Segars: Antipsychotics Flashcards
Which drug is good for recurrent suicidal behavior?
-Clozapine
Positive sx of schizophrenia
- hallucinations, delusions, disorganized speech/thinking, agitation, abnormal motor behavior
- meso-limbic pathway
What is the main difference between agent-groups?
-reduction in movement-disorder SE’s
What are the 2 kinds of antipsychotics?
- First gen
- second gen
First Generation agents (typical)
- Choropromazine
- fluphenazine
- haloperidol
- Thioridazine
- Thiothixene
Second generation agents (atypical)
-Aripiprazole
-clozapine
-olanzapine
-quetiapine
=risperidone
=ziprasidone
Negative sx for schizo
- apathy, avolition, alogia, cognitive deficits, social withdrawal
- mesocortical pathway
What does dopamine inhibit?
- prolactin release
- tuberoinfundibular pathway
Which brain pathways are associated with side effects?
-Nigrostriatal pathway and the EPS
what do first gen antipsychotics do?
-block DA type 2 (D2) post synaptic receptors
what other receptors do FGA’s bind to?
- muscarinic
- Histamin
- alpha adrenergic receptors
- D2 receptors
Muscarinic FGA SE’s
- dry mouth
- cant poo
- cant pee
- blurred vision
- sedation
Alpha adrenergic effects of FGA’s
-orhtostatic hypotension
-dizziness/syncope
-
Histamine effects for FGA’s
-sedation
What does dopamine affect?
-hyperprolactinemia
=extrapyramidal sx (like parkinsonism)
Tx for extrapyramidal sx
-anticholinergic agents
-Diphenhydramine
=beztropine
=trihexyphenidyl
What does High D2 occupancy lead to?
-High EPS risk
What 2 categories do we divide the FGA’s into?
- Low potency: chlorpromazine
- thioridazine
- high potency
- High potency:
- Fluphenazine
- Haloperidol
- Thiothixene
What doe SGA’s do?
- block D2 receptors and also 5HT2A
- stronger for serotonin
What is the D2 partial agonist?
- Aripiprazole
- aiding in dysregulation in the mesocortical pathway
what is clozapine only reserved for?
-recurrent suicidal effects
SGA SE’s
- weight gain
- metabolic effects: hyperglycemia/insulin resistance, hyperlipidemia
Which drugs will give you weight gain and diabetes?
- the SGA’s!
- Clozapine
- olanzapine
- but aripiprazole and ziprasidone are good
Which drugs will give us hypercholesterolemia
- clozapine
- olanzapine
Which first gen drug had a lot os +’s
-Chorpromazine
Which drug will give us EPS/ tardive dyskinesia?
-haloperidol
Which drug will give us prolactin elevation?
-the FGA’s!
Which drugs will give us sedation?
- Chlorpromazine
- Thioridazine
- clozapine (the suicide question is the only one when this will be the answer)
- Quetipaine (quieting the patient lol)
Which drugs are the really good ones generally?
- Aripiprazole
- ziprasidone
Which drugs will give us Anticholinergic SE’s
- Chlorpromazine
- Thioridazine
- Clozapine
Which drug will give us QT prolongation
-Thioridazine
rare but severe SE for Clozapine
-agranulocytosis
Which drug will give us a drug reaction w/ eosinophilia and systemic sx?
-olanzapine
What is the tx for Neuoleptic malignant syndrome?
- dantrolene
- blocks RyR
What is the baseline antipsychotic monitoring we want to do?
- Medical and gamily hx including CV disease
- Weight
- Waist circumference
- Blood Pressure
- Fasting glc
- fasting lipid
Which agents are more commonly recommended and utilized as first line, initial therapy?
-the atypical agents
What is critical?
- adherence
- non adherence can be managed with long acting jecectable agents
- ROAP
- Risperidone
- olanzapine
- aripiprazole
- Paliperidone palmitiate
Does antipsychotic tx take long?
-yes, god yes
What drug do we give for multi drug resistance or suicidal thoughts?
-clozapine
Which agents are known for having EPS related SE’s?
- First Gen!
- Haloperidol
Easy way to remember the SGA’s?
-the ending “apine”
