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From Flashcardlet > Psych 7: Antipsychotics > Flashcards

Psych 7: Antipsychotics Flashcards

1
Q

Key features of Risperidone

A
  1. high affinity for D2 receptors
  2. more likely to cause EPS than other atypicals
  3. more likely to cause hyperprolactinemia
    * *most like typicals b/c made first = retro
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2
Q

Key features of Olanzapine

A
  1. most likely to cause metabolic syndrome –> esp obesity! (“O for obesity”)
  2. causes sedation
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3
Q

Key features of Quetiapine

A
  1. causes a significant H1 blockade –> causes lots of sedation = quieting
  2. has low EPS incidence
  3. off label use = insomnia and anxiety
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4
Q

Key features of Ziprasidone

A
  1. least likely to cause weight gain

2. might lengthen the QT interval

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5
Q

Key features of Aripiprazole

A
  1. partial D2 agonist

2. most likely to cause akathisia

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6
Q

Key features of Clozapine

A
  1. blocks D4 receptors
  2. can cause agranulocytosis –> so need to closely monitor pts! & pt adherence is critical!!
  3. can cause sedation & metabolic syndrome –> esp wt gain
  4. can improve pre-existing TD
  5. can cause cardiac arrest
    * *use as last resort since it has so many dangerous sfx!
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7
Q

What does the efficacy of antipsychotics correlate with?

A

-the amnt of dopamine blockade (= decrease dopamine)

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8
Q

What can induce psychotic sx?

A
  • dopamine agonists (= increased dopamine)

- ex. amphetamines, cocaine, amantadine

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9
Q

Name the 4 dopamine pathways:

A
  1. mesolimbic
  2. mesocortical
  3. nigrostriatal
  4. tuberoinfundibular
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10
Q

Mesolimbic pathway key features

A
  1. from VTA –> limbic system
  2. increased dopamine causes + sx!
  3. D2 blockade causes a DECREASE in + sx!

**so this pthwy deals with POSITIVE sx!

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11
Q

Mesocortical pathway key features

A
  1. from VTA –> frontal cortex
  2. plays a role in NEGATIVE sx
  3. a serotonin blockade –> increased dopamine –> alleviates negative sx!
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12
Q

Nigrostriatal pathway key features

A
  1. from substantia nigra –> striatum (BG)
  2. D2 blockade in this pathway causes EPS sx (parkinsonism, akathisia, dystonia, tardive dyskinesia) = hypokinetic mvmnt (hyperkinetic mvmnt can result from too much dopamine)

**by blocking the dopamine you are allowing for an increase in Ach = causes mvmnt disorders! –> tx = anti-cholinergics!

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13
Q

Tuberoinfundibular pathway key features

A
  1. from hypothalmus –> pituitary gland
  2. Dopamine inhibits prolactin
  3. D2 blockade causes HYPERLACTINEMIA
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14
Q

3 Anticholinergic drugs

A
  1. benztropine
  2. trihexyphenidyl
  3. diphenyhydramine = benadryl
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15
Q

Drug induced parkinsonism sx + cause

A
  1. shuffling gait
  2. muscular rigidity
  3. tremor
  4. bradykinesia
    * *can be the result of too much blockade of D2 receptors in the nigrostriatal pthwy
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16
Q

Akathsia: what is it? sx? cause? tx?

A
  • psychological mvmnt disorder
  • can be a side effect of aripiprazole or risperidone
  • sx: unpleasant sensation & urge to move legs + inner restlessness
  • tx: beta-blocker
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17
Q

Dystonia: what is it? when does it occur? who is it most common in? tx?

A
  • painful involuntary muscle spasms - usually in head/neck
  • usually occurs with 48 hrs or 5 days
  • most common in young muscular AA males
  • tx: anticholinergics
18
Q

4 types of dystonia?

A
  1. oculogyric crisis = eye muscles
  2. torticolis =neck muscles
  3. trismus = jaw muscles
  4. buccolingual crisis = tongue muscles
19
Q

Tardive dyskinesia: cause? sx? prognosis?

A
  • cause: continuous blockade in DA receptors will lead to the up-regulation of receptors –> hyperkinetic mvmnt disorder
  • sx: abnormal involuntary mvmnts of face, neck, extremitied (chewing mvmnts, toung protrusions, grimacing, etc.)
  • usually does NOT go away :(
20
Q

What are the 4 ideal effects of an antipsychotic?

A
  1. decrease dopamine in the mesolimbic pthwy
  2. increase dopamine in the mesocortical pthwy
  3. no changes with dopamine in the nigrostriatal and tuberoinfundibular pthwys
21
Q

What are the 8 anti-cholinergic side effects? The blocking of which type of receptor will cause these?

A
  1. hot as a hare = hyperthermia
  2. dry as a bone = dry mouth
  3. red as a beet = flushing
  4. mad as a hatter = confusion
  5. blind as a bat = dbl vision
  6. cant see = vision changes
  7. cant pee = urinary retention
  8. cant sh*t = constipation
    * *blocking of muscarinic receptor can cause this!
22
Q

What are the 3 sfx of adrenergic blockade?

A
  1. drowsiness
  2. orthostatic hypotension
  3. dizziness
23
Q

What are the 2 sfx of histamine blockade?

A
  1. drowsiness

2. weight gain

24
Q

Low potency typical antipsychotics and their sfx?

A
  1. Chlorpromazine
    - sfx: cause anti-cholinergic, anti-histaminic, and anti-adrenergic sfx
    * *less likely to cause EPS –> bc since they need to be given at a higher dose they tend to cause blockage of muscarinic receptors = act as anti-cholinergics too!
25
Q

High potency typical antipsychotics & sfx?

A
  1. haloperidol
  2. fluphenazine
  3. trifluoperazine
    - sfx: EPS b/c have greater affinity for D2 receptor & have less anti-cholinergic effects
26
Q

Neuroleptic Malignant syndrome: sx? cause? tx?

A
  • sx: muscle rigidity, fever, autonomic instability, decreased level of consciousness, elevated CPK
  • cause: dopamine receptors being blocked too rapidly
  • tx: STOP ANTIPSYCHOTICS + dopamine agonists & muscle relaxants
27
Q

Antipsychotics and seizures?

A
  • ALL antipsychotics reduce seizure threshold = pt will have more seizures when on these meds
  • dose dependent –> avoid rapid increase in dose and high doses
  • highest risk is w/ chlorpromazine & clozapine
28
Q

2 MOA of atypical antipsychotics?

A
  1. Serotonin antagonist

2. fast dissociation from D2 receptors

29
Q

What are 2 things that atypicals are less likley to cause than typicals?

A
  1. EPS

2. TD

30
Q

What is the effect of the blocking of serotonin by the atypicals?

A
  • since serotonin inhibits dopamine release, blocking serotonin with cause domaine to be released to the 4 dopamine pthwys
  • this allows for more dopamine to be around and compete with the atypical antipsychotic for dopamine receptors = some of the effects of dopamine blockade get reversed
  • this means that negative sx get reduced b/c they are not being created
31
Q

Atypicals and the mesolimbic pthwy

A
  • *dopamine blockade is NOT reversed

- serotonin receptor blockade does NOT reverse the effects of teh D2 receptor blockade –> so + sx are reversed!

32
Q

Atypicals and the mesocortical pthwy

A
  • *dopamine release > blockade
  • there are more serotonin receptors than D2 receptors, so there will be more dopamine release than dopamine blockade
  • this increase in dopamine levels = less neg sx present + improvement in cognitive fctning
33
Q

Atypicals and the nigrostriatal pthwy

A
  • *dopamine blockade paritally reversed
  • the blockde of serotonin = increase in dopamine levels = more dopamine to compete for synaptic receptors –> partially reverses the blockade and decreases EPS
  • *less TD occurs with atypiclas!
34
Q

Atypicals in the tuberoinfundibular pthwy?

A
  • *dopamine blockade partially reversed
  • serotonin increases prolactin and dopamine decreases prolactin levels
  • serotonin blockade = to some degree cancels the effects of the dopamine blockade
35
Q

2 most common sfx w/ halloperidol

A
  1. EPS
  2. TD
    * *its a typical!
36
Q

Atypicals and QTc

A
  • ALL atypicals can cause QT prolongation (but not torsades)

- except: aripiprazole!

37
Q

Typicals and QTc

A
  • ALL typicals can cause prolonged QT AND torsades! –> esp when given IV
  • esp. haldol
  • *but the CATIE study may have disproved any link btwn any of these drugs and the QT interval
38
Q

Black box warnings for atypicals

A
  1. can cause potentially fatal diabetes
  2. when given to elderly with dementia + psychosis–> can increase risk of death!
    * *these warning were eventually extended to include typicals too!
39
Q

What are the 3 sx of metabolic syndrome?

A
  1. weight gain
  2. dyslipidemia
  3. glucose intolerance
    * *ALL atypicals need to be monitored for these!
40
Q

Which 2 antipsychotics have the greatest risk for metabolic syndrome?

A
  1. clozapine

2. olanzapine

41
Q

Which psychotic sx go away first with tx?

A
  • *within first few days or hours
    1. agitation
    2. psychomotor excitement
42
Q

Which psychotic sx go away later with tx?

A
  • *over 3-5 wks
    1. though disorder
    2. hallucinations –> decreased intensity and freq
    3. delusions

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