NURS 660 ANTIPSYCHOTIC MEDICATIONS DETAILED EXAM 2026

NURS 660 ANTIPSYCHOTIC MEDICATIONS DETAILED EXAM 2026 3 classes of classical/ FGA - - 1) phenothiazines 2) thioxanthenes 3) butyrophenones Prototypical SGA - -clozapine Chlorpromazine (THORAZINE) - --lowest potentcy antipsychotic -significant alpha-1 adrenergic blockade -- sedation, hypotention -DA blockage in basal ganglia -- EPS Classic example of butyrophenone (FGA) - -haloperidol (HALDOL) Haloperiol (HALDOL) - --potent D2 blockade -- acute treatment of psychosis -high EPS, sedation -less weight gain, anticholinergic effects, hypotension Drug usually used to treat acute psychotic episodes - -haloperidol (HALDOL) First generation antipsychotics block what receptors? - -block D2 receptors- therapeutic efficacy correlates with D2 blockade Which antipsychotics alleviate mainly positive symptoms, and carry higher risk of EPS and tardive dyskinesia with high doses and long-term use - -first generation/ typical antipsychotics -haloperidol -chlorpromazine SGA have greater affinity for which receptors - --affinity for serotonin dopamine SGA characteristics - --block more than 1 type of receptor -help positive and negative sxs -improve cognitive fx -less EPS/TD SGA/ atypical (5+) - -1) clozapine (CLOZARIL) 2) risperidone (RIPERDAL) 3) olanzapine (ZYPREXA) 4) quetiapine (SEROQUEL) NURS 660 NURS 660 5) ziprasidone (GEODON) Unique MOA of aripiprazole (ABILIFY) - -acts as partial agonist of D2 receptors - stabilizes DA hyperactivity and hypoactivity At what receptors/ areas does aripiprazole act as an agonist? - --at presynaptic D2 receptors -in regions where DA is low -- PFC in SCZ At what receptors/ areas does aripiprazole act as an antagonist? - --at postsynaptic D2 receptors -in regions where DA is high -- limbic regions in SCZ In what brain regions are DA levels ELEVATED in SZC patients? - -limbic regions/ subcortical areas (remove inhibitory control of GABA -- positive symptoms In what brain regions are DA levels REDUCED in SZC patients - -PFC -- negative symptoms Key antipsychotic side effects (9) - - 1) EPS (TD) 2) metabolic (weight, lipids, DM) 3) cardiac (QT prolongation) 4) endocrine (hyperprolactinemia) 5) adrenergic (orthostasis) 6) anticholinergic 7) antihistaminergic 8) akathisia (restlessness) 9) neuroleptic malignant syndrome (muscular rigidity, fever- fatality) Nigrostriatal pathway and dopamine effects (SCZ) - -normal fx = voluntary movement D2 receptor blockage = EPS Mesolimbic pathways and dopmaine effects (SCZ) - -normal fx = arousal, memory, motivation Excess DA = positive sxs D2 blockage = resolution of psychosis Mesocortical pathways and dopamine effects (SCZ) - -normal fx = cognition, communication, stress, social fxing Hypoda = negative sxs Fgas may worsen negative sxs through this pathway more than SGA (5HT antagonism) Tuberoinfundibular pathways and dopamine effects (SCZ) - -DA antagonism = increase in prolactin (hyperprolactinemia- ADE) NURS 660 NURS 660 Which dopaminergic pathway is this ideal target for antipsychotics - -mesolimbic - treat positive sxs related to SCZ Which dopaminergic pathways explain ADE of antipsychotics - -nigrostriatal -- EPS Mesocortical -- hypoda- worsen neg sxs Tuberinfundibular -- hyperprolactinemia Key factor related to FGA side effects - -depends on potency at D2 dopamine receptor High potency FGA with high rate of EPS - -haloperidol Lowest potency fgas with increasing off-site ades- anticholinergic, sedation, orthostasis - -chlorpromazine, thioridazine Sgas with most EPS (dose-related)- 2 - - 1) paliperidone (active metabolite of risperidone) 2) risperidone Sgas with least EPS- 2 - -1) quetiapine 2) clozapine Sgas with highest risk of increased prolactin and gynecomastia (2) - -1) paliperidone (active metabolite of risperidone) 2) risperidone SGA with lowest risk fo hyperprolactinemia/ gynecomastia (1) --actually lower prolactin levels - -aripiprazole (ABILIFY) - D2 partial agonist Which receptor targets are responsible for causing weight gain as ADE in SGA? - - 1) serotonin (5HT-2c) 2) histamine (H1) Which SGA are most known for causing weight gain/ metabolic -related side effects? - 1) olanzipine 2) clozapine Which SGA has highest rate of anticholinergic side effects - -clozapine Which receptor target is the cause of anticholinergic side effects of SGA? - -muscarinic- M1 Which receptor target is the cause of orthostasis (orthostatic hypotension) side effects of SGA - -alpha-1 Which receptor targets are the cause of sedating side effects of SGA? - -alpha-1 and histamine (H1) NURS 660 NURS 660 Which sgas are most notorious for orthostasis as ADE (2) - -1) clozapine 2) quetiapine FGA that needs dose-titrated due to dose-limiting orthostatic - -haloperidol Which SGA are most sedating? (3) - -1) clozapine 2) quetiapine 3) olanzapine- some Effect of smoking tobacco on antipsychotic metabolism/ levels and why - -smoking -- induces CYP1A2 Increased AP metabolism= decreased AP levels and efficacy Aps with calorie requirements (2) - -1) ziprasidone (500 cal) 2) lurasidone (350 cal) Considerations for olanzapine LAI (Zyprexa Relprevv) - --complicated administration -BBW -post-injection delirium/ sedation syndrome -must monitor for 3 hrs post injection -in sesame oil- viscous, irritating, allergy concern Monitoring parameters for SGA - -1) personal/ fam hx 2) weight (BMI) 3) waist circumference 4) blood pressure 5) fasting glucose 6) fasting lipid profile Which metabolic monitoring paramter should be assessed most regularly (every patient evaluation) - -BMI Tardive dyskinesia and aps - --rapid, repetitive, sterotypical movements -often permanent/ irreversible -cumulative risk with prolonged exposure (esp FGA) -believed to be higher risk of developing with FGA Risk factors of tardive dyskinesia - --chronic exposure to AP med