Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
50 Cards in this Set
- Front
- Back
|
What is the mode of administration for all anti-psychotic drugs?
|
PO - erratice pattern of absorption, high 1st pass metabolism, IM produces better absorption
|
|
|
What is the binding of anti-pyschotic drugs?
|
most are highly PP bound, mainly to albumin = interacts with warfarin
|
|
|
What is fluphenazine or haloperidol decanoate?
|
long acting preparation, decanoate is a fatty acid that gets trapped in fat/muscle and releases slowly
|
|
|
does the potency or efficacy vary for the different antipsychotic agents?
|
potency varies 1mg/day for pimozide to 800 me/day for clorpromazine; all have similar efficacy
|
|
|
what are the early onset symptoms of extrapyramidal adverse effects of antipsychotics?
|
pseudoparkinsonism, acute dystonia, oculogryic crisis; they are sometimes reversible
|
|
|
what causes the early sypmtoms of extrapyramidal adverse effects?
|
dopamine receptor sensitization
|
|
|
what can be used to treat early symptoms of extrapyramidal adverse effects?
|
muscarinic blocker or anticholinergics
|
|
|
what are the intermediate symptoms of extrapyramidal adverse effects?
|
akathisia (motor restlessness)
|
|
|
what causes the intermediate symptoms of extrapyramidal adverse effects?
|
duronal tracts downstream of dopaminergic neurons in the mesolimibic system
|
|
|
what are the late symptoms of extrapyramidal adverse effects?
|
tardive dyskinesia, tardive dystonia, dardive akathisia; seldom reversible
|
|
|
What are the ANS adverse effects of antipyschotic drugs?
|
atropine like effects - especially with THIORIDAZINE
|
|
|
what are the endocrine/metabolic adverse effects of anti-psychotic drugs?
|
hyperlipidemia, hyperglycemia, hyperprolactinemia, weight gain, gynecomastia, amenorrhea, galactorrhea
|
|
|
what causes the endocrine/metabolic adverse effects?
|
dopamine receptor blockade
|
|
|
what is the mechanism that causes sedation when taking anti-psychotic drugs?
|
histamine receptor blockade in the CNS - PTZs are the worst!
|
|
|
what are the symptoms of neuroleptic malignant syndrome?
|
hyperthermia, muscular rigidity, autonomic instability, altered consciouness
|
|
|
what is the treatment of neuroleptic malignant syndrome?
|
dantrolene and bromocriptine (dopamine agonist) and hydration
|
|
|
what are the CV adverse effects of antipsychotics?
|
otherostatic hypotension - due to alpha1 blockade; prolonged QT - associated with thioridazine and ziprasodone
|
|
|
which anti-psychotics are known to cause tosades?
|
haloperidol, thioridazine and ziprasidone
|
|
|
what are the symptoms of metabolic syndrome due to antipsychotic drugs?
|
weight gain, hyperlipidemia and hyperglycemia
|
|
|
which drugs are more likely to cause metabolic syndrome?
|
clozapine > olanzapine > quetiapine > risperidone > ziprasidone = aripiprazole
|
|
|
what is the interaction between PTZs and phenytoin
|
increase or decrease in phenytoin can occur with PTZs due to PP binding and metabolism
|
|
|
what is the interaction between antipsychotics and carbamazepine?
|
carbamazepine induces P450 levels = decreases levels of most antipyschotics - especially haloperidol
|
|
|
what is the interaction between cimetidine and antipsychotics?
|
cimetidine inhibits P450 at higher doses = increases levels of most antipsychotics
|
|
|
what is the interaction between aluminum antacids and antacids?
|
Al antacids decrease absorption of PTZs
|
|
|
what do most older and middle generation agents do to seizure activity?
|
they lower the seizure threshold
|
|
|
what class of antipsychotic drug is chlorpromazine?
|
phenothiazine
|
|
|
what class of antipsychotic drug is thioridazine?
|
phenothiazine
|
|
|
What class of antipsychotic drug is fluphenazine?
|
phenothiazine
|
|
|
what is the M.O. of PTZs?
|
D2 antagonist in the mesolimibic cortex; also inhibits 5HT2 receptors
|
|
|
when is chlorpromazine used?
|
only in severely refractory patients due to severe side effects
|
|
|
what are the adverse effects of thioridazine?
|
there are fewer EPS than with most PTZs but there are cardiac adverse effects - long QT, increased incidence of delayed ejaculation and high doses causes pigmented retinopathy
|
|
|
what class of antipsychotic drug is haloperidol?
|
butyrophenone
|
|
|
what is the M.O. of haloperidol?
|
D2 antagonism with very little effect on 5HT antagoinst activity compared to PTZs
|
|
|
what are the adverse side effects associated with haloperidol?
|
greatest chance of EPS and neuroleptic malignant syndrome!!, but it is less likely to cause sedation and hypotension than PTZs
|
|
|
what class of drug is clozapine?
|
2nd generation (atypical) antipsychotic
|
|
|
what class of drug is olanzapine?
|
2nd generation (atypical) antipsychotic
|
|
|
What class of drug is quetiapine?
|
2nd generation (atypical) antipsychotic
|
|
|
what class of drug is risperidone?
|
2nd generation (atypical) antipsychotic
|
|
|
what class of drug is ziprasidone?
|
2nd generation (atypical) antipsychotic
|
|
|
What class of drug is aripiprazole?
|
2nd generation (atypical) antipsychotic
|
|
|
What is the M.O. of the 2nd generation agents?
|
5HT2a antagonist + D2 receptor antagonist - EXCEPT aripiprazole
|
|
|
what are the adverse effects of clozapine?
|
low EPS incidience, granulocytosis, myocarditis, marked sedation, weight gain and hyperglycermia are common
|
|
|
what is the M.O. of clozapine?
|
5HT2a >>> D2 antagonist
|
|
|
what are the ADRs of quetiapine?
|
sedation, dizziness, headache, GI upset, some incidence of weight gain - less than with risperidone or olanzapine
|
|
|
what are the ADRs of olanzapine?
|
HYPERLIPIDEMIA! Weight gain, hyperglycemia; lower chance of hyperprolactinemia
|
|
|
what are the ADRs of risperidone?
|
less sedation than with other, weight gain and cold-like rhinitis; more STIMULATORY effects - agitation, insomnia, anxiety; HIGHEST INCIDENCE OF HYPERPROLACTINEMIA!!!
|
|
|
what is paliperidone?
|
active metabolite of risperidone - similar ADRs and efficacy, no real advantages
|
|
|
What are the ADRs of ziprasidone?
|
mild sedation and prolonged QT interval BUT SELDOM causes weight gain!!
|
|
|
What is the M.O. of aripiprazole?
|
partial agonist (NOT ANTAGONIST) at D2 receptors and partial 5HT1a angonist; very little D antagonist effects
|
|
|
What are the ADRs of aripiprazole?
|
anxiety, HA, N&V and dizziness; little/no effect on weight gain, hyperprolactinemia, hyperlipidemia, hyperglycemia or EPS
|
