Antipsychotic Drugs and Lithium

Question 1

Thorazine

Answer 1

Chlorpromazine (1st) (sedation, weight gain), anticholinergic, A-1 antagonists

Question 2

Haldol

Answer 2

Haloperidol (1st) (Butyrophenones)

Question 3

Prolixin

Answer 3

Fluphenazine (1st)

Question 4

Trilafon

Answer 4

Perphenazine (1st)

Question 5

Navane

Answer 5

Thiothixene (1st) (Thiothixenes)

Question 6

Clozaril

Answer 6

Clozapine (2nd) for treatment resistant schizophrenia

reduces risk of suicide in schizophrenia

Question 7

Zyprexa

Answer 7

Olanzapine (2nd) like clozapine (sedating, antichol. and alpha block)

Question 8

Latuda

Answer 8

Lurasidone (2nd) new, w/ 350calorie meal, akathisia, for bipolar depression

Question 9

Seroquel

Answer 9

Quetiapine (2nd) used as sleeping pill (bad), weight/metabolic effects, first-line agent for depression in bipolar disorder

Question 10

Risperdal

Answer 10

Risperidone (2nd) significant weight/metabolic effects, more EPS above 6mg/day, syncope due to a1 block, prolactin increase, decreased libido

Question 11

Geodon

Answer 11

Ziprasidone (2nd) temporary akathesia common, should be taken with 500 calorie meal which doubles the absorption, cardiac conduction disturbances possbily

Question 12

Invega

Answer 12

Paliperidone (2nd) metabolite of risperidone, same effect profile, renal excretion instead of hepatic

Question 13

Fanapt

Answer 13

Iloperidone (2nd) similar to risperidone for effects, little prolactin elevation, VERY slow dose titration b/c of hypotension

Question 14

Saphris

Answer 14

Asenapine (2nd) SUBLINGUAL, no food or liquid 10 min after dosing,

Question 15

Compazine

Answer 15

Prochlorperazine (1st)

Question 16

Abilify

Answer 16

Aripiprazole, akathesia in beginning, increased DA in frontal cortex

Question 17

Schizophrenia

Answer 17

Illogical thinking, hallucinations, emotion uncontrolled from thinking, bizarre erratic behavior, relationships disrupted, genetic component, environment may precipitate

Question 18

Schizophrenia Positive Symptoms

Answer 18

Hallucinations, Delusions, Disorganized Speach, Paranoia, Hostility, Tension, Hyperactivity

Question 19

Schizophrenia Negative Symptoms

Answer 19

Flat/Absent, Alogia (doesn’t speak much), Anhedonia (decreased pleasure), Avolition (lack of drive), decreased socialization/connectedness

Question 20

Schizophrenia Cognitive Symptoms

Answer 20

Impairment of: Attention, Info processing speed, Working Memory

Question 21

Meso-limbic

Answer 21

OVER activity, causes positive mood symptoms

Question 22

Meso-Cortical

Answer 22

UNDER activity, causes negative/cognitive symptoms

Question 23

NigroStriatal

Answer 23

Movement disorders

Question 24

Tuberoinfundibular

Answer 24

Associated with prolactin

Question 25

Schizophrenia Treatment

Answer 25

Pharmacotherapy (for symptoms), Psychosocial Important, 2nd Gen (atypical) first line, 1st Gen (typical)

Question 26

Chlorpromazine MOA

Answer 26

D2 receptor antagonist, Treats mostly positive symptoms, causes parkinson's-like movement disorders

Question 27

High Dose / Low Potency

Answer 27

Chlorpromazine (sedative), Acute EPS less common! 300-600mg daily

Question 28

Low Dose / High Potency

Answer 28

Haldol, Fluphenazine, Perphenazine, less sedation/orthostasis/anticholinergic block, acute EPS more common, 6-12mg per day

Question 29

1st Gen. Problems

Answer 29

movement disorders, tardive syndromes, increased prolactin, lack of effect on negative symptoms, may not work in up to 30% of patients

Question 30

Movement Disorders

Answer 30

``` Early onset, reversible: Dystonia- spasms of voluntary muscles Parkinsonism- resting tremor, muscular rigidity Akathisia- feeling of inner restlessness due to blockade of D2 receptors in CNS ```

Question 31

2nd Gen.

Answer 31

act differently, not more effective (except clozapine!)

Question 32

2nd Gen. "The Good"

Answer 32

Treat schizophrenia, mania, depression, Bi-polar, less movement disorder issues, less prolactin elevation

Question 33

2nd Gen. "The Bad"

Answer 33

increased weight gain, precipitate diabetes, cardiac risk, many people still treatment resistant

Question 34

2nd Gen. "The Ugly"

Answer 34

Clozapine causes: More wight gain, seizures at high doses, excessive salivation, potentially fatal agranulocytosis (decreased WBC)

Question 35

2nd Gen. Weight Gain, Increased Lipids (metabolic)

Answer 35

Clozapine>olanzapine>lurasidone=ziprasidone

Question 36

2nd Gen. Sedation

Answer 36

Clozapine=quetiapine=olanzapine>lurasidone=ziprasidone

Question 37

Akathesia-like symptoms

Answer 37

Aripiprazole, Ziprasidone, Lurasidone

Question 38

Monitoring

Answer 38

Tardive Dyskinesia for all antipsychotics | Weight, BP, glucose and lipids 2nd and possibly 1st

Question 39

Aripiprazole MOA

Answer 39

Partial agonism at D2 receptors (lowers DA)

Question 40

Bi-polar Disorder

Answer 40

episodes of depression and at least one episode of mania or hypomania

Question 41

Hypomania

Answer 41

less severe than mania, 4-7 days, NO psychotic symptoms, less impairment of functioning

Question 42

Treatment of Bi-polar disorder

Answer 42

Lithium and Antipsychotic 2nd Gen. b/c lithium has delayed onset of action (7-10 days), also antiepileptics like depakote and epitol

Question 43

Bi-polar disorder

Answer 43

meds. used for mood stabilization, antidepressants not very good to treat depression of bi-polar disorder

Question 44

Lithium

Answer 44

Reduces suicidality!!!, renally cleared, slowed absorption b/c of food, .5-1mEq/L blood levels,

Question 45

Lithium Side Effects

Answer 45

tremor at therapeutic doses "intention tremor", can add propranolol, GI DISCOMFORT, possible weight gain, intoxication >1.5 (slurred speech, disorientation)

Question 46

Lithium Cautions

Answer 46

changes in diet, furosemide okay, dehydration, NSAID's cause Li retention, no abrupt discontinuation.

Question 47

Lithium Monitorin

Answer 47

Li inhibits thyroid gland, increased parathyroid, Li induced renal function, Li induced diabetes insipidus (very dilute urine)