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Block 8 Week 6 Rhonda > Kirkpatrick > Antipsychotics > Flashcards

Kirkpatrick > Antipsychotics Flashcards

1
Q

what are the 4 appropriate uses for antipsychotics?

A

psychosis
non-psychotic mania
autism
adjunct to antidepressants

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2
Q

what are 2 common uses for antipsychotics that do not follow guidelines?

A

behavioral probs in pts w/ dementia (2nd or 3rd line)

delirium (2nd or 3rd line)

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3
Q

do all pts respond to antipsychotics?

A

nope

responses are variable, some don’t respond at all

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4
Q

what 3 things can transiently increase psychotic symptoms?

A 
NMDA antagonist (ketamine)
serotonin agonist (MCPP)
cannabis
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5
Q

T/F: because DM drugs work on schizophrenia, schizophrenia must be a disease of DM only

A

false

think of plague > if aspirin lowers your fever, that doesn’t mean that plague is a disease of aspirin deficiency

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6
Q

what are the 2 dopamine pathways?

A

mesocorticolimbic

nigrostriatal

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7
Q

what dopamine pathway is useful for antipsychotic drugs?

A

mesocorticolimbic

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8
Q

what dopamine pathway has extrapyramidal side effects?

A

nigrostriatal

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9
Q

what 5 functions does the DM pathway control?

A 
reward (motivation)
pleasure/euphoria
motor fxn
compulsion
perseveration
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10
Q

what 4 functions does the serotonin pathway control?

A

mood
memory processing
sleep
cognition

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11
Q

what are the 4 commonly used 1st gen antipsychotics?

A

fluphenazine/Prolixin
perphenazine/Trilafon
trifluoperazine/Stelazine
haloperidol/Haldol

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12
Q

what 2 1st gen antipsychotics have depot formulations?

A

fluphenazine/Prolixin

haloperidol/Haldol

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13
Q

what are the 2nd gen antipsychotics (there are 9)?

A 
aripiprazole/Abilify
olanzapine/Zyprexa
quetiapine/Seroquel
risperidone/Risperdal
ziprasidone/Geodon
iloperidone/Fanapt
asenapine/Saphris
paliperidone/Invega
lurasidone/Latuda
(AOQRZIAPL)
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14
Q

T/F: all of the 2nd gen antipsychotics are superior to 1st gen

A

FALSE

no superiority est for negative sx

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15
Q

which 2nd gen antipsychotics have depot formulations?

A

aripiprazole/Abilify
olanzapine/Zyprexa
risperidone/Risperdal
paliperidone/Invega

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16
Q

do 2nd gen antipsychotics have a risk of extrapyramidal side effects?

A

yes
varies by drug
dose related

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17
Q

do antipsychotics undergo a linear dose response?

A

partly
there’s a linear range containing the ED50
then there’s a near-maximal effective dose range
then a plateau

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18
Q

what are the side effects of 1st gen antipsychotics?

A

extrapyramidal side FX
orthostatic hypotension
liver probs
neuroleptic malignant syndrome

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19
Q

what is neuroleptic malignant syndrome?

A 
adverse drug rxn
muscle rigidity
fever
autonomic instability
cognitive changes like delirium
elevated plasma creatine phosphokinase
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20
Q

what is the primary problem w/ 2nd gen antipsychotics?

A

metabolic side effects
weight gain
diabetes (w/ or w/o weight gain)

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21
Q

which 3 2nd gen antipsychotics have extrapyramidal sx?

A

risperidone (esp w/ high doses)
geodon
abilify

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22
Q

which 2 2nd gen antipsychotics can cause akathisia?

A

abilify & geodon

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23
Q

what is akathisia?

A

the inability to be still

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24
Q

what is Clozapine?

A 
a drug in a class all its own w/ superior efficacy 
but it's hard to use
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25
Q

what are the side effects of Clozapine?

A 
agranulocytosis
sustained tachycardia
weight gain
orthostatic hypotension
hypersalivation
sedation
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26
Q

is the agranulocytosis w/ Clozapine permanent?

A

no it’s reversible

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27
Q

when does agranulocytosis w/ Clozapine occur?

A

in the 1st year of taking the drug

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28
Q

how many people that take clozapine experience agranulocytosis?

A

1% (w/i the 1st year)

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29
Q

what are some extrapyramidal side effects?

A 
rigidity
tremor
bradykinesia
hypersalivation
neuroleptic malignant syndrome
akathisia
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30
Q

what is the treatment for extrapyramidal sx d/t antipsychotics?

A

decrease dose
change meds
anticholinergic drugs
amantadine

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31
Q

what is the treatment for akathisia as a side effect of antipsychotics?

A

change meds
beta blockers > propranalol

MAYBES
high dose B6
clonazepam

32
Q

what are the anticholinergic drugs you can give for extrapyramidal symptoms?

A

diphenhydramine/Benadryl
trihexiphenidyl/Artane
benztropine/Cogentin

33
Q

what drugs do not work for akathisia?

A

anticholinergics

34
Q

why do pts discontinue their antipsychotics?

A

intolerable side effects
inadequate sx control
“other”

35
Q

what is tardive dyskinesia?

A

syndrome of involuntary choreo-athetoid movements

involuntary repetitive movements w/ belated onset

36
Q

what can cause tardive dyskinesia (generally)?

A

1st gen antipsychotics

37
Q

what can increase the risk of tardive dyskinesia?

A

other extrapyramidal side FX

38
Q

T/F: tardive dyskinesia only affects the mouth & lips

A

FALSE

39
Q

is tardive dyskinesia dose or time related?

A

BOTH

40
Q

who is at greatest risk for developing tardive dyskinesia? (race, gender)

A

male, african american

41
Q

what can happen if you stop the meds causing tardive dyskinesia?

A

it might worsen

or it might resolve

42
Q

which has the higher risk of developing tardive dyskinesia: haloperidol vs. olanzapine

A

haloperidol (risk = 7.45%)

olanzapine risk = 0.52%
at 1 yr

43
Q

which antipsychotic drug has the greatest weight gain?

A

clozapine (nearly tied w/ olanzapine)

44
Q

which antipsychotics have the lowest weight gain?

A

moban (weight loss)

geodon

45
Q

what can you do to treat weight gain d/t antipsychotics?

A 
change meds
decrease dose
exercise
nutritional counseling
metformin
46
Q

what side effects can D2 receptor drugs cause?

A

EPS

elevated prolactin

47
Q

what side effects can muscarine receptor drugs cause?

A 
cognitive deficits
dry mouth
constipation
inc HR
urinary retention
blurred vision
48
Q

what side effects can histamine receptor drugs cause?

A

sedation
weight gain
dizziness

49
Q

what side effects can alpha 1 receptor drugs cause?

A

hypotension

50
Q

what side effects can serotonin (5-HT2C) receptor drugs cause?

A

satiety blockade

51
Q

what side effects can serotonin (5-HT2A) receptor drugs cause?

A

maybe anti-EPS

52
Q

what is the QT interval?

A

time btwn start of Q wave & end of T wave in an EKG

53
Q

what is happening in the heart during the QT interval?

A

electrical depolarizaiton & repolarization of the ventricles

54
Q

what is prolonged QT a risk factor for?

A 
ventricular tachyarrhythmias (esp torsades de pointes)
sudden death
55
Q

what does the normal QT interval depend on?

A

heart rate

56
Q

what is QTc?

A

corrected QT interval

57
Q

what does QTc estimate QT interval at? (what HR)

A

60 bpm

58
Q

what is NORMAL QT?

A

less than or equal to 400ms (some debate)

59
Q

what is abnormal QT for males?

A

<450 ms

60
Q

what is abnormal QT for females?

A

<470ms

61
Q

what is borderline QT for males?

A

431-450 ms

62
Q

what is borderline QT for females?

A

451-470 ms

63
Q

when is a pt at risk for sudden death d/t QT?

A

at borderline or abnormal QT (diff for males vs females)

64
Q

what are the 4 most important risk factors for increased QTc?

A

hypokalemia
hypomagnesemia
hypocalcemia
meds

65
Q

what is the avg QT prolongation for risperidone?

A

4 ms

66
Q

what is the avg QT prolongation for thioridazine?

A

30 ms

67
Q

what are the common behavioral probs in dementia?

A

psychosis
agitation
suspiciousness
irritability

68
Q

what meds should you treat dementia behavioral probs with?

A

antipsychotics & benzos short term (dangerous & ineffective long term)

69
Q

what side effects might benzos have w/ behavioral probs in dementia?

A

increased confusion

falls (d/t sedation)

70
Q

what should your first step be in managing behavioral probs w/ dementia?

A

psychosocial interventions esp managing env cues (social interactions)

71
Q

what is the black box warning you should be worried about w/ pts w/ dementia?

A

increased mortality in elderly pts w/ dementia-related psychosis

72
Q

which drug is NOT approved for tx of pts w/ dementia-related psychosis?

A

zyprexa

73
Q

what drugs can you use for pts w/ dementia-related psychosis?

A

citalopram

risperidone

74
Q

T/F: citalopram & risperidone work for dementia-related psychosis immediately

A

false

takes some time to work

75
Q

T/F: citalopram & risperidone may not work in pts w/ vascular dementia

A

true

76
Q

what increases risk of drug-induced long QT & arrhythmia propensity?

A 
pts w/...
hypokalemia
abn T wave morphology
Hep C virus infection
HIV infection

Block 8 Week 6 Rhonda (12 decks)

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