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Antipsychotics
| Question | Answer |
|---|---|
| Which neurotransmitters are imbalanced in Schizophrenia? | dopamine and serotonin |
| State the mechanism of action of the 1st generation antipsychotics? | block D2 receptors |
| State the mechanism of action of the 2nd generation antipsychotics? | block D1, D2, & D4 receptors and block serotonin receptors |
| State the differences between 1st and 2nd generation antipsychotics? | 2nd generation cause less EPSEs, less prolactin ADRs, less anticholinergic side effects |
| List some commonly used 2nd generation antipsychotics: | risperidone (Risperdal), quetiapine (Seroquel), olanzepine (Zyprexa), and others |
| List a commonly used 1st generation antipsychotic: | Although not a drug of choice, haloperidol (Haldol) is still commonly used |
| List some other therapeutic uses of the antipsychotics: | bipolar disorder, treatment-resistant depression, agitation & irritability & aggression in Autism |
| List side effects of the antipsychotics: | sedation, sexual dysfunction, poor blood glucose control, anticholinergic side effects, orthostatic hypotension, hyperprolactinemia, EPSE |
| Define akathisia: | pacing, squirming, need to be in constant motion |
| Define acute dystonia: | severe spasms of muscles of tongue, face, neck, or back |
| Define tardive dyskinesia | involuntary movement of tongue or face, rapid blinking, facial tics, lip-smacking, tongue thrusting |
| Define Parkinsonism-like movement disorders: | looks just like PD, bradykinesia, drooling, tremor, rigidity, shuffling gait, cogwheeling |
| Which type of EPSE is associated with long-term use & may be irreversible? | tardive dyskinesia |
| Which type of EPSE occurs within the first few days of therapy & is considered a medical emergency? | acute dystonia |
| What causes the EPSE associated with antipsychotics? | blocking D2 receptors |
| How are antipsychotic-induced EPSEs treated? | treat with anticholinergic drugs (diphenhydramine if IV is needed or benztropine if oral is needed) |
| What is akathisia often mistaken as? | anxiety or exacerbation of psychoses |
| State the FDA black box warning for the 2nd generation antipsychotics: | Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death |
| Acute dystonia is best treated with: | IV diphenhydramine |
| Which 2nd generation antipsychotic has the highest incidence of EPSEs? | risperidone |
| Which antipsychotic can cause agranulocytosis? | clozapine |
| Which antipsychotic is sometimes called a 3rd generation because it also "stabilizes" dopamine? | aripiprazole |
| The most commonly used scale to monitor for tardive dyskinesia is: | Abnormal Involuntary Movement Scale (AIMS) |
| Which cardiac dysrhythmia can the antipsychotics cause? | QT prolongation (Torsades) Check a baseline EKG |
| Endocrine-related ADRs of the antipsychotics include: | hyperprolactinemia, glucose dysregulation, hypercholesterolemia |
| How often should body weight, fasting glucose, HgA1c, & lipids be checked? | baseline; at 4 months; and annually thereafter |
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