Psych: Antipsychotics Flashcards
Which antipsychotic is useful for suicidal behavior?
Clozapine
Which antipsychotic is useful for the hallucinations/delusions associated with Parkinson’s Disease?
Pimavanserin
How long does it take for antipsychotics to work?
Minimum of 2-3 weeks
MOA of Chlorpromazine, fluphenazine, perphenazine, thioridazine, trifluoperazine?
D2 receptor antagonists
-also block muscarinic, H1
First generation (Typical) antipsychotics
MOA of haloperidol?
D2 receptor antagonists
-also block muscarinic, H1
First generation (Typical) antipsychotics
MOA of loxapine, molindone, pimozide, and thiothixene?
D2 receptor antagonists (D2>5HT)
-also block muscarinic, H1
First generation (Typical) antipsychotics
MOA of iloperidone, lurasidone, paliperidone, risperidone, ziprasidone?
5HT2A and D2 blockers (5HT>DA)
Second generation (Atypical) antipsychotics
MOA of apripiprazole and brexipiprazole?
Partial DA/5HT1 receptor agonists
Second generation (Atypical) antipsychotics
MOA of cariprazine ?
5HT2/D2 antagonist and partial DA/5HT1 agonist
Second generation (Atypical) antipsychotics
MOA of asenapine, clozapine, olanzapine, quetiapine and lumateperone?
Multi-acting Receptor target agents
Second generation (Atypical) antipsychotics
MOA of pimavanserin?
Inverse 5HT agonist
Second generation (Atypical) antipsychotics
What are some of the adverse effects associated with the first-generation antipsychotics?
Muscarinic
-dry mouth, constipation, urinary retention, blurred vision
Alpha-adrenergic
-orthostatic hypotension, dizziness/syncope
Other
-risk of QTc
Hyperprolactinemia
Extrapyramidal symptoms
What are the acute extrapyramidal symptoms associated with first generation antipsychotics?
Acute akathisia, dystonia, parkonsonian like
What are the late symptoms of first generation antipsychotics?
Tardive dyskinesia
How do you treat the extrapyramamidal symptoms?
Benztropine and Trihexyphenidyl
Also diphenhydramine
How do you treat tardive dyskinesia associated with first gen antipsychotics?
Selective VMAT2 inhibitors
Valbenazine and deutetrabenazine
What are common side effects among all the second generation antipsychotics?
Weight gain and metabolic effects
QT prolongation
Stroke
What do you have to test for before starting a patient on second gen antipsychotics?
serum glucose, lipids, BMI, BP, waist circumference, personal/family history of CV disease
Mainly establishing baseline of metabolic issues due to the risk**
Which second gen antipsychotic is associated with agranulocytosis?
Clozapine
-monitor WBC
Which second gen antipsychotic is associated with DRESS syndrome?
Olanzapine
What is a severe adverse reaction that includes severe fever and muscle rigidity that is associated with all antipsychotics?
Neuroleptic Malignant Syndrome (NMS)
-Tx: dantrolene
How do you treat Neuroleptic Malignant Syndrome (NMS)?
Dantrolene
-Ca++ channel blocker (RYR channel)
Which drugs should be used for non-adherence to meds?
Haloperidol decanoate
Fluphenazine decanoate
Risperidone
Olanzapine
Ariprazole lauroxil
Paliperidone palmitate
Which second-generation antipsychotics are LEAST associated with weight gain? (3)
Aripiprazole
Lurasidone
Ziprasidone
which subclass of first-generation antipsychotics is LEAST associated with sedation, anticholinergic, and orthostatics? (H1, M1, and a1 blockage in other terms)
Haloperidol, Thiothixene, and Fluphenazine
-High potency
Hal Tries Flying High
which subclass of first-generation antipsychotics is MOST associated with sedation, anticholinergic, and orthostatics? (H1, M1, and a1 blockage in other terms)
Chlorpromazine and thioridazine
-low potentcy
Cheating Thieves are Low
Which class, 1st or 2nd, is more associated with extrapyramidal symptoms?
1st
Which class, 1st or 2nd, is more associated with metabolic symptoms?
2nd
Antagonism of what receptor causes amenorrhea and galactorrhea? What could you prescribe to prevent this?
D2 antagonists (Resperidone is worst of this)
To prevent, prescribe a D2 partial agonist (ie Ariprazole)
