[PHARM] Anti-psychotics [Segars]

Question 1

What antipsychotic is used for suicidal behavior?

Answer 1

Clozapine

Question 2

What 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 (2) high potency 1st gen agents?

Answer 19

Haloperidol

Fluphenazine

Question 20

What are the (2) classes of drugs used to treat extrapyramidal symptoms (EPS)?

What are those drugs?

Answer 20

Anticholinergic agents = Benztropine & Trihexyphenidyl

Antihistamine agents = Diphenhydramine

Question 21

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

What are those drugs?

Answer 21

Selective vesicular monoamine transporter 2 inhibitors

Valbenazine

Deutetrabenazine

Question 22

What is the MOA of second generation antipsychotics?

Answer 22

Block dopamine (D2) receptors

AND

5HT2A

Question 23

What is the -suffix for the second generation antipsychotics that are 5HT-2A/DA receptor antagonists?

Name the (3) drugs

Answer 23

• idone
• Lurasidone
• Risperidone
• Ziprasidone

Question 24

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

Name the (1) drugs

Answer 24

-piprazole

Aripiprazole

Question 25

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

Answer 25

-apine Clozapine Olanzapine Quetiapine

Question 26

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

Answer 26

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

Question 27

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

Answer 27

Weight gain Metabolic effects QTc prolongation/ECG changes

Question 28

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

Answer 28

Aripiprazole

Question 29

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

Answer 29

Agranulocytosis

Question 30

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

Answer 30

Drug reaction w/ eosinophilia and systemic symptoms (DRESS)

Question 31

What is neuroleptic malignant syndrome (NMS)?

Answer 31

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

Question 32

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

Answer 32

Dantrolene

Question 33

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

Answer 33

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

Question 34

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

Answer 34

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

Question 35

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

Answer 35

Chlorpromazine Fluphenazine Haloperidol Thioridazine

Question 36

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

Answer 36

Aripiprazole Cariprazine Clozapine Lurasidone Olanzapine Quetapine Risperidone Ziprasidone