NMSP Exam I > Pharm: Antipsychotics > Flashcards

Pharm: Antipsychotics Flashcards

(29 cards)

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1
Q

Which anti-psychotic is indicated for tx of recurrent suicidal behavior?

A

Clozapine

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2
Q

What are the 5 first-gen. aka typical/conventional antipsychotics?

A
  • Chlorpromazine (low-potency)
  • Fluphenazine (high-potency)
  • Thioridazine (low-potency)
  • Haloperidol (high-potency)
  • Thiothixene (high-potency)
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3
Q

What are the 6 second-gen. aka atypical/novel antipsychotics?

A
  • Aripiprazole
  • Clozapine
  • Olanzapine
  • Quetiapine
  • Risperidone
  • Ziprasidone
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4
Q

What is the MOA of the first gen. anti-psychotics?

A

Block dopamine (D2) post-synaptic receptors

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5
Q

Other than D2-receptors, which other receptors may be blocked by first gen. antipsychotics and how does this correlate with AE’s?

A
  • Muscarinic receptors: dry mouth, constipation, blurred vision…
  • Histamine (H1) receptors: sedation
  • α1-adrenergic receptors: orthostatic hypotension, dizziness/syncope
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6
Q

What are the dopamine-associated AE’s of the first gen. antipsychotics?

A
  • Hyperprolactinemia (tuberoinfundibular pathway): amenorrhea, galactorrhea, gynecomasta, and ↓ libido
  • Extrapyramidal sx’s and Tardive Dyskinesia
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7
Q

What is the only second-gen anti-psychotic that is assoc. with hyperprolactinemia (like the first-gen’s)?

A

Risperidone

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8
Q

What are the 2 low-potency first gen. antipsychotic agents and what AE’s are they more associated with?

A
  • Chlorpromazine and Thioridazine
  • More sedation, hypotension, and ↓ seizure-threshold
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9
Q

What are the 3 high-potency first gen. antipsychotic agents and what AE’s are they more associated with?

A
  • Fluphenazine + Haloperidol + Thiothixene
  • More movement (EPS) and endocrine effects (prolactin)
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10
Q

What are the 2 classes + agents used to tx the extrapyramidal sx’s (EPS) of first gen. antipsychotics?

A
  • Anticholinergic agents: benztropine + trihexyphenidyl
  • Antihistamine agents: diphenhydramine
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11
Q

Which class and 2 agents are used for tx of Tardive Dyskinesia (TD) assoc. with first gen. antipsychotics?

A

Selective VMAT2 inhibitor’s: Valbenazine and Deutetrabenazine

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12
Q

What is the MOA of the second-gen antipsychotic agents?

A
  • Block D2 post-synaptic receptors AND the 5HT2A receptors
  • Stronger 5HT2A receptor blockers than D2 receptor blockers
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13
Q

What are some of the common AE’s associated with the second gen. antipsychotics?

A

Weight gain and Metabolic Sydrome: hyperglycemia/insulin resistance, hyperlipidemia

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14
Q

What are some of the rare AE’s associated with the first and second gen. antipsychotics?

A
  • QTc prolongation and negative inotropic effects –> ↑ risk for women, elderly and those on anti-arrhythmics
  • Seizures: with first gen.
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15
Q

Which first generation antipsychotic is more often associated with weight gain, DM, and hypercholesterolemia?

A

Chlorpromazine

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16
Q

Which 2 second-gen antipsychotics have the least amount of AE’s with it?

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A

Aripiprazole and Ziprasidone

17
Q

Which first gen. antipsychotic is associated with more prolactin elevation, sedation, anticholinergic effects, orthostatic hypotension and a dose-dependent retinitis pigmentosa?

18
Q

Which second gen. antipsychotic is more often assoc. with EPS/Tardive Dyskinesia, elevated prolactin, and weight gain/DM?

19
Q

Which second-gen. antipsychotic is associated with agranulocytosis and requires monitoring of WBC; REMS program?

20
Q

Before beginning antipsychotics the guidelines recommend determining in all patients which baseline items?

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A
  • Serum glucose + Lipids + Weight (BMI)
  • Blood pressure
  • Waist circumference and Personal/Family hx of metabolic and CV dz
21
Q

How can non-adherence to antipsychotic meds be managed; which 6 agents can be used? *test Q*

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A
  • Manage w/ Long-Acting Injectable Agents (LAIA’s)
  • Haloperidol decanoate
  • Fluphenazine decanoate
  • Risperidone + Olanzapine + Aripiprazole + Paliperidone (ROAP)
22
Q

What SGAs are 5HT-2A/DA R antagonists?`

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A

-idone

iloperidone

lurasidone

paliperidone

risperidone

ziprasidone

23
Q

What SGAs are partial DA/5HT-1A R agonists?

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A

-piprazole

Aripiprazole

Brexpiprazole

24
Q

What SGAs are multi-acting R targets?

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A

-apine

asenapine

clozapine

olanzapine

quetiapine

25
What SGA is a inverse serotonin agonist/antagonist?
**pimavanserin** "PD psychosis)
26
Which FGA has high risk of weight gain, DM, and hypercholesterolemia?
**chlorpromazine (+++)**
27
Which FGA has large risk of anticholinergic effects and orthostatic hypotension?
**thioridazine (++++)** also, +++ for prolactin elevation and sedation
28
What SGA has the least AEs?
aripiprazole
29
Which SGAs are bad for weight gain, DM, and hypercholestemia?
clozapine = olanzapine \> quetiapine \> risperidone
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