Antipsychotics PMHNP Exam

Описание: *Antipsychotics in the PMHNP Exam*

Antipsychotics are *essential medications in psychiatry**, used primarily for **schizophrenia, bipolar disorder, and psychotic disorders**. The **PMHNP-BC exam* frequently tests *mechanism of action, side effects, monitoring, and clinical applications* of both **first-generation (typical) and second-generation (atypical) antipsychotics**.

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*1. Classification of Antipsychotics*

*A. First-Generation Antipsychotics (FGAs) - "Typical"*
*Mechanism:* *Dopamine (D2) receptor blockade* in the *mesolimbic pathway* → reduces positive symptoms.
*Higher risk of extrapyramidal symptoms (EPS)* due to **nigrostriatal D2 blockade**.
*Main Uses:* Schizophrenia, acute agitation, psychosis, Tourette’s, delirium.

| *Medication* | *Potency* | *Key Side Effects* |
|--------------|------------|----------------------|
| *Haloperidol (Haldol)* | High | EPS, tardive dyskinesia |
| *Fluphenazine (Prolixin)* | High | EPS, akathisia |
| *Chlorpromazine (Thorazine)* | Low | Sedation, hypotension |
| *Thioridazine* | Low | QT prolongation, retinal deposits |

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*B. Second-Generation Antipsychotics (SGAs) - "Atypical"*
*Mechanism:* **Dopamine (D2) blockade + Serotonin (5-HT2A) antagonism**.
*Lower risk of EPS**, but **higher risk of metabolic syndrome* (weight gain, diabetes).
*Main Uses:* Schizophrenia, bipolar disorder, treatment-resistant depression, autism-related irritability.

| *Medication* | *Key Side Effects* | *Notes* |
|--------------|----------------------|----------|
| *Clozapine (Clozaril)* | Agranulocytosis, myocarditis, seizures | *Most effective* for treatment-resistant schizophrenia |
| *Olanzapine (Zyprexa)* | Weight gain, sedation, metabolic syndrome | Avoid in obese patients |
| *Quetiapine (Seroquel)* | Sedation, orthostatic hypotension | Low EPS risk, used in bipolar & depression |
| *Risperidone (Risperdal)* | Hyperprolactinemia, EPS at high doses | Approved for autism-related irritability |
| *Paliperidone (Invega)* | Similar to risperidone | Long-acting injectable available |
| *Ziprasidone (Geodon)* | QT prolongation, dizziness | Weight neutral, take with food |
| *Aripiprazole (Abilify)* | Akathisia, insomnia | **Partial D2 agonist**, lower metabolic risk |
| *Lurasidone (Latuda)* | Akathisia, nausea | Used in bipolar depression, take with food |

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*2. Side Effects & Management*
| *Side Effect* | *Cause* | *Management* |
|---------------|----------|--------------|
| *EPS (Akathisia, Dystonia, Parkinsonism, Tardive Dyskinesia)* | Dopamine D2 blockade | Benztropine, Diphenhydramine, Propranolol (for akathisia) |
| *Neuroleptic Malignant Syndrome (NMS)* | Dopamine blockade → Muscle rigidity, fever, autonomic instability | *Stop antipsychotic, give Dantrolene & Bromocriptine* |
| *Hyperprolactinemia* | D2 blockade in tuberoinfundibular pathway | Switch to Aripiprazole |
| *Metabolic Syndrome (Weight gain, diabetes, dyslipidemia)* | 5-HT2C & H1 blockade | Monitor BMI, glucose, lipids; switch to Ziprasidone, Aripiprazole, or Lurasidone |
| *QT Prolongation* | Inhibition of cardiac potassium channels | Avoid in cardiac patients, monitor ECG (highest with Ziprasidone, Thioridazine) |

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*3. Long-Acting Injectable (LAI) Antipsychotics*
Used for *non-adherent patients* or those with severe illness.
*Examples:*
*Risperidone LAI (Consta)* – Every *2 weeks*
*Paliperidone LAI (Invega Sustenna)* – Every *1 month*
*Aripiprazole LAI (Abilify Maintena)* – Every *1 month*
*Haloperidol Decanoate* – Every *4 weeks*

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*4. PMHNP Exam Key Takeaways*
*First-generation (FGAs) = Higher EPS risk* (Haloperidol, Fluphenazine).
*Second-generation (SGAs) = Higher metabolic risk* (Olanzapine, Clozapine).
*Clozapine = Most effective for treatment-resistant schizophrenia but requires ANC monitoring.*
*Aripiprazole is a partial D2 agonist, has lower metabolic risk.*
*NMS vs. Serotonin Syndrome:* NMS has **lead-pipe rigidity, fever, autonomic instability**.
*LAI antipsychotics are best for non-adherence.*

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