anti-psychotics

Question 1

positive sx are from

Answer 1

excess DA in mesolimbic pathway

Question 2

negative sx are from

Answer 2

decreased DA in mesocortical pathway

Question 3

side effects are from

Answer 3

decreased DA in nigrostriation and tubuloinfundibular pathways

Question 4

antipsychotics in pregnancy

Answer 4

all are cat C

except clozapine is cat B

Question 5

FGAs MOA

Answer 5

block DA in mesolimbic

effect on positive sx

Question 6

7 types of ADRs from FGAs

Answer 6

anticholinergic
antihistaminic
anti-alpha 1
EPS
increase PRL
increased seizures
worsening of negative symptoms

Question 7

risk factors for developing TD (4)

Answer 7

elderly, white, female, high potency FGA

Question 8

cause of NMS

Answer 8

rapid decrease in DA (high potency med or rapid dose escalation) leads to disinhibition of SNS

Question 9

onset of NMS

Answer 9

2/3 cases within 1 week of starting meds, most within 1 month

Question 10

symptoms

Answer 10

FEVER- fever, encephalopathy, vitals unstable, elevated CPK, rigidity

Question 11

risk factors (7)

Answer 11

family history
catatonia
mental retardation
organic brain disease 
agitation
dehydration
exhaustion

Question 12

low potency FGAs (2)

Answer 12

chlorpromazine

thioridazine

Question 13

side effects of low potency FGAs

Answer 13

more anticholinergic, antihistaminic, anti-alpha1

Question 14

SE of thioridazine

Answer 14

QTc prolongation

Question 15

side effects of high potency FGAs

Answer 15

EPS

Question 16

high potency FGA that can cause QTc prolongation

Answer 16

IV haloperidol

Question 17

MOA of SGAs

Answer 17

address + by blocking D2 in mesolimbic

address - by blocking 5HT2A and partial agonist of 5HT1A

Question 18

2 benefits of SGA or FGA

Answer 18

lower EPS

lower prolactin levels

Question 19

main ADR of SGAs

Answer 19

endocrine effects (due to H1 antagonism)- hyperglycemia, hyperlipidemia, weight gain

Question 20

antipsychotics and elderly patients with dementia

Answer 20

all increase mortality risk

Question 21

describe use of clozapine

Answer 21

used after 2 other agents fail, very effective but serious ADRs

Question 22

clozapine ADRs (4)

Answer 22

endocrine
agranulocytosis
seizures
myocarditis

Question 23

SGA with lowest EPS

Answer 23

clozapine

Question 24

SGAs with high incidence of galactorrhea (2)

Answer 24

risperidone, paliperidone

Question 25

SGAs with highest EPS

Answer 25

risperidone and paliperidone

Question 26

SGAs with high risk of metabolic effects (2)

Answer 26

olanzapine, illoperiodne

Question 27

SGAs with QTc prolongation

Answer 27

ziprasodone, iloperiodone