Kirkpatrick: Antipsychotics Flashcards
What are antipsychoticcs used for?
psychosis non-psychotic mania autism with antidepressants behavioral probs in patients with dementia and delirium (2nd and 3rd line)
Is schizophrenia entirely due to too much dopamine?
nooo!
T/F: All cases of psychosis respond to antipsychotics
false
Psychotic symptoms have a transient increase with infusion of low doses of ketamine (NMDA antagonist), MCPP (5HT antagonist), and cannabis. Why is this important to consider?
this fact refutes the dopaminergic hypothesis of schizophrenia
**schizophrenia not just a disease of dopamine overactivity
There are two dopaminergic pathways. What are they? Which one do antipsychotics act on? Which pathway is associated with extrapyramidal side effects of antipsychotic meds?
- mesocorticolimbic **target of antipsychotic meds
2. nigrostrital **extrapyramidal side effects
What is one 1st generation antipsychotic we should know about?
haloperiodol (Haldol)
What are 5 2nd generation antipsychotics we should know about?
Aripiprazole (Abilify) Olanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperidal) Ziprasidone (Geodon)
T/F: All of the 2nd generation antipsychotics have superior efficacy, esp for negative symptoms
False!!
**no established superiority for negative symptoms
T/F: 2nd generation drugs have no risk of EPS
False!!
**it varies by drug and is dose related
T/F: More is better… If a patient isn’t responding to an antipsychotic, raise the dose! If a patient has symptoms in the gray zone, they should get a lower dose.
Just false
**there is a dose-response curve which shows that all antipsychotics hit a plateau at which point increasing the dose does not increase effectivity
What are the 3 efficacy groups of antipsychotics?
- Clozapine
- Risperidone and Olanzapine
- Everything else
What are side effects of 1st generation drugs?
EPS
orthostatic hypotension
liver probs
neuroleptic malignant syndrome
What are side effects of 2nd generation drugs?
metabolic side effects: weight gain, diabetes
some cause EPS
Which second gen drugs can cause EPS?
risperidone (at high doses)
geodon and abilify
This drug is in a class of its own; has superior efficacy but is difficult to use
Clozapine
What are the side effects of Clozapine? The main side effect we should be concerned about?
agranulocytosis: it's reversible but requires that the pt get their blood drawn frequently sustained tachycardia weight gain orthostatic hypotension hypersalivation sedation
What are extrapyramidal side effects? What are these referred to as?
rigidity tremor bradykinesia hypersalivation neuroleptic malignant syndrome akathisia (can't sit still)
**these are known as pseudoparkinsonian symptoms
What are three ways you can treat extra pyramidal symptoms? What symptom is an exception to these treatment modalities?
- decrease dose or change med
- anticholinergic drugs, like diphenhydramine, trihexiphenidyl
- amantadine
**akathisia doesn’t respond to these treatments
Two good strategies for treating akathisia (EPS). Will anticholinergics work?
change med
beta-blocker like propranolol;
no, anticholinergics are not effective
What did the study on discontinuation of antipsychotics show? Which drug was the most effective?
1st gen antipsychotics were not superior to 2nd gen antipsychotics;
olanzapine was most effective!!
What is one downside to olanzpine even though it was discontinued less often than other antipsychotics?
it causes weight gain and metabolic changes
Syndrome of involuntary choreo-athethoid movements Not just the mouth and face Dose-related, time-related Especially first-generation drugs Other EPS mark greater risk Male gender, African-American
tardive dyskinesia
What happens when you stop meds that are causing tardive dyskinesia?
transient worsening of symptoms, then improvement
T/F: Tardive dyskinesia worse for 1st gen antipsychotics
True
What is a huge problem with Clozapine, olanzapine, and resperidone?
weight gain!!
Clozapine > olanzapine > resperidone
How can you treat the weight gain associated with antipsychotic use?
change meds? decrease dose? exercise? nutrition? metformin
Which receptor must you block to get EPS?
D2
Which receptor must you block to get cognitive deficits, dry mouth, constipation, increased HR, urinary retention, and blurred vision?
M1
Which receptor must you block to get sedation, weight gain, and dizziness?
H1
This is increased in patients on antipsychotics and can lead to sudden death
QT interval
What are 3 other risk factors for increased QT interval?
hypokalemia
hypomagnesemia
hypocalcemia
This antipsychotic increases the QT interval by 30 sec!!!
thioridazine
What two things are used to treat behavior problems and dementia?
antipsychotics
benzos
Why are benzos bad for treating dementia?
they can lead to increased confusion and thus, increased falls :(
What can be used instead to treat the behavioral problems and dementia?
citalopram
- *antidepressant
- *equal efficacy to risperidone
How is abilify different from the other 2nd generation antipsychotics?
it is a partial dopamine agonist, which apparently has the same effect as a dopamine antagonist…
