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Phar 507 > Therapeutics of antipsychotics > Flashcards

Therapeutics of antipsychotics Flashcards

1
Q

T/F: Antipsychotics are used in schizophrenia for reduction in symptoms but do not eliminate the symptoms

A

True

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2
Q

What are the three SGAs that have the greatest efficacy, what order is the efficacy

A

Clozapine, Olanzapine, Risperidone/ Clozapine Olanzapine, Risperidone

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3
Q

T/F: There is no difference in efficacy between First generation antipsychotics and second generation antipsychotics

A

False: Clozapine, Olanzapine, and Risperidone have the highest amount of efficacy among all antipsychotics while first generation antispychotics have no difference in efficacy

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4
Q

T/F: Patients should be put on clozapine before combination treatment

A

True

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5
Q

What type of dosing should be done for a 1st episode compared to the chornically ill, partial responder who is tolerating

A

Lower than usual, titrate above usual dose range

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6
Q

What type of antipsychotic agent should be chosen after the first episode (stage 1) , stage 2, stage 3

A

Atypical for a 6 week period, typical or atypical not tried in stage 1, clozapine

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7
Q

Which AP is considered first line if the patient also has suicidal ideation

A

Clozapine

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8
Q

What is the therapeutic trial for APs, initial symptom improvement, duration of treatment

A

4-12 weeks, 1-2 weeks, one year

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9
Q

What is the most common side effects of SGAs, FGAs

A

Metabolic complications, Extrapyramidal side effects (EPS)

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10
Q

What is the BBW for antispsychotic agents

A

Elderly patient with demntia-related psychosis treated with antipsychotic drugs are at an increased risk of death

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11
Q

What is a rare but deadly risde effect of FGAs, symptoms

A

Neurpoleptic Malignant Syndrome/ muscle rigidity, hyperpyrexia (really high fever), altered consciousness

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12
Q

What are the early onset types of EPS, Late onset

A

Akathisia, Dystonic reactions, Pseudoparkinsonism/ Tardive dyskinesia

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13
Q

How is akathisia treated

A

Propanolol, short term BZDS (lorazepam), anticholinergic (benztropine or diphenhydramine)

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14
Q

Which EPS symptoms is seen in 90% of patients within 4 days, which antispsychotics are more likely to cause this, treatment

A

Dystonic reactions, high dose or high potency typical antipsychotics, Stop offending agent or antichoinergic or BZD

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15
Q

What are the treatment options for pseudoparkinsonism

A

Reduce dose, switch to another agent with lower D2 affinity or high M1 affinity, anticholiergic agents

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16
Q

How is tardive dyskinesia treated, prevented

A

Reduce dose, stop, switch (may not get better)/ minimize daily dose, AIMS at baseline then 6 months then yearly

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17
Q

Which antipsychotic is most known to cause QTc prolongation

A

Ziprasidone

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18
Q

Which antipsychotic is wieght neutral, potentially loose weight

A

Ziprasidone, Molindone

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19
Q

Which antipsychotics are associated with the most sedation

A

Chlopromazine, Clozapine, and quetiapine/ Olanzapine (moderate)

20
Q

Which antipsychotics are associated with the most EPS (strongest D2 affinity)

A

Haloperidol, perhenzazine

21
Q

What antipsychotics are associated with the most anticholinergic effect

A

Chlorpromazine, Clozapine

22
Q

Which antipsychotics are associated with orthostasis

A

Chorpromazine, Clozapine, iIloperidone

23
Q

What antispychotics are associated with the high increases in prolactin

A

Haloperidol, perphenzine, Risperidone/paliperidone

24
Q

Which antispychotic is has the least amount of side effects

A

Aripiprazole

25
Q

What must be done before a patient is given long-acting injectable agents

A

Must try PO before switching to long-acting to establish tolerability

26
Q

Which long acting injectable agents must be done every 2-4 weeks

A

Haloperidol, fluphenazine, risperidone, Olanzapine

27
Q

Which long-acting injectable is every 4 or 8 weeks, every 3 months

A

Arpiprazole, Paliperidone

28
Q

What is the low potency FGA, side effects

A

Chlopromazine, High sedation, high anticholinergics, high orthostasis

29
Q

What are the two high potency FGAs, side effects

A

Haloperidol and Fluphenazine/ High EPS and Increasing prolactin levels

30
Q

What are the recommended SGAs in stage 1

A

Aripirazole, olanzapine, quetiapine, risperidone, ziprasidone

31
Q

What are the indications for clozapine, what is the the therapeutic trial

A

treatment resistant schizophrenia and sucidal behabior associated with schizophrenia, 12 weeks

32
Q

What is the BBW for clozapine

A

Seizures, leukopenia/neutropenia/agranulocytosis, myocarditis/cardiomyopathy

33
Q

What are the common side effects of clozapine

A

Drowsiness, weight gain, tachycardia, orthostatic hypotension, constipation

34
Q

How does the REMS program for clozapine work

A

ANC must be AT LEAST 1000/uL for general population and must be AT LEAST 500/uL for patient with documented Benign Ethnic Neutropenia (BEN)/ weekly blood monitoring for 1st 6 months, then every 2qweeks for 6 months then even every 28 days if ANC is at goal

35
Q

Which antipsychotic is known for increased risk of hyperlipidemia and hyperglycemia

A

Olanzapine

36
Q

What are side effects of ziprasidone, what is special about its kinetics

A

moderate sedation, moderate EPS, nausea, akathisia/ must take with food (absoprtion 50% lower without food)

37
Q

Which is the FDA warning for using aripiprazole

A

Compulsive and excessive urge and behaviors

38
Q

What is the active metabolite of paliperidone, advantage

A

Paliperidone. not sifnificantly metabolized by CYPs

39
Q

What other antipsychotic has a warning of QTc prolongation and also has NE-alpha antagonism

A

Iloperidone

40
Q

Which antipsychotic is the only sublingual tablet, tip

A

Asenapine, avoid eating and drinking for 10 minutes after administration

41
Q

What are pharmcokinetic tips for lurasidone

A

Must take with food (weight neutral)

42
Q

Which antipsychotics are effected by smoking

A

Clozapine and Olanzapine

43
Q

Which APs have the most drug-drug interactions

A

Clozapine and Perphenazine

44
Q

Which typical APs have significant weight gain

A

Chlopromazine, thioridazine

45
Q

Which atypical APs have significant weight gain

A

Clozapine, Olanzapine, risperidone

Phar 507 (33 decks)

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