exam 1 antipsychotics

Question 1

describe schizophrenia

Answer 1

Psychosis with positive or negative symptoms or both. It is a REAL emergency and must be treated with meds, PO or IV.

Question 2

when giving FGAs what else should be given and why? what symptoms do FGAs treat

Answer 2

should also be given with anticholinergics or antihistamines to prevent EPS or dystonia. They only treat positive symptoms and can worsen negative symptoms

Question 3

what conditions can have psychosis

Answer 3

bipolar and depression

Question 4

what symptoms do FGAs treat

Answer 4

positive, hallucinations and grandiosity

Question 5

what symptoms do SGAs treat

Answer 5

positive and negative (depression, anhedonia) as well as cognitive (memory difficulties)

Question 6

what do FGAs act on

Answer 6

D2 receptors in the mesolimbic and nigrostriatal pathways, also act on noradrenergic, cholinergic, histaminergic, muscarinic-1, and alpha-1 to a lesser extent

Question 7

what do SGAs act on

Answer 7

act on both dopamine and serotonin pathways

Question 8

FGAs or SGAs are the first line treatment for schizophrenia and why

Answer 8

SGAs. they have fewer neurological side effects. but can increase weight, HDL, and diabetes risk. Acts on both dopamine and serotonin

Question 9

hallmarks of neuroleptic malignant syndrome (FALTERED)

Answer 9

F= Fever
A= Autonomic Instability (Tachy, HTN)
L= Leukocytosis
T= Tremor
E= Elevated CPK
R= Rigidity (lead pipe)
E= Excessive sweating (diaphoresis)
D= Delirium (mental status changes)

Question 10

more about NMS

Answer 10

LIFE THREATENING

20% mortality if untreated

more common with FGAs

more likely in young males early in treatment

Question 11

side effects of FGAs and SGAs

Answer 11

sedation, weight gain, QTc prolngation, Increased SZ occurance, liver enzymes, prolactinemia, and increased risk of tardive dyskinesia AND NEUROLEPTIC MALIGNANT SYNDROME

Question 12

what is the timeframe for onset of EPS

Answer 12

hours to months after taking medication

Question 13

what does EPS consist of

Answer 13

akasthesia, acute dystonia, pseudo-parkinsonism

Question 14

what is acute dystonia

Answer 14

sudden onset of neck contracture, oculogyric crisis, can be life threatening if it affects the airway

Question 15

what is akathesia

Answer 15

pt is suddenly anxious cannot sit still, feels like they are coming out of their skin (reglan too fast)

Question 16

what is pseudo-parkinsonism

Answer 16

shuffling gait, pill rolling, mask like face

Question 17

what medication is used in the treatment for acute dystonia and psuedo-parkinsonism

Answer 17

cogentin

Question 18

what is the drug treatment for akathesia

Answer 18

beta-blocker

Question 19

what percentage of dopamine receptors need to be occupied to cause EPS

Answer 19

at least 80%

Question 20

what medication is used to treat treatment resistant schizophrenia

Answer 20

clozapine/fazaclo (ODT)

Question 21

what does clozapine increase that other drugs do NOT

Answer 21

suicidal ideation

Question 22

side effects and must knows about clozaril/clozapine

Answer 22

causes wt gain and hypersalivation
causes agranulocytosis
must STOP if ANC is less than 1,500

less likelihood of TD

Question 23

what causes metabolic syndrome

Answer 23

caused by H1 receptor antagonism and is associated with increased sedation and wt gain.

Question 24

characteristics of metabolic syndrome

Answer 24

elevated BP, triglycerides, and wt
decreased HDL

Question 25

when using SGAs what is the monitor schedule

Answer 25

Baseline: Wt, BMI, waist circumference, BP, fasting BS, fasting lipids
4w: wt., BMI
8w: Wt., BMI
12w: Wt., BMI, waist circumference, BP, fasting bs, fasting lipids
Quarterly: Wt., BMI
Yearly: waist circumference, BP, fasting BS,
5yrs: Fasting lipids

If taking olanzapine, quetiapine or clozapine do lipids at 4weeks as well

Question 26

what drug commonly causes prolactinemia

Answer 26

risperdal

Question 27

how is prolactinemia caused (what and where) and how does it affect men and women

Answer 27

D2 is blocked in the tuberoinfundibulum
M- gynocomastia, ED, low libido
W-galactorrhea, no period, low libido

Question 28

how is prolactinemia treated

Answer 28

decrease or stop the meds or switch the med. Can add aripiprazole and add cialis or viagra if too many problems with sex drive

Question 29

what causes neuroleptic malignant syndrome

Answer 29

blockade of dopamine receptors by FGAs or SGAs (less likely)

Question 30

how do you treat NMS

Answer 30

STOP THE MED!!
hydrate, benzos, cooling blankets
use dantrolene, bromocriptine, amantadine
ETC can be helpful

Question 31

what is tardive dyskinesia

Answer 31

abnormal movement of the face, lips, and tongue

Question 32

who does tardive dyskinesia affect more

Answer 32

anyone taking antipsychotics
old women post menopausal
frequently AA

Question 33

what risk factors create higher likelihood of TD

Answer 33

using FGAs for long term or with high doses. Those with substance use disorders

Question 34

is TD reversible and if so how which med can be substituted

Answer 34

mostly reversible
stop the med or lower the dose
switch to clozapine
treat using amatadine or tetrabenzine

Question 35

what is the 2017 FDA approved treatment for TD

Answer 35

Ingrezza or Austedo

Question 36

what can clinicians use to measure TD and how often should it be done

Answer 36

Abnormal Involuntary Movement Scale, before starting and every 3-6 mo after