc prolongation and the potential for heart blocka nd ventricular tachycardia
Rare risk for agranulcytosis/ seizures

Chlorpromazine- orthostatic hypotension, blue-gray skin, photosensitivity. Also to treat nauseia
Thioridazine - retinitis pegmentosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Midpotency typical antipsychotics

A

Loxapine (higher risk of seizures, metabolite is an antidepressant)
Thothixene (can cause ocular pigment changes)
Molindone
Perphenazein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

High potency typical antipsychotics

A

greater affinity for dopamine receptors –> low dose needed to achieve effect
less sedation, orthostatic hypotension, anticholinergic effects
greater risk for EPS and TD

Haloperidol- can be given PO/ IM/ IV. Decanoate available
Fluphenazine- decanoate available
Trifluoperazine - approved for nonpsychotic anxiety
Pimozide - associated with QTc prolongation and ventricular tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mesolimic dopamine pathway

A

treats the positive symptoms of schizophrenia

includes the nucleus accumbens, the fornix, the amygdala, and the hippocampus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

why do negative symptoms of schizophrenia occur?

A

thought to occur due to decreased dopaminergic action in the mesocortical pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Extrapyramidal symtoms occur why?

A

through blockade of of the dopamine pathways in the nigrostriatum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Side effects of antipsychotics

A 
Antidopaminergic
Anti-HAM (histaminic, adrenergic, muscarinic)
Tardive dyskinesia
Neuroleptic malignant syndrome (less common)
Elevated liver enzymes, jaundice
Ophthalmologic problems
Dermatologic problems
Seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Extra-Pyramidal Symptoms

A

(anti-dopaminergic)
Parkinsonism- bradykinesia, masklike face, cogwheel rigidity, pill-rolling tremor
Akathisia- subjective anxiety and restlessness, objective fidgetiness. Patients may report a sensation of inability to sit still. Best treated with B-blockers or benzos.
Dystonia- sustained painful contraction of muscles of neck (torticollis), tongue, eyes (oculogyric crisis). It can be life threatening if it involves the airway or diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hyperprolactinemia –>

A 
decreased libido
glaactorrhea
gynecomastia
impotence
amenorrhea
(anti-dopaminergic effect of anti-psychotics)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anti-HAM effects of antipsychotics

A

Antihistaminic –> sedation, weight gain
Anti-alpha1 adrenergic–> orthostatic hypotension, cardiac abnormalities, sex dysfunction
antimuscarinic–> dry mouth, tachycardia, urinary retention, blurry vision, constipation, preciptation of narrow-angle glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tardive dyskinesia

A

choreoathetoid (writhing) movements of mouth and tongue (or other body parts) that may occur in patients who have used neuroleptics for > 6 months.
Older age is a risk factor
Women and patients with affective disorders may be at an increased risk
Although 50% of cases will spontaneously remit (without further antipsychotic use), most cases are permanent
Treatment- usually discontinuation of current antipsychotic if clinically possible and changing to a med with less TD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Neuroleptic malignant syndrome

A

esp in yount males in early treatment w/ high-potency typical antipsychotics
medical emergency– 20% mortality rate if untreated
Fever
Autonomic instability (tachycardia, labile hypertension, diaphoresis)
Leukocytosis
Tremor
Elevated CPK
Rigidity (lead pipe)
Excessive sweating (diaphoresis)
Delirium (mental status changes)

RX- discontinuation of med, administration of supportive care (hydration, cooling, etc.)
Sodium dantrolene, bromocriptine, amantadine may be used but have their own side effects and unclear efficacy
NOT an allergic reaction
Pt is not prevented from restarting the same neuroleptic later; increased risk of another episode, though

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment of EPS

A

reduce the dose of the antipsychotic
administer anticholinergic medication (benztropine = cogentin) or diphenhydramine (Benadryl) or or, less commonly, an antiparkinsonian med such as amantadine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What atypical antipsychotic is less likely to cause tardive dyskinesia?

A

Clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

chances of developing TD with typical antipsychotic

A

5% per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Onset of antipsychotic side effects

A 
NMS- any time, usually early
Acute dystonia- hours to days
Parkinsonism/ akathisia- days to weeks
TD- months to years
Abnormal Involuntary Movement Scale (AIMS) can be used to quantify and monitor for TD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Atypical antipsychotics (in general)

A

block both dopamine and serotonin receptors.
different side effects from typicals
less likely to cause EPS, TD, neuroleptic malignant syndrome
MAY be more effective at negative symptoms
also used for mania, bipolar, adjunctive in unipolar
Also used for borderline, PTSD, psychiatric disorders in childhood (tic disorders, e.g.)

include Clozapine, Risperidone, Quetiapin (=Seroquel), Olanzapine (Zyprexa), Ziprasidone (Geodon), Aripiprazole (Abilify).
Paliperidone (Invega) = metabolite of resperidone
Asenapine (Saphris)- sublingual
Iloperidone
Lurasidone (Latuda)- take with food, used in bipolar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Clozapine

A

= Clozaril
Less likely to cause TD
Only antipsychotic shown to be more efficacious, used in treatment of refractory schizophrenia
Associated with tachycardia and hypersalivation
more anticholinergic side effects than other atypical or high-potency typical antipsychotics
Small risk of myocarditis
1% incidence of agranulocytosis
Clozapine must be stopped if the absolute neutrophil count drops below 1500/microliter
4% incidence of seizures
Only antipsychotic shown to DECREASE the RISK OF SUICIDE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Haldol vs Clozapine

A

Haldol- increased risk of EPS (dystonia, TD) but does not typially lead to agranulocytosis (associated with clozapine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Risperidone

A

atypical antipsychotic

can –> increased prolactin
Orthostatic hypotension and reflex tachycardia
Long-acting infectable form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Quetiapine

A

(Seroquel) much less likely to cause EPS; common side effects include sedation and orthostatic hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Olanzapine

A

(Zyprexa) - common side effects include weight gain, sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Ziprasidone

A

(Geodon)
Less likely to cause significant weight gain, associated with QTc prolongation, must be taken with food (50% reduction in absorption without a 300 calorie meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Aripiprazole
(Abilify) unique mechanism of partial D2 agonism Can be more activating (akathisia) and less sedating less potential for weight gain
26
Newer antipsychotics
Paliperidone (Invega)- metabolite of risperidone. Asenapine (Saphris)- orally dissolving (sublingual) table Iloperidone (Fanapt) Lurasidone (Latude)- must be taken with food; used in bipolar depression
27
Side effects of 2nd gen antipsychotics
Metabolic syndrome (monitor with baseline weight, waist circumference, BP, fasting glucose, fasting lipids Weight gain Hyperlipidemia hyperglycemia- rarely, diabetic ketoacidosis has bene reported elevated liver function tests QTc prolongation
28
Mood stabilizers in general
treat acute mania, hep prevent relapses of manic episodes in bipolar and schizoaffective. Less commonly used for: - augment antidepressant for refractory major depression - potentiation of antipsychotics in pts with schizophrnia or schizoaffective disorder - treatment of aggression and impulsivity (e.g. neurocognitive disorders, intellectual disability, personality disorders, other medical conditions) - enhancement of abstinence in treatment of alcoholism
29
common mood stabilizers
lithium | anticonvulsants: valproic acid, lamotrigine, carbamazepine
30
Lithium
drug of choice in acute mania and as prophylaxis for both manic and depressive episodes in bipolar and schizoaffective disorders also cyclothymic disorder, unipolar depression metabolized by kidney (caution: renal dysfunction) Have ECG, basic chemistries, thyroid test, CBC, pregnancy test onset- 5-7 days blood levels correlate with clinical efficacy, should be checked after 5 days and then every 2-3 days until therapeutic Major drawback: high incidence of side effects, narrow therapeutic indx: .6-1.2, toxic >1.5. Potentially leathal >2.0
31
Side effects of lithium
toxic levels --> altered mental status, coarse tremors, convulsions, delirium, coma, death monitor blood levels of lithium, thyroid function, kidney function fine tremor nephrogenic diabetes insipidus ``` GI disturbance weight gain sedation thyroid enlargement, hypothyroidism ECG changes benign leukocytosis Lithium can --> EBSTEIN's ANOMALY, cardiac defect in babies born to mothers taking lithium ```
32
Carbamazepine
anticonvulsant esp useful in treating mania with MIXED FEATURES and RAPID cycling bipolar; less effective for depressed phase act by blocking sodiium channels and inhibiting action potentials onset- 5-7 days CBC and LFTs must be obtained before initiating treatment and regularly monitored during treatment
33
Carbamazepine side effects
most common: GI and CNS (drowsiness, ataxia, sedation, confusion) possible skin rash (Stevens Johnson) Leukopenia, hyponatremia, aplastic anemia, thrombocytopenia, agranulocytosis elevation of liver enzymes, causing hepatitis TERATOGENIC effects when used during pregnancy (neural tube defects) significant drug interactions with may medications metabolized by the cytocrhome P450 pathway; including inducing its own metabolism through AUTOINDUCTION (requiring increasing dosages) Toxicity: confusion, stupor, motor restlessness, ataxia, tremor, nystagmus, twitching, vomiting
34
only mood stabilizer shown to decrease suicidality
lithium
35
blood levels useful for what drugs?
lithium valproic acid carbamazapine clozapine
36
Factors that increase lithium levels
``` NSAIDs Aspirin thiazide diuretics dehydration salt deprivation sweating (salt loss) impaired renal function ```
37
Valproic Acid
useful in acute mania, ania with mixed features, rapid cycling multiple mechanisms of action: blocks sodium channels and increases GABA concentrations in the bbrain Monitoring of LFTs and CBC is necessary Drug levels check after 4-5 days. Therapeutic range: 50-150 microg/mL contraindicated in preggers; neural tube defects
38
Lamotrigine
(Lamictal) efficacy for bipolar deprsession most serious side effect: Stevens Johnson syndrome valproate increases lamotrigine levels, lamotrigine decreases valproate levesls dizziness, sedation, headaches, ataxia
39
Oxcarbazepine
(Trileptal) as effective in mood disorders as carbamazepine, better tolerated less risk of rash and hepatic toxicity monitor sodium levels for hyponatremia
40
Gabapentin
(neurontin) used adjunctively to help with anxiety; sleep; neuropathic pain little efficacy in bipolar
41
Pregabalin
(lyrica) used in GAD (second-line) and fibromyalgia little efficacy in bipolar disorder
42
Tiagabine | Topiramate
(gabitril)- questionable benefit in treating anxiety (topamax) may be helpful with impulsee control disoders beneficial side effect: weight loss can cause hypochloremic, metabolic acidosis, as well as kidney stones most limiting side effect is COGNITIVE SLOWING
43
In alcoholics or liver disease, use what benzos?
LOT Lorazepam Oxazepam Temazepam not metabolized by liver
44
Anxiolytics/ Hypnotics in general
Include benzos, barbiturates, and buspirone BDZs are most widely prescribed psychotropic meds ``` Common indications: Anxiety disorders Muscle spasm Seizures Sleep disorders Alcohol withdrawal Anesthesia induction ```
45
Benzos in general
work by potentiating the effects of GABA reduce anxiety, can treat akathisia DEPENDENCE and tolerance potential for abuse Choice- based on time of onset, duration, method of metabolism.
46
Long-acting benzos:
Diazepam (valium) - rapid onset - detox from alcohol/ sedative-hypntoci-anxiolytics, seizures - Effective for MUSCLE SPASM - less comon for anxiety because of euphoria Clonazepam (Klonopin) - treat anxiety, panic attacks - avoid with renal dysfunction; longer halflife allows 1-2/day
47
Intermediate-acting benzos
half life 6-20 hours Alprazolam (Xanax)- anxiety, panic attacks. shorter onset of action --> euphoria, high abuse Lorazepam (ativan)- panic attacks, alcohol, sedative-hypnotic-anxiolytic detox, agitation - not metabolized by liver Oxazepam (Serax)- alcohol and sedative-hypnotic-anxiolytic detox - not metabolized by liver Temazepam (Restoril)- dependenc; not used so much for insomnia. Not metabolized by liver
48
Short-acting benzos
Triazolam (halcion)- insomnia, risk of anterograde amnesia and sleep- related activities (e.g. eating, driving) Midazolam (Versed)- VERY SHORT half-life. Primarily for medical and surgical settings
49
Benzo overdose?
flumazenil to reverse effects | careful not to induce withdrawal too quickly- can be life threatening
50
benzos plus alcohol
can be lethal | respiratory depression may cause death
51
Side effects of benzos
drowsiness impairment of intellectual function reduced motor coordination (careful in elderly) Anterograde amnesia Withdrawal can be life threatening and cause seizures Toxicity- respiratory depression in OD, esp when combined with alcohol
52
Non BDZ hypnotics
Zolpidem (Ambien), Zaleplon (Sonata)/ Eszopiclone (Lunesta) - work by selective receptor binding to the omega-1 receptor on the GABA-A receptor, which is responsible for sedation shoudl be used for short-term treatment of insomnia - compared to BDZs, less tolerance/ depenence occurs with prolonged use (but still can occur) - anterograde amnesia/ sleepwalking, GI side effects? Diphenhydramine- antihistamine with moderate anticholinergic effects. --> sedation, dry mouth, constipation, urinary retention, blurry vision Ramelteon (Rozerem)- selective melatonin MT1 and MT2 agonist. No tolerance or dependence
53
Buspirone
non bdz anxiolytic partial agonist at 5HT-1A receptor slower onset of action than BDZs (takes 1-2 weeks for effect) not as effective as other options, often used in combo with anoter agent (eg an SSRI) for GAD does not potentiate CNS depression of alcohol(useful in alcoholics), low potential for abuse/ addiction
54
Hydroxyzine (Atarax)
non BDZ anxiolytic an antihistamine side effects include sedation, dry mouth, constipation, urinary retention, blurry vision useful for patients who want quick-acting, short-term medication, but who cannot take BDZs for various reasons
55
Barbiturates
butalbitol, phenobarbital, amobarbitol, pentobarbital. | Rearely used because of lethalty of overdose, potential for abuse, side-effect profile
56
Propanolol
Beta-blocker useful in treating the autonomic effects of panic attacks or social phobia (i.e. performance anxiety), such as palpitations, sweating, and tachycardia Can also be used to treat akathisia (side efffect of antipsychotics)
57
Psychostimulants
used in ADHD and in treatment of refractory depression Dextroamphetamine and amphetamines (Dexedrine, Adderall)- high potential for abuse/ diversion. Monitor BP, watch for weight loss, insomnia, exacerbation of tics, decreased seizure threshold Methylphenidate (Ritalin, Concerta)- CNS stimulant, similar to amphetamine. Watch for leukopenia/ anemia. . Monitor BP an dCBC with differential, watch for weight loss, insomnia, exacerbation of tics, decreased seizure threshold Atomexitine (Strattera)- inhibits presynaptic NE reuptake, resulting in increased synaptic NE and dopamine. Not controlled, less abuse, less efficacy Modafinil- narcolepsy, not ADHD
58
Cognitive enhancers
for dementias ACH inhibitors: Donepezil (Aricept), Galantamine (Razdyne), Rivastigmine (Exelon) NMDA (Glutamate) receptor antagonist- Memantine (Namenda), use with ACH inhibitor
59
Meds that can cause psychosis
Sympathomimetics, analgesics, abx (isoniazid, antimalarials), anticholinergics, anticonvulsants, antihistamines, corticosteroids, antiparkinsonian agents
60
Meds that can cause agitation, confusion, delirium
antipsychotics, ANTICHOLINERGICS, ANTIHISTAMINES, antidepressants, antiarrhythmics, antineoplastics, corticosteroids, nonsteroidal anti-inflammatories (NSAIDS), antiasthmatics, ABX, antihypertensives, antiparkinsonian agents, thyroid hormones
61
meds that can cause Depression
antihypertensives, antiparkinsonian agents, CORTICOSTEROIDS, calcium channel blockers, NSAIDs, abx, peptic ulcer drugs
62
meds that can cause anxiety
sympathomimetics, antiasthmatics, antiparkinsonian agents, hypoglycemic agents, NSAIDs, thyroid hormones
63
meds that can cause sedation/ poor concentration
antianxiety agents/ hypnotics, anticholinergics, abx, antihistamines

First Aid for Psych Clerkship (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions