Neuroleptics/Antipsychotics Flashcards
What is another name for antipsychotics?
Neuroleptics
What are antipsychotics used to treat? What are three examples?
They are used primarily to treat psychosis
i.e., hallucinations, delusions, and thought disorder
The word neuroleptic is derived from which two Greek words?
The Greek words for “nerve” and “affecting” (lentikos, which means seizing)
Neuroleptics were originally understood to do what?
Reduce the intensity of nerve function
Neuroleptics used to be called what?
Major tranquilizers
Thorazine
First Generation
Chlorpromazine
Prolixin
First Generation
Fluphenazine
Haldol
First Generation
Haloperidol
Loxitane
First Generation
Loxapine
Trilafon
First Generation
Perphenazine
Orap
First Generation
Pimozide
Mellaril
First Generation
Thioridazine
Navane
First Generation
Thiothixene
Stelazine
First Generation
Trifluoperazine
Abilify
Second Generation
Aripiprazole
Saphris
Second Generation
Asenapine
Clozaril
Second Generation
Clozapine
Fanapt
Second Generation
Iloperidone
Latuda
Second Generation
Lurasidone
Zyprexa
Second Generation
Olanzapine
Invega
Second Generation
Paliperidone
Seroquel
Second Generation
Quetiapine
Risperdal
Second Generation
Risperidone
Geodon
Second Generation
Ziprasidone
Both first and second generation antipsychotics block what type of receptors? In which specific system?
They block post-synaptic dopamine receptors in the mesolimbic system
How do you first and second generation antipsychotics each impact serotonin receptors?
First generation antipsychotics have minimal antagonism of serotonin receptors
Second-generation antipsychotics have greater antagonism of serotonin receptors
The side effects associated with both first and second generation antipsychotics are due to antagonism at which three types of receptors?
Histaminic, muscarinic, and Alpha adrenergic receptors
Antipsychotic medications are FDA approved for which 5 conditions?
Schizophrenia
bipolar disorder
major depressive disorder (adjunctive therapy)
autism
Tourette’s disorder
In dementia, what is the non-FDA approved use of antipsychotic medications?
For behavioral disturbances
What is the non-FDA approved use of antipsychotic medications in substance use disorder?
To promote reduction in use
What is the non-FDA approved use of antipsychotic medications in patients with anorexia nervosa?
To increase body weight
Antipsychotic medications are used as non-FDA approved adjunctive therapy in which 2 conditions?
Obsessive-compulsive disorder
post-traumatic stress disorder
True or false: antipsychotic medication is used as a non-FDA approved therapy for generalizing anxiety disorder?
True
Antipsychotic medications are also not FDA approved for the treatment of which three symptoms?
Hiccups, nausea/vomiting, and delirium
What are 4 examples of extrapyramidal side effects?
Dystonia, akathisia, parkinsonism, tardive dyskinesia, Etc.
What type of syndrome can antipsychotic medication use trigger?
What 4 aspects of this syndrome characterize the condition?
Metabolic syndrome
Elevated lipids, hypertension, hyperglycemia, and obesity
What are 6 anti-cholinergic effects caused by antipsychotic medication use?
Confusion, agitation, constipation, xerostomia, blurred vision, and urinary retention
What kind of does-related effect can some antipsychotic medications have?
Does-related sedation
Use of antipsychotic medication may exhibit what type of EKG change in some patients?
Prolongation of QTC interval
Antipsychotic medications can cause what type of endocrinopathy?
Hyperprolactinemia (Inhibition of dopamine)
What effect can some antipsychotic medications have on blood pressure?
orthostatic hypotension
What impact can antipsychotic medications have on relationships and sexual health?
It can cause sexual dysfunction
Do some antipsychotic medications impact liver functioning?
Yes, they can lead to LFT elevations and hepatitis
A patient currently taking antipsychotic medications who presents with confusion, hyperthermia, tachycardia, muscle rigidity, and labile blood-pressure is more than likely suffering from what condition?
Neuroleptic malignant syndrome
Inducers or inhibitors of CYP450 have the potential to influence antipsychotics serum concentrations in what ways?
They have the ability to either decrease or increase serum concentrations of antipsychotic medications
Inducers or inhibitors of which 3 specific genotypes of CYP450 have the potential to influence antipsychotic serum concentrations?
1A2
3A4
2D6
Using antipsychotic medications in combination with antihypertensive agents may increase the risk of what complication?
Orthostatic hypotension
The use of antipsychotic medications in combination with benzodiazepines may increase the risk for what complication?
Over sedation
Using antipsychotic medications in combination with agents known to increase the QTC interval may increase the risk of what complication?
Torsades
Why are the second-generation antipsychotics now considered first-line therapy?
What three side effects are they associated with?
They are considered first-line due to their lower risk of extrapyramidal symptoms
Weight gain, lipid abnormalities, and incident diabetes
A 2012 journal article in the Annals of Internal Medicine, by Hartling, et al., which was a review of first vs. second generation antipsychotics showed what general finding?
It showed that there are few differences of clinical importance with regard to the use of first vs. second-generation antipsychotics for treating the core symptoms of schizophrenia
A 2012 journal article in the Annals of Internal Medicine, by Hartling, et al., which was a review of first vs. second generation antipsychotics, showed what type of clinical relationship between haloperidol and olanzapine?
There was some evidence for benefit of haloperidol over olanzapine for improving POSITIVE symptoms of schizophrenia
A 2012 journal article in the Annals of Internal Medicine, by Hartling, et al., which was a review of first vs. second generation antipsychotics, showed what second type of clinical relationship between olanzapine and haloperidol?
There was also some evidence of olanzapine over haloperidol for improving NEGATIVE symptoms of schizophrenia
A 2012 journal article in the Annals of Internal Medicine, by Hartling, et al., which was a review of first vs. second generation antipsychotics, showed an increased incidence of what syndrome with olanzapine?
Metabolic syndrome
A 2012 journal article in the Annals of Internal Medicine, by Hartling, et al., which was a review of first vs. second generation antipsychotics, showed low-strength evidence of a higher incidence of what adverse effect for chlorpromazine versus clozapine?
Tardive dyskinesia
A 2012 journal article in the Annals of Internal Medicine, by Hartling, et al., which was a review of first vs. second generation antipsychotics, showed what regarding diabetes mellitus?
Evidence was insufficient to draw conclusions regarding diabetes mellitus
The CATIE trial, Which was a 2005 journal article published in the New England Journal of Medicine by Lieberman et al. Compared perphenazine (a first-generation antipsychotic) with several second-generation antipsychotics in a double-blind study. The majority of patients in each group ended up doing what?
The majority of patients in each group discontinued their assigned treatment due to a lack of efficacy or intolerable side effects (74% by 18 months)
The CATIE trial, Which was a 2005 journal article published in the New England Journal of Medicine by Lieberman et al. Compared perphenazine (a first-generation antipsychotic) with several second-generation antipsychotics in a double-blind study. Which medication showed the greatest weight gain and increases in glucose and lipids?
Olanzapine
The CATIE trial, Which was a 2005 journal article published in the New England Journal of Medicine by Lieberman et al. Compared perphenazine (a first-generation antipsychotic) with several second-generation antipsychotics in a double-blind study. Which medication showed the greatest risk of extrapyramidal side effects?
Perphenazine
