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