N: Antipsychotics

Front 1

Chlorpromazine
- trade name?
- class
- mechanism
- indications
- contraindications
- SE
- drug interactions?

Back 1

- throazine
- typical antipsychotic
- blocks a1 and 5HT-2 > D2 > D1 receptors; it has an effect of all of these, in decreasing order.
- psychosis, N&V, sedation, intractable hiccups, tetanus (adjunct), actue intermittent porphyria
- hyperS, CNS depression, BMD, hypotension, parkinsonism, hepatic dysfunction, glaucoma
- drowsiness, seizures, agranulocytosis, aplastic anemia, thrombocytopenia, neuroleptic malignant syndrome, tardive dsykinesia
- antacids, alcohol, BP meds, anticoags, phenytoin

Front 2

Haloperidol
- class
- mechanism
- indications
- contraindications
- SE
- drug interactions?
- admin?

Back 2

- antipsychotic (typical)
- bl/ D2 >D1, D4 > a1 > 5-HT2
- psychosis (schizo), Tourette's
- *Prolonged QT*, hyperS, CNS depression, Parkinson's dz
- Parkinson-esque sx, tardive dyskinesia, torsade de pointes, orthostatic hypotension, neuroleptic malignant syndrome
- lithium, CNS depressants
- DO NOT give via IV

Front 3

Risperidone
- class
- mechanism
- indications
- contraindications
- SE
- drug interactions?

Back 3

- ATYPICAL antipsychotic
- bl/ D2, 5HT-2. Also blocks M, a1, and H1 receptors.
- psychosis (schizo), dementia
- hyperS, prolonged QT, renal/liver dz
- insomnia, agitation, anxiety, Parkinson's sx, constipation, rhinitis
- carbamazepine, clozapine, drugs to tx Parkinson's, anti HTN

Front 4

Clozapine:
- class
- effectiveness wrt other atypical antipsychotics?
- mechanism
- indications
- contraindications
- SE
- drug interactions?

Back 4

- ATYPICAL antipsychotic
- more effective, but dangerous side effect
- bl/ D4, a1 > 5HT-2 > D2, D1; also blocks M1 and H1.
- schizo (resistant)... it is only FDA approved for resistant b/c of the agranulocytosis risk, suicided risk associated w/ schizo.
- WBC <3500, myloproliferative dz, renal/liv dz, heart dz, hyperS
- *agranulocytosis*, Drowsiness, dizz/vertigo, HA, tachycardia, constipation, hypersalivation, aspiration pneumonia, tremor, disturbed sleep, hypokinesia, seizures,
- drugs suppressing BM function (ties in w/ the WBC requirement), benzodiazepines, and psychotropic drugs.

Front 5

Olanzapine
- trade name?
- class
- mechanism
- indications
- contraindications
- SE
- drug interactions?

Back 5

- zyprexa
- ATYPICAL antipsychotic
- 5HT-2 > D1-D4 & a1. also M & H1.
- bipolar dz, psychosis
- hyperS
- drowsiness, flu-like, increased salivation, nausea, highest incidence of clinically significant weight gain, (maybe tardive dyskinesias... would be more rare than in a typical APD tho')
- antiHTN, L-DOPA, dopamine agonists, carbamazepine (p-450 inducer)

Front 6

What are the differences between atypical and typical antipsychotics? Classic examples of each?

Back 6

typical: cause EPS, elevated serum prolactin, induce tardive dyskinesias w/ chronic use
- classic example = Haloperidol

Atypical: minimal EPS, minimal elevation of prolactin, less propensity for tardive dyskinesia due to less antagonism of D2 receptors.
- clozapine

Front 7

In most cases, we select antipsychotics based on what?

Back 7

side effect profile.

Front 8

What is a dystonic reaction? What can cause it? tx?

Back 8

- dystonia (contortion movements, tensing...), swelling of tongue, oculogyric crisis....
+ acute onset (hours/days) after chance in dose/drug or compliance
- responds rapidly to IM or IV anticholinergic drugs (benztropine, diphenhydramine [1st gen antihistamine: as such has anticholinergic properties])

Front 9

What types of drugs work to tx APD-induced parkinsonism?

Back 9

antimuscarinics.

Front 10

What is Akathisia? Can be a side effect of which drugs?

Back 10

restless leg syndrome

Antipsychotic (typicals)

Front 11

What is the rarest of all EPS?
- potentially fatal?
- triad of which sx?
+ other sx?
+ lab value changes?
- what should you do?

Back 11

Neuroleptic malignant syndrome
- yes
- fever, rigidity, cognitive change
- autonomic instability (sweating, BP/HR)
- ^CPK and ^WBC
- stop the APD and hospitalize

Front 12

What side effects can the DA antagonism of APD drugs have via their elevation of prolactin lvls?

Back 12

breast engorgement, amenorrhea, gynecomastia, reduced libido, sexual dysfunction.

Front 13

Although MANY APD's can affect QTc, which two have the larger effects?
- what does this mean re: our perscriptions of APDs in general?

Back 13

thioridazine and ziprasidone
- monitory EKG, avoid using APDs in combo with other QTc drugs (amiodarone, chlorpromazine, cisapride, quinidine, procainamide, etc.)

Front 14

Antipsychotics induce sedation by which mechanism?

Back 14

histamine receptor activation; perhaps w/ some help from 5HT-2a antagonism in the atypicals.