[PHARM] Anti-psychotics [Segars] Flashcards
What antipsychotic is used for suicidal behavior?
Clozapine
What antipsychotic drug is used for hallucinations/delusions associated with parkinson disease psychosis?
Pimavanserin
(remember, P with Parkinson)
What are examples of positive symptoms of schizophrenia?
Hallucinations
Delusions
Disorganized speech/thinking
Agitation
Abnormal motor behavior
What are examples of negative symptoms of schizophrenia?
Apathy
Avolition
Alogia
Cognitive deficits (working memory)
Social withdrawal
What are the implications with D2 antagonism?
1) Induces extrapyramidal symptoms (pseudoparkinsonism)
2) Hyperprolactinemia
What is suffix is -azine associated with?
First generation agents
-azine
What suffix is -idone associated with?
Second generation agents
-idone
What suffix is -piprazole associated with?
Second generation agents
-piprazole
What suffix is -apine associated with?
Second generation agents
-apine
What is the primary difference b/w 1st generation agents and 2nd generation agents?
Second generation have reduced movement disorder side effects than first gen
MOA of first generation antipsychotics?
Primarily block dopamine type 2 (D2) post synaptic receptors
Where are other sites of action of 1st generation antipsychotics?
In addition to primarily blocking D2 receptors…
- Muscarinic (M)
- Histamine (H1)
- Alpha adrenergic (Alpha1)
What are the SE associated with blocking muscarinic receptors?
Dry mouth
Constipation
Urinary retention
Blurred vision
Sedation
What are the SE associated with blocking alpha adrenergic receptors?
Orthostatic hypotension
Dizziness/syncope
What are the SE associated with blocking histamine receptors?
Sedation
Describe the dopamine associated side effects:
Hyperprolactinemia
Extrapyramidal symptoms (EPS) (acute or tardive dyskinesia)
When is the D2 occupancy dangerous for getting extrapyramidal symptoms?
Greater than approx 80%
What are the (2) low potency 1st gen agents?
Chlorpromazine
Thioridazine
What are the low potency agents more well known for?
more sedation, hypotension, tachycardia, ECG-changes
What are the (2) high potency 1st gen agents?
Haloperidol
Fluphenazine
What are the high potency agents more associated with?
more movement (EPS) and endocrine effects (prolactin)
How do you treat a patient with dystonia (EPS)?
- Anticholinergics (benztropine, Diphenhydramine, and Trihexyphenidyl)
What can you use to treat a patient with akathisia?
3 Bs:
- Beta-blocker (propranolol)
- Benzodiazepine (lorazepam)
- Anticholinergic (Benztropine)
How can you treat a patient with EPS of parkinsonism?
- Anticholinergic (benztropine)
- Dopamine enhancer (release/reuptake) (amantadine)
what is tardive dyskinesia and how can you treat it?
repetitive, uncontrollable movements, >6 months
selective vesicular monoamine transporter 2 (VMAT2) (valbenazine and deutetrabenzine)
What is the class of drugs used to treat tardive dyskinesia (TD)?
What are those drugs?
Selective vesicular monoamine transporter 2 inhibitors
Valbenazine
Deutetrabenazine
What is the MOA of second generation antipsychotics?
Block dopamine (D2) receptors
AND
5HT2A
What is the -suffix for the second generation antipsychotics that are 5HT-2A/DA receptor antagonists?
Name the (3) drugs
- idone
- Lurasidone
- Risperidone
- Ziprasidone
What is the -suffix for the second generation antipsychotics that are PARTIAL 5HT-1A/DA receptor AGONISTS?
Name the (1) drugs
-piprazole
Aripiprazole
What is the -suffix for the second generation antipsychotics that are multi-acting receptor-target agents?
Name the (3) drugs
-apine
Clozapine
Olanzapine
Quetiapine
What is the ONE inverse serotonin agonist/antagonist?
Pimavanserin
(Parkinson’s psychosis)
What are the common side effects with second generation anti-psychotics?
Weight gain
Metabolic effects
QTc prolongation/ECG changes
Which second generation antipsychotic med should be your go-to?
(fewest side effects)
Aripiprazole
What is one of the RARE side effects of clozapine?
Agranulocytosis
What is the ONE rare side effect of olanzapine that is noteworthy?
Drug reaction w/ eosinophilia and systemic symptoms (DRESS)
What is neuroleptic malignant syndrome (NMS)?
Rare but potentially fatal, severe Parkinson’s like movement disorder w/ wide spread muscle contraction
What is the antidote for neuroleptic malignant syndrome?
Dantrolene
What sort of labs should you aquire before prescribing second gen antipsychotics?
Serum glucose
Lipids
Weight
BP
Waist circumference
Personal/FH of metabolic and CV disease
What are the (4) Long acting injectable agents?
“ROAP”
R= Risperidone
O= Olanzapine
A= Aripiprazole lauroxil
P= (will not be on exam) just remember top 3
What are the (4) first generation agents that segars wants you to know?
Chlorpromazine
Fluphenazine
Haloperidol
Thioridazine
What are the (8) second generation agents that segars wants you to know?
Aripiprazole
Cariprazine
Clozapine
Lurasidone
Olanzapine
Quetapine
Risperidone
Ziprasidone
