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HLSC 220 - Pharmacotherapeutics for Healthcare Professionals > Chapter 34 - Antipsychotics > Flashcards

Chapter 34 - Antipsychotics Flashcards

1
Q

What is a ‘neuroleptic’?

A

an older name for antipsychotics that is usually used for major tranquilizers

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2
Q

What are antipsychotics used for?

A

-schizophrenia
-delusional disorders
-bipolar disorder
-depressive psychoses
-drug-induced psychoses
-anti-emetic
-Tourette’s syndroma
-Huntingtons’s chorea

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3
Q

Are antipsychotics used for dementia?

A

no, especially in older adults

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4
Q

What are some risk factors for schizophrenia?

A

-family hx
-life experience (poverty, stress, danger)
-pregnancy and birth issues (exposure to toxins or virus)
-taking psychoactive drugs at young age

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5
Q

What are the POSITIVE schizophrenia symptoms?

A

-exaggeration of normal function
-hallucinations
-delusions
-agitation
-tension
-paranoia

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6
Q

What are the NEGATIVE schizophrenia symptoms?

A

-loss of normal function
-lack of motivation
-poverty of speech
-blunted affect
-poor self-care
-social withdrawal

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7
Q

What are the COGNITIVE schizophrenia symptoms?

A

-disordered thinking
-impaired attention
-learning and memory difficulty
-incomprehensible thinking and speech

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8
Q

How an acute schizophrenia episode present?

A

-delusions
-hallucinations

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9
Q

What are the residual symptoms of schizophrenia?

A

-suspiciousness
-poor anxiety management
-diminished judgement, insight, motivation, self-care

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10
Q

How does long-term schizophrenia present?

A

acute exacerbations separated by partial remission

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11
Q

Possible etiology of schizophrenia: excessive activation of CNS receptors for _____________

A

dopamine

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12
Q

Possible etiology of schizophrenia: insufficient activation of CNS receptors for _____________

A

glutamate

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13
Q

What receptors do 1st gen antipsychotics (typical) block?

A

dopamine

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14
Q

What receptors do 2nd gen antipsychotics (atypical) block?

A

serotonin (a little bit of dopamine)

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15
Q

Are 1st gen antipsychotics used for positive or negative symptoms of schizophrenia?

A

positive

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16
Q

Are 2nd gen antipsychotics used for positive or negative symptoms of schizophrenia?

A

negative

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17
Q

What are some possible complications of 1st gen antipsychotics?

A

movement disorders:
-extrapyramidal symptoms
-neuroleptic malignant syndrome (NMS)
-increase prolactin

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18
Q

Do 2nd gen antipsychotics have the same effects as 1st gen?

A

no - less EPS, less NMS, no change in prolactin

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19
Q

What are inappropriate off-label uses of atypicals?

A

-controlling agitated nursing home residents
-sleep aid

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20
Q

How are 1st gen (typical) antipsychotics classified?

A

potency (low, medium, high)

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21
Q

What is the 1st gen low potency prototype?

A

Chlorpromazine

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22
Q

What is the 1st gen high potency prototype?

A

Haloperidol (Haldol)

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23
Q

Do antipsychotics block dopamine 1 or 2 receptors?

A

2

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24
Q

Where do antipsychotics act?

A

mesolimbic area of the brain

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25
Q

What causes adverse effects from antipsychotics?

A

blocking dopamine, ACh, serotonin, histamine, norepi

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26
Q

What are extrapyramidal symptoms (EPS)?

A

-acute dystonia
-oculogyric crisis
-akathisia
-parkinsonism

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27
Q

Are EPS symptoms reversible?

A

yes with anticholinergic meds (benztropine and procyclidine)

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28
Q

What can EPS symptoms progress to?

A

tardive dyskinesia (is irreversible)

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29
Q

What are the symptoms of tardive dyskinesia?

A

-choreoathetoid movements of tongue and face
-lip-smacking, fly-catching
-slow, worm-like movement of tongue
-involuntary limb movement

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30
Q

What is neuroleptic malignant syndrome (NMS)?

A

a rare but serious adverse effect that causes rigidity, high fever, sweating, autonomic instability, dysrhythmias, BP fluctuations, altered LoC, seizures, coma

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31
Q

Does NMS have a slow or fast onset?

A

slow

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32
Q

How does NMS present on labs?

A

-elevated creatine kinase
-elevated creatine phosphokinase
-elevated transaminases
-leukocytosis

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33
Q

How can death result from NMS?

A

-respiratory failure
-CV collapse
-dysrhythmias

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34
Q

How is NMS treated?

A

-supportive measures
-drugs
-withdrawal of antipsychotics

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35
Q

What drugs are used for NMS?

A

dantrolene and bromocriptine

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36
Q

What are ALL the AE of antipsychotics?

A

-extrapyramidal symptoms
-tardive dyskinesia
-neuroleptic malignant syndrome
-dry mouth
-blurred vision
-photophobia
-urinary hesitancy
-constipation
-tachycardia
-orthostatic hypotension (A1 blockade)
-sedation
-gynecomastia
-sexual dysfunction
-increased prolactin levels
-seizures
-agranulocytosis
-dysrhythmias (prolonged QT interval)
-dementia
-sunburn
-menstrual irregularities

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37
Q

Agranulocytosis is uncommon in ____ gen drugs?

A

1st

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38
Q

What kind of drugs do antipsychotics interact with?

A

-anticholinergics (↑ effect)
-CNS depressants (↑ effect)
-levodopa and dopamine agonists (counteract effects)

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39
Q

Sudden stoppage of antipsychotics can…

A

-cause some SE (restlessness, insomnia, headache, GI, sweating)

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40
Q

What family is Haloperidol?

A

Butyrophenone family

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41
Q

Is Haloperidol low, moderate, or high potency?

A

high

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42
Q

What is Haloperidol used for?

A

schizophrenia and acute psychosis

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43
Q

Haloperidol is the preferred drug for…

A

Tourette’s syndrome

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44
Q

What are the adverse effects of Haloperidol?

A

-extrapyramidal reactions
-neuroendocrine effects
-dysrhythmias (prolonged QT interval)

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45
Q

How is Haloperidol administered?

A

-depot injection
-short-acting injection
-oral

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46
Q

What potency is fluphenazine?

A

high

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47
Q

What family is fluphenazine?

A

piperazine subclass of phenothiazines

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48
Q

What are the adverse effects of fluphenazine, flupenthixol, and zuclopenthixol?

A

-early EPS
-acute dystonia
-parkinsonism
-akathisia
-sedation
-orthostatic hypotension
-anticholinergic effects
-gynecomastia
-galactorrhea (milk production)
-menstrual irregularities

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49
Q

How are fluphenazine and flupenthixol administered?

A

depot injection and oral tablet

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50
Q

What is the potency of flupenthixol?

A

high

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51
Q

What class is flupenthixol?

A

thioxanthine

52
Q

What is the potency of zuclopenthixol?

A

high

53
Q

What family is zuclopenthixol?

A

thioxanthine

54
Q

What is a unique use for zuclopenthixol?

A

acute psychosis and psychotic agitation

55
Q

What level of potency is chlorpromazine?

A

low-potency

56
Q

What is chlorpromazine used for?

A

-schizophrenia
-schizoaffective disorder
-manic phase of bipolar disorder
-antiemetic
-hiccup relief

57
Q

What are the adverse effects of chlorpromazine?

A

-sedation
-orthostatic hypotension
-anticholinergic effects

58
Q

How is chlorpromazine administered?

A

PO, IM, or IV

59
Q

How do ATYPICAL (2nd gen.) antipsychotics differ from typical antipsychotics?

A

-less risk of tardive dyskinesia
-do not increase prolactin levels (as much)
-less NMS
-work better on POSITIVE symptoms of schizophrenia

60
Q

Aytpical antipsychotics have an increased risk of…

A

-weight gain
-diabetes
-dyslipidemia
-metabolic syndrome

61
Q

Which receptors do atypical antipsychotics block?

A

mainly dopamine 2 and serotonin (5-HT 2A) receptors, also histamine, alpha, muscarinic (ACh), norepinephrine

62
Q

What is responsible for improved efficacy and safety of atypical antipsychotics?

A

differences in MOA of serotonin receptors

63
Q

What gen is clozapine?

A

2nd gen

64
Q

What receptors does clozapine block?

A

-dopamine
-serotonin
-histamine
-ACh
-NE
-alpha

65
Q

What special cases are clozapine used for?

A

-treatment resistant schizophrenia that is not responsive to other drugs
-Parkinson’s disease related psychosis

66
Q

How is clozapine transported in blood?

A

95% plasma protein bound

67
Q

How is clozapine metabolized and excreted?

A

-hepatic
-urine and feces

68
Q

What are the adverse effects of clozapine?

A

-agranulocytosis (really low neutrophil count)
-seizures
-diabetes
-dyslipidemia
-weight gain (!!!)
-myocarditis
-constipation
-hyper salivation
-EPS (rare)

69
Q

What is used for hypersalivation treatment?

A

ATROPINE

70
Q

What should the nurse monitor for with patients taking clozapine?

A

-WBC and neutrophil count weekly for 26 weeks
-if WBC levels are stable monitor count every 2-4 weeks

71
Q

How is clozapine administered?

A

orally

72
Q

What is special about the dosing of clozapine?

A

a test dose should be administered once then increased until therapeutic

73
Q

What are the DI’s of clozapine?

A

-smoking
-drugs that suppress bone marrow function
-anticancer drugs
-phenytoin and rifampin can lower
-ketoconazole and erythromycin can raise

74
Q

What generation is risperidone?

A

2nd. gen (atypical)

75
Q

Increasing the dose of risperidone increases…

A

receptor binding (dopamine)

76
Q

How is risperidone metabolized?

A

-hepatic
-active metabolite

77
Q

What are the AE’s of risperidone?

A

-EPS (high doses)
-endocrine effects
-dizziness
-agitation
-anticholinergic

78
Q

How is risperidone administered?

A

-orally
-IM

79
Q

Paliperidone is the active metabolite of _____________

A

risperidone

80
Q

How is paliperidone (invega) administered?

A

-orally
-depot shot (invega sustenna and invega trinza)

81
Q

For Invega Sustenna (Paliperidone) where is the shot administered?

A

-deltoid (initial dose)
-gluteal (maintenance dose)

82
Q

When is Invega Trinza (Paliperidone) used?

A

-after invega sustenna is used for at least 4 months

83
Q

How often is invega trinza administered?

A

every 3 months

84
Q

How is the IS dose converted to the IT dose?

A

3.5x multiplier

85
Q

How does the nurse prepare an Invega Sustenna injection?

A

shake vigorously for minimum of 10 seconds

86
Q

What needle gauge is used for Invega sustenna if the patient weighs less than 200 pounds?

A

1 inch 23 gauge

87
Q

What needle gauge is used for Invega sustenna if the patient weighs more than 200 pounds or if giving gluteal injection?

A

1.5 inch 22 gauge

88
Q

How is Invega Trinza administered?

A

IM

89
Q

What kind of antipsychotic is Olanzapine?

A

atypical (2nd gen)

90
Q

What are the adverse effects of Olanzapine?

A

-low risk of EPS
-high risk of metabolic effects
-akathisia (restlessness)
-increased BP

91
Q

What kind of antipsychotic is Ziprasidone?

A

Atypical (2nd gen)

92
Q

What is Ziprasidone used for?

A

schizophrenia and acute bipolar mania

93
Q

What receptors does Ziprasidone block?

A

-D2
-5-HT2
-H1

94
Q

What are the adverse effects of Ziprasidone?

A

-somnolence
-orthostatic hypotension
-rash
-EPS
-weight gain
-increased QT interval

95
Q

How is Ziprasidone administered?

A

oral capsules with food

96
Q

What class of antipsychotic is Quetiapine (seroquel)?

A

atypical (2nd gen)

97
Q

What is Quetiapine used for?

A

-schizophrenia
-major depression
-acute episodes in bipolar disorder
-SLEEP (off label)

98
Q

What are the adverse effects of Quetiapine?

A

-metabolic effects
-cataracts
-prolonged QT interval
-low EPS
-somnolence
-hypotension

99
Q

How is Quetiapine administered?

A

orally

100
Q

What kind of antipsychotic is Aripiprazole?

A

atypical (2nd gen)

101
Q

Ariprprazole is a _________ system stabilizer meaning…

A

Dopamine, it ensures just the right amount of dopamine is released (also works on 5-HT1A and 5-HT2A)

102
Q

What is Ariprprazole used for?

A

-schizophrenia
-autism

103
Q

What are the adverse effects of Aripiprazole?

A

-headache
-agitation
-nervousness
-anxiety
-insomnia
-N&V
-dizziness
-somnolence
-weight gain
-risk of impulsive behaviour (gambling, hypersexuality, suicide)

104
Q

Does aripiprazole affect prolactin?

A

no

105
Q

What does aripiprazole interact with?

A

-barbiturates
-carbamazepine
-phenytoin
-rifampin
-ketoconazole
-itraconazole
-fluconazole
-erythromycin
-quinidine
-fluoxetine
-paroxetine

106
Q

How is aripiprazole administered?

A

orally or IM

107
Q

What class is asenapine?

A

atypical

108
Q

Where does asenapine act?

A

D2, 5-HT2A, and their subtypes

109
Q

What are the AE of asenapine?

A

-drowsiness
-hypotension
-prolonged QT interval
-EPS
-mouth numbness
-LESS ANTICHOLINERGIC

110
Q

How is asenapine administered?

A

sublingually

111
Q

Brexpiprazole is a partial agonist at ________ and _____ and an antagonist at _______

A

5-HT1A and D2; 5-HT2A

112
Q

Who shouldn’t take Brexpiprazole?

A

-renal and hepatic impairment
-poor CYP2D6 metabolizers
-risk for impulsive behaviour
-dehydration
-elderly clients with dementia

113
Q

What should the nurse monitor for in patients taking Brexpiprazole?

A

suicidal ideation

114
Q

What are the side effects of Brexpiprazole?

A

-constipation
-weight gain
-dizziness
-akathisia
-increased prolactin
-QT prolongation

115
Q

How is Brexpiprazole administered?

A

orally

116
Q

Lurasidone is used for schizophrenia in people older than _____

A

14

117
Q

What receptors does Lurasidone block?

A

5-HT2 and D2

118
Q

Who can’t take Lurasidone?

A

-renal and hepatic impairment
-cardiac impairment
-elderly clients

119
Q

What are the side effects of Lurasidone?

A

-weight gain
-dizziness
-EPS
-sedation
-increased prolactin

120
Q

How is Lurasidone administered?

A

orally with FOOD (not grapefruit juice)

121
Q

What are Depot preparations?

A

-long-acting injections used for long-term maintenance

122
Q

What vital signs should be monitored after depot injection?

A

BP, pulse, respirations

123
Q

What are key points for depot injections?

A

-SLOW admin
-don’t MASSAGE
-protect from LIGHT
-use in 15 MINS

124
Q

Most typicals and atypicals are equally effective except ________ which is more effective than the rest.

A

clozapine

125
Q

Do typicals or atypicals cost more?

A

atypicals

126
Q

Typicals have a high risk of ____

A

EPS

127
Q

Atypicals have a high risk of __________ effects

A

metabolic

HLSC 220 - Pharmacotherapeutics for Healthcare Professionals (18 decks)

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