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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