IDT Exam 3 Flashcards by Ammon Kunz

D2 agonists end with

zine
xene
zide
peridol

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D2/5HT2 antagonists end with

pine
done

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D2 partial agonists end with

azole

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The 2 D2 partial agonists/5HT2 antagonists

Cariprazine
Lumateperone

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Pimvanserin is a

Pure 5HT2 antagonist

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Which generation of antipsychotic has greater affinity for 5HT2

SGA

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D2 antagonism where causes what

Basal ganglia
EPS

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Stages/progression of EPS

Dystonia
Akathesia
Pseudoparkinsonism
Tardive dyskinesia

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How to treat EPS

Lower dose
Change to dirty drug
SGA cause less EPS than FGA

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Types of dementia

MCI
Alzheimer’s
Vascular
Lewy body
Frontotemporal

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MMSE weakness

Relies on language and is less accurate if poorly educated

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MMSE parameters

Orientation
Memory
Attention
Language
Visuospatial fxn

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How is MoCA different from MMSE

MoCA more sensitive to mild symptoms

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MoCA parameters

Orientation
Delayed word recall
Attention
Language
Visuospatial

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AD clinical manifestation progression

Memory
Language
Reasoning
Behavior

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AD proteins

Amyloid alphabeta peptides
Tau proteins

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Frontotemoral dementia is characterized by

Mood and aphasia

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Frontotemporal dementia responds well to
But not

SSRIs
CEI may worsen

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Lewy body dementia is characterized by

Hallucinations
Parkinson’s symptoms

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Lewy body dementia should not be treated with

Typical APD
May worsen motor symptoms

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Nonpharm treatment for dementia

Educate pt and care giver
Exercise
Eliminate comorbidities
Ethanol avoid and meds that worsen

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Drugs to avoid in dementia

CNS depressants
Benzos
Opioids
Anticholinergics
Antipsychotics

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Drugs for dementia

CEIs
Donepezil
Galantamine
Rivastigmine
Glutamatergic inhibitor
Memantine

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AD patients have less
Which decreases

Choline acetyl transferase
ACh synthesis

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Donepezil Dosing Formulation

5-10mg QD Tabs or ODT

Rivastigmine Dosing Formulations

1.5-6 mg BID Caps Sln and TD patch Patch is 4.6-13.3 mg QD

Galantamine Dosing Formulations

IR 4-12 mg ER 4-24 mg Tabs Sln ER caps

When is donepezil given and why

AM to avoid vivid dreams

Rivastigmine is specifically for

Dementia in PD

Galantamine requires

Renal adjustments

CEIs take how long to be efficacious

3-6 months

CEIs cause

SLUDS BB

What supplements do people try to give with dementia

Vitamin E Ginkgo biloba Curcumin None has evidence

Tx for anxiety in dementia

Buspar SSRI Gabapentin Rather than benzodiazepines

Tx dementia apathy

Stimulants

Tx dementia depression

SSRIs Mirtazapine Not TCA due to antiACh

Tx dementia insomnia

Melatonin Not benzodiazepines or Z drugs

Tx dementia hallucinations

Atypical APD low dose

How to treat MCI

No drugs needed

Tx Alzheimer’s

CEI and memantine

Tx vascular dementia

Control CV risk factors BP Statin ASA

LB dementia Tx

CEI and memantine

Frontotemporal dementia tx

Antidepressants are good here Speech therapy

Phenothiazine SAR

Position 2 EWG -not 1 and 4 3 carbon chain btwn Ns Tert amine

Why does fluphenazine have less antimuscarinic fx

It has an ethanol group on the sidechain

Which antipsychotic phenothiazide is prodrug

Fluphenazine decanoate

Which APD has an active sulfoxide metabolite

Thioridazine

Which APD causes QT prolongation

Thioridazine

You should not give thioridazine to

Poor 2D6 metabolizers

Clozapine is a

D4/D2 5HT2 antagonist

Clozapine may cause Because it has a

Agranulocytosis Reactive nitrenium ion

What APD dibenzazepine has no agranulocytosis And why

Olanzapine It doesn’t have an EWG Has sulfur group This alters metabolism

What is added to olanzapine to make IM sln How does it help?

Pamoate ion Much less water soluble

Why is loxapine not considered atypical

Still has EPS

Loxapines active metabolite And mechanism of action

Amoxapine Blocks NE reuptake NRI

Which two APD have less antimuscarinic SEs and why

Fluphenazine and quetiapine They have an ethanol on their sidechain

Which APD flourobutyrophenone is a prodrug

Haloperidol decanoate

What toxicity does haloperidol have

Neurotoxic HPP+ Causes EPS N is oxidized then the sidechain is dehydrated and becomes aromatic

This APD like haloperidol has DA antagonism But it Lao has

Lumateperone 5HT2A antagonism

Lumateperone should not be taken with

3A4 inhibitors/inducers

Risperidone is metabolized into

Paliperidone

Which atypical APD is mostly excreted unchanged

Paliperidone

What atypical APD is a prodrug

Paliperidone palmitate

Which D2 partial agonist is a prodrug

Aripiprazole lauroxil

Cariprazine is a

D3/D2 partial agonist like the -iprazoles

Three drugs for tardive dyskinisia

Tetrabenazine Deuterbenazine Valbenazine

Samidorphan is an

Opioid receptor antagonist/partial agonist