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Year 2 Psych exam I > Pharm, Antipsychotics, Linger > Flashcards

Pharm, Antipsychotics, Linger Flashcards

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1
Q

atypical antipsychotics

A 
ariprprazole
lurasidone
olanzapine
quetiapine
risperidone
ziprasidone
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2
Q

special use atypical antipsychotics

A

clozapine

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3
Q

typical low potency agents for antipsychotic

A

chlorpromazine

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4
Q

typical high potency agents for anitpsychotic

A

haloperidol

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5
Q

chlorpromazine

A

dopamine R antagonist

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6
Q

most widely used type of antipsychotic

A

atypical like clozapine

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7
Q

dopamine R densities in schizophrenics

A

increased

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8
Q

phenothiazine derivative

A

chlorpromazine

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9
Q

butyrophenone derivative

A

haloperidol

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10
Q

common pharm attribute of atypical antipsychotics

A

greater effects at 5HT2a than at D2 R

most are partial agonists at 5HT1a which is synergistic with 5 HT2a R antagonisms

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11
Q

PK antipsychotics

A

first pass meatbolism
highly lipid soluble and protein bound
longer clinical duration than estimated
discontinuation well tolerated

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12
Q

which antipsychotic does not have a well tolerated discontinuation

A

clozapine

cause cholinergic rebound, and movement disorders

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13
Q

metabolism antipyschotics

A

cytochrone P450

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14
Q

all effective antipsychotics block what R

A

D2

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15
Q

atypical antipsychoitcs block what R more than D2

A

5-HT2a

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16
Q

mesolimbic-mesocortical pathway

A

involved in behavior and cognitive function
cell bodies in ventral tegmental area
antipsychotic if inhibit dopaminergic acitivy in pathway

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17
Q

nigrostriatal pathway

A

coordination voluntary movement
striatum
inhbition of dopaminergic activity causes extrapyramidal side effects

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18
Q

tuberoinfundibular system

A

regulates prolactin release (dopamine is inhibitory)

arcuate and periventricular nucli project hypothal and post pituitary

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19
Q

adverse effect if anti dopamine works in tuberinfundibular system

A

hyperprolactinemia

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20
Q

d2 like dopamine R

A

D2-4

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21
Q

how do d2 like R work

A

decrease cAMP via Gi and inhibit Ca Ch, open K Ch

pre and post synaptically and in caudate putamen

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22
Q

typical antipsychotics need what occupancy of D2 R to be effective

A

60%

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23
Q

extrapyramidal side effects from D2 antagonists occur at waht saturation

A

> 80%

24
Q

how can aripiprazole inhibit D2 with no EPS

A

partial agonist at D2

25
Q

what reduces suicide attempts in schizophrenics

A

clozapine

26
Q

nonpsych indications for antipsychotics

A

antiemesis
neurleptanesthesia
sleep onset and maintanence

27
Q

first line for schizoprenia

A

atypical antipsychotics (not clozapine or olanzapine)

28
Q

what is used for maintenance of uncooperative patients

A

IM formualations

haloperidol decanoate, fluphenazine decanoate, Risperdal consta

29
Q

side effect clozapine

A

agranulocytosis
dose related lowering of seizure threshold
myocarditis

30
Q

disadvantage to risperidone

A

EPS at high dose

hypotension at high dose

31
Q

disadvantage olanzapine

A

weight gain

dose related lowering seizure threshold

32
Q

disadvantage questiapine

A

high dose if assoc hypotension

twice day dosing from low halt life

33
Q

advantage questiapine

A

less weight gain

34
Q

disadvantage ziprasidone

A

QT prolongation

35
Q

which antipsychotics have lower weight gain

A

quistiapine
ziprasidone
aripiprazole

36
Q

Tx for how long before full effect

A

16-20 weeks

37
Q

electroconvulsive therapy

A

in adjunct for treating mood Sx and + Sx

can augment clozapine if max dose ineffective

38
Q

behavioral effects of antipsychotics

A

older drugs: anhedonia cannot expierieve pleasure, akinesia, toxic confusional state, sedation of antimuscarinic drugs

39
Q

early motor effects from antipsychotics

A

EPS like parkinsonism, increased acitivity (akathisia), acute dystonic reactions, dystonic reactions

40
Q

what is used to Tz early dystonic features of antispychotics

A

anticholinergic like benztropine or antihistamine antimuscarinic.
NEVER levodopa

41
Q

late motor effects antipsychotics

A

tardive dyskinesia, choreathetoid movements

imabalance

42
Q

which drugs have lower risk tardive dyskinesia

A

questiapine or clozapine

43
Q

if drug change or reduction does not help with tardive dyskinesia next step is to

A

remove all drugs with central anticholinergic acivity like tricyclic antidepressants,

44
Q

which antipyschotic may cause seziures

A

clozapine

45
Q

ANS effects antipsychoics

A

older drugs that bind alpha 1 and histamine
leads to anti PAN side effects: dry mouth, loss accomodation, difficulty urinating, constipation and anti alpha adrenergic side effects like orthostatic hypotensions, dizziness, sedation, impotence and failure to ejeculate

46
Q

weight gain is seen with what antipsychotics

A

majority
greatest effect with clozapine and olanzapine
be careful in DM because of hyperglycemia and ketoacidosis

47
Q

intermediate risk weigh gain

A

iloperidone
paliperidone
quetiapine
risperidone

48
Q

lowest risk weight gain

A

aripiprazole
lurasidone
ziprasidone

49
Q

hyperprolactinemia can cause

A

amenoorhea galactorrhea
infertility
osteoporosis in women
men: infertility, loss libido, impotence, breast enlargement

50
Q

which drugs can cause hyperPRL

A

risperidone and paliperidone

51
Q

minimal effects on PRL

A

quetiapine

olanzapine and aripiprazole

52
Q

is agranulocytosis from clozapine reversible

A

yes upon discontinuance

53
Q

what CV medications should be avoided in patients on antipsychotics

A

antiarrhythmics, and erythromycin because also prolong QT

54
Q

which antipsychotics preferred in pregnancy

A

atypical

category C

55
Q

Neuroepileptic Malignant Syndrome

A

patients sensitive to EPS
rare but life threatening
acute severe parkinsonism, muscl rigidity, ANS instability and HTN, hyperthermia and keukocytosis

56
Q

Tx neuroleptic Malignant Syndrome

A

mm relaxants like diazepam or dantrolene

dopamine agonists like bromocriptine

57
Q

what antipsychotic overdose is fatal

A

thioridazine- arrhythmia

Year 2 Psych exam I (15 decks)

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