Typical Antipsychotics

Question 1

primary use of anti-psychotics

Answer 1

schizophrenia, other disorders with psychotic features (schizoaffective d/o, mood d/o or brief psychotic d/o)

Question 2

other names for typical antipsychotics

Answer 2

also called 1st generation antipsychotics, traditional antipsychotics or conventional antipsychotics

Question 3

chlorpromazine

Answer 3

thorazine

Question 4

fluphenazine

Answer 4

prolixin

Question 5

haloperidol

Answer 5

haldol

Question 6

pimpzide

Answer 6

orap

Question 7

MOA of typicals

Answer 7

dopamine antagonists

Question 8

what is the efficacy of typicals related to?

Answer 8

binding to dopamine D2 receptors

Question 9

are the typicals all equally effective?

Answer 9

yes BUT side effects are related to binding to the D2 receptors

Question 10

high affinity typical agents

Answer 10

Haldol, Orap and Prolixin
also called high potency
effective at lower doses
extrapyramidal symptoms (EPS)

Question 11

low affinity typical agents

Answer 11

Thorazine
also called low potency
need larger doses to be effective
less EPS, MORE anticholinergic, histamenergic and adrenergic SE

Question 12

what hinders absorption of typicals?

Answer 12

smoking, coffee, antacids and food

Question 13

when is steady state reached for typicals?

Answer 13

3-5 days

Question 14

how are typicals metabolized?

Answer 14

CYP450 (watch with liver disease)

Question 15

indication for typicals

Answer 15

schizophrenia
schizoaffective d/o
mania with psychotic features
depression with psychotic features
delusional disorder
severe agitation and violent behavior
tourette's syndrome
borderline personality disorder (only if psychotic sx)
dementia and delirium

Question 16

what do typicals do for schizophrenia?

Answer 16

reduce acute symptoms
POSITIVE symptoms, NOT negative
decreased risk of exacerbation after remission obtained by using med

Question 17

what are typicals commonly combined with for the treatment of mania with psychotic features?

Answer 17

antimanic agents - Lithium, Tegretol or Lamictal
why? steady action of antimanic agents takes time but antipsychotics work faster (taper when antimanics are therapeutic)
follow blood levels

Question 18

what are typicals commonly combined with for the treatment of depresison with psychotic features?

Answer 18

antidepressants

Question 19

when can typicals be used for severe agitation and violent behavior?

Answer 19

regardless of the cause of behavior and also in dementia patients with aggressive behavior (use lowest effective dose in elderly to decrease risk of hypotension)

Question 20

which typicals can be used for tourette’s?

Answer 20

Haldol and Orap

Question 21

what hypertension med can also be used for tourette’s? and why?

Answer 21

clonidine (catapress)

lower risk of neurological side effects

Question 22

cardiac side effects from typicals

Answer 22

decreased cardiac contractility, increased circulating levels of catecholamines

Question 23

EKG changes from typicals

Answer 23

prolong QT, ST depression, blunt T waves and Torsades

Question 24

Possible blood cell side effect from typicals

Answer 24

agranulocytosis - usually in elderly females during the first 4 months, but can occur at anytime - MUST train pts to report persistent sore throats, infections or fever

Question 25

what hormone could typicals cause an increased secretion of?

Answer 25

prolactin - breast enlargement, galactorrhea, amenorrhea, inhibited sexual function

Question 26

what does thorazine increase the risk of?

Answer 26

seizure, jaundice, bluish skin discoloration, granular deposits in the lens/cornea, hypotensive/anticholinergic effects, agranulocytosis, significant EKG changes, lethality in overdose

Question 27

IM typical antipsychotics

Answer 27

Haldol and prolixin