Segars Anti Psychotics chart high yield Flashcards
What generation is most likely to case Weight gain and Diabetes?
examples?
- Second Generation (SGAs)
- the “prazoles”, “apines” and “idones”
- Most likely Clozapine and Olanzapine
SGAs Least likely to cause weight gain and Diabetes?
- Aripiprazole
- Ziprasidone
Which Generation is most likely to cause hypercholesterolemia?
examples?
- SGAs
- Clozapine
- Olanzapine
Generation most like to cause EPS/Tardive Dyskenesia?
Most likely drug?
which drug in that generation is least likely?
- FGAs
- “idol”, “azine”, “ixene”
- MOST LIKELY is haloperidol
- LEAST LIKELY Chlorpromazine and Thiordazine
Which FGA is most likely to cause hypercholesterolemia?
least likely?
- most likely = chlorpromazine
- least likely Fluphenazine and Haloperidol
Which SGA is the worst for causing EPS/Tardive dyskenisia?
-Risperidone is the most likely
Generation most likely to cause prolactin elevation?
examples?
- FGAs
- HALOPERIDOL, Fluphenazine, and thioridazine
Generation most likely to cause sedation?
examples?
- FGAs most but also some SGAs
- FGAs ie Chlorpromazine, Thioridazine
- SGAs ie Quetiapine, Olanzapine, and Clozapine
Quetiapine sounds like quiet as in sedation
Generation most likely to cause anticholinergic side effects?
examples?
- FGAs and SGAs
- FGAs ie Thioridazine
- SGAs Clozapine
Least likely to cause anticholinergic effects?
- SGAs ie Aripiprazole and Ziprasidone
- these two drugs have VERY LOW risk of side effects. they are the best atypical antipsychotics
- only rarely do weight gain/diabetes, eps, sedation
Generation most likely to cause orthostatic hypotension?
what receptor?
examples?
- SGAs has more examples Clozapine
- alpha receptor
- FGAs ie Thiroidazine (most stars) or Chlorpromazine
Generation most likely to cause QT prolongation?
examples?
- FGAs
- ie Thioridazine
- if on a SGA, Ziprasidone is most likely
Why is Clozapine used last?
- it causes agranulocytosis, so you must monitor WBC
- very rare hypersensitivity reaction called……. Drug reaction w/ Eosinophillia and Systemic Symptoms (DRESS)
- you’ll see skin eruptions and other allergic signs
- doctors must be trained before using this drug
Besides DRESS what else does Clozapine cause?
Treatment? How does it work?
Olanzapine or Clozapine will be in the question stem
- Neuroleptic Malignant Syndrome (NMS)
- rare, severe parkinsons like mvt disorder w/ wide spread muscle contraction
- patients develop rhabdomyolysis
Treatment = Dantrolene, which stops malignant hyperthermia by closing the rhyanodine receptor so that calcium cant get out which limits the profound muscle contractions
If you put a patient on a FGA and especially a SGA what must you do?
- serum glucose
- lipid profile
- weight (BMI)
- blood pressure
- waist circumference
- FH of heart/metabolic issues
What do most clinician start with?
-SGAs
how do we defeat nonadherent patients, jobless, homeless patients?
-long acting injectable agents (LAIAs)
- ie ‘ROAP”
- Risperidone
- Olanzapine
- Aripiprazole
- Paliperidone
How long until we see changes of therapy?
-weeks w/ maximum benefit taking several months
is multimodal or unimodal therapy better?
-multimodal therapy
ie drugs along with support and emotional help
What do we use for treatment resistant disease?
-Clozapine
issues in the Mesolimbic pathway from VTA to NA deals with?
positive symptoms of schizophrenia
issues in the Mesocortical pathway from VTA to Cortex deals with?
negative symptoms of schizophrenia
issues in the Nigrostriatal pathway from substantia nigra to basal ganglia deals with?
associated with the side effects
ie. psuedoparkinson symptoms
issues in the Tuberoinfundubular pathway from Hypophysis to infundibular region deals with?
increases in prolactin levels
What three drugs are antidotes to dopamine OD
DBT
“D.opamine B.eating T.reatments”
Diphenhydramine (Benadryl)
Benztropine ( Congentin)
Trihexyphenidyl
FGAs in general cause what categories of side effects?
EPS/Tardive dyskinesia
prolactin elevation
SGAs in general cause what categories of side effects?
Weight gain/hyperglycemia
hypercholesterolemia
These cause weight gain/Diabete Mellitus
SGAs»_space; FGAs
Olanzapine**
Clozapine**
Arip* and Zipra*
FGA
Chlorpromazine***
These cause hypercholesterolemia
SGAs»_space; FGAs
Olanzapine**
Clozapine**
Aripprazole* and Ziprasidone*
FGA
Chlorpromazine*
These cause EPS/Tardive Dyskinesia
FGAs»_space; SGAs
Haloperidol**
Chlorpromazine and Thioridazine*
SGAs
Risperidone***
These cause prolactin elevation, breast growth, glacctorreah, amenorrhea
FGAs»_space; SGAs
Fluphenazine*
Haloperidol*
What are the high potency FGAs?
Fluphenazine
Haloperidol
Thiothixene
These cause sedation
FGAs = SGAs
FGAs
Chlorpromazine*
Thioridazine*
SGAs
Clozapine* BUT this will only be the correct answer on the test for treatment resistant disease and suicide prone
Olanzapine and Quetiapine**
These cause anticholinergic side effects
FGAs > SGAs
FGAs
Thioridazine**
Chlorpromazine*
SGAs
Clozapine***
What SGAs cause little to no side effects?
Aripiprazole and Ziprasidone
Ziprasidone** for QTc prolongation
These cause orthostatic hypotension
FGAs > SGAs
Thioridazine**
Chlorpromazine*
SGAs
Clozapine***
Receptor involved in orthostatic hypotension?
blockade of the alpha adrenergic
These cause QTc prolngation
FGAs > SGAs
Thioridazine***
SGAs
Ziprasidone**
