[PHARM] Anti-psychotics [Segars]

Question 1

What antipsychotic is used for suicidal behavior?

Answer 1

Clozapine

Question 2

What antipsychotic drug is used for hallucinations/delusions associated with parkinson disease psychosis?

Answer 2

Pimavanserin

(remember, P with Parkinson)

Question 3

What are examples of positive symptoms of schizophrenia?

Answer 3

Hallucinations

Delusions

Disorganized speech/thinking

Agitation

Abnormal motor behavior

Question 4

What are examples of negative symptoms of schizophrenia?

Answer 4

Apathy

Avolition

Alogia

Cognitive deficits (working memory)

Social withdrawal

Question 5

What are the implications with D2 antagonism?

Answer 5

1) Induces extrapyramidal symptoms (pseudoparkinsonism)
2) Hyperprolactinemia

Question 6

What is suffix is -azine associated with?

Answer 6

First generation agents

-azine

Question 7

What suffix is -idone associated with?

Answer 7

Second generation agents

-idone

Question 8

What suffix is -piprazole associated with?

Answer 8

Second generation agents

-piprazole

Question 9

What suffix is -apine associated with?

Answer 9

Second generation agents

-apine

Question 10

What is the primary difference b/w 1st generation agents and 2nd generation agents?

Answer 10

Second generation have reduced movement disorder side effects than first gen

Question 11

MOA of first generation antipsychotics?

Answer 11

Primarily block dopamine type 2 (D2) post synaptic receptors

Question 12

Where are other sites of action of 1st generation antipsychotics?

Answer 12

In addition to primarily blocking D2 receptors…

• Muscarinic (M)
• Histamine (H1)
• Alpha adrenergic (Alpha1)

Question 13

What are the SE associated with blocking muscarinic receptors?

Answer 13

Dry mouth

Constipation

Urinary retention

Blurred vision

Sedation

Question 14

What are the SE associated with blocking alpha adrenergic receptors?

Answer 14

Orthostatic hypotension

Dizziness/syncope

Question 15

What are the SE associated with blocking histamine receptors?

Answer 15

Sedation

Question 16

Describe the dopamine associated side effects:

Answer 16

Hyperprolactinemia

Extrapyramidal symptoms (EPS) (acute or tardive dyskinesia)

Question 17

When is the D2 occupancy dangerous for getting extrapyramidal symptoms?

Answer 17

Greater than approx 80%

Question 18

What are the (2) low potency 1st gen agents?

Answer 18

Chlorpromazine

Thioridazine

Question 19

What are the low potency agents more well known for?

Answer 19

more sedation, hypotension, tachycardia, ECG-changes

Question 20

What are the (2) high potency 1st gen agents?

Answer 20

Haloperidol

Fluphenazine

Question 21

What are the high potency agents more associated with?

Answer 21

more movement (EPS) and endocrine effects (prolactin)

Question 22

How do you treat a patient with dystonia (EPS)?

Answer 22

1. Anticholinergics (benztropine, Diphenhydramine, and Trihexyphenidyl)

Question 23

What can you use to treat a patient with akathisia?

Answer 23

3 Bs:

1. Beta-blocker (propranolol)
2. Benzodiazepine (lorazepam)
3. Anticholinergic (Benztropine)

Question 24

How can you treat a patient with EPS of parkinsonism?

Answer 24

1. Anticholinergic (benztropine)
2. Dopamine enhancer (release/reuptake) (amantadine)

Question 25

what is tardive dyskinesia and how can you treat it?

Answer 25

repetitive, uncontrollable movements, \>6 months selective vesicular monoamine transporter 2 (VMAT2) (valbenazine and deutetrabenzine)

Question 26

What is the class of drugs used to treat **tardive dyskinesia (TD)?** What are those drugs?

Answer 26

Selective vesicular monoamine transporter 2 inhibitors Val**benazine** Deutetra**benazine**

Question 27

What is the MOA of **second generation antipsychotics?**

Answer 27

Block **dopamine (D2) receptors** AND **5HT2A**

Question 28

What is the -suffix for the **second generation antipsychotics** that are **5HT-2A/DA receptor antagonists?** Name the (3) drugs

Answer 28

- idone - Luras**idone** - Risper**idone** - Zipras**idone**

Question 29

What is the -suffix for the second generation antipsychotics that are **PARTIAL** 5HT-1A/DA receptor **AGONISTS**? Name the (1) drugs

Answer 29

-piprazole Ari**piprazole**

Question 30

What is the -suffix for the second generation antipsychotics that are **multi-acting receptor-target agents**? Name the (3) drugs

Answer 30

-apine Clozapine Olanzapine Quetiapine

Question 31

What is the ONE **inverse serotonin agonist/antagonist?**

Answer 31

Pimavanserin (**P**arkinson's **p**sychosis)

Question 32

What are the common side effects with **second generation anti-psychotics?**

Answer 32

Weight gain Metabolic effects QTc prolongation/ECG changes

Question 33

Which second generation antipsychotic med should be your go-to? (fewest side effects)

Answer 33

Aripiprazole

Question 34

What is one of the RARE side effects of **clozapine?**

Answer 34

Agranulocytosis

Question 35

What is the ONE rare side effect of **olanzapine** that is noteworthy?

Answer 35

Drug reaction w/ eosinophilia and systemic symptoms (DRESS)

Question 36

What is neuroleptic malignant syndrome (NMS)?

Answer 36

Rare but **potentially fatal,** severe Parkinson's like movement disorder w/ wide spread muscle contraction

Question 37

What is the antidote for **neuroleptic malignant syndrome?**

Answer 37

Dantrolene

Question 38

What sort of labs should you aquire before prescribing **second gen antipsychotics?**

Answer 38

Serum glucose Lipids Weight BP Waist circumference Personal/FH of metabolic and CV disease

Question 39

What are the **(4) Long acting injectable agents?**

Answer 39

"ROAP" R= Risperidone O= Olanzapine A= Aripiprazole lauroxil P= (will not be on exam) just remember top 3

Question 40

What are the (4) first generation agents that segars wants you to know?

Answer 40

Chlorpromazine Fluphenazine Haloperidol Thioridazine

Question 41

What are the (8) second generation agents that segars wants you to know?

Answer 41

Aripiprazole Cariprazine Clozapine Lurasidone Olanzapine Quetapine Risperidone Ziprasidone