Antipsychotic Drugs (Segars)

Question 1

The following list of drugs makes up what class?

Chlorpromazine
Fluphenazine
Perphenazine
Thioridazine
Trifluoperazine
Haloperidol 
Loxapine
Molindone
Pimozide
Thiothixene

Answer 1

First generation antipsychotic agents

Question 2

The following list of drugs makes up what class?

Iloperidone
Lurasidone
Paliperidone
Risperidone
Ziprasidone
Aripiprazole
Brexpiprazole
Cariprazine
Lumateperone
Asenapine
Clozapine
Olanzapine
Quetiapine
Pimavanserin

Answer 2

Second generation antipsychotic agents

Question 3

What is the primary difference between first generation agents and second generation agents?

Answer 3

Second generation agents have reduced movement disorder symptoms

Question 4

First generation agents are also called?

Second generation agents are also called?

Answer 4

1) Typical

2) Atypical

Question 5

What is the MOA for the FGA’s?

Answer 5

Block D2 post synaptic receptors

Question 6

FGA’s can cause dry mouth, constipation, urinary retention, blurred vision, and sedation due to?

Answer 6

Also blocking muscarinic receptors

Question 7

FGA’s can cause orthostatic hypotension and dizziness/syncope due to?

Answer 7

Also blocking α1-adregneric receptors

Question 8

FGA’s can cause sedation due to?

Answer 8

Also blocking H1 receptors

Question 9

Amenorrhea/Galactorrhea/Gynecomastia/Decreased libido are dopamine associated side effects due to?

What pathway is involved?

Answer 9

1) Hyperprolactinemia

2) Tuberoinfundibular pathway

Question 10

Acute akathisia/dystonia/parkinsonism-like and tardive dyskinesia are what type of dopamine associated side effects?

What pathway is involved?

Answer 10

1) Extrapyramidal symptoms

2) Nigrostriatal pathway

Question 11

Anticholinergic agents such as Benztropine & Trihexyphenidyl are used to treat what side effects?

Answer 11

Extrapyramidal symptoms

Question 12

Selective vesicular monoamine transporter 2 (VMAT2) inhibitors such as Valbenazine and Deutetrabenazine are used to treat what side effects?

Answer 12

Tardive Dyskinesia

Question 13

What drugs make up the FGAs?

Answer 13

(-azine make up a bunch)

1) Chlorpromazine
2) Fluphenazine
3) Perphenazine
4) Thioridazine
5) Trifluoperazine
6) Haloperidol
7) Loxapine
8) Molindone
9) Pimozide
10) Thiothixene

Question 14

What is the MOA of SGA’s?

Answer 14

Blocks D2 post synaptic receptors and blocks 5HT2A receptors

Question 15

Are SGAs stronger at blocking D2 or 5HT2A receptors?

Answer 15

5HT2A

Question 16

The following list of drugs make up what category of SGAs?

Iloperidone
Lurasidone (also partial 5HT-1A agonist)
Paliperidone (metabolite of Risperidone)
Risperidone
Ziprasidone

Answer 16

5HT-2A/DA Receptor Antagonists

Question 17

The following list of drugs make up what category of SGAs?

Aripiprazole
Brexpiprazole

Answer 17

Partial DA/5HT-1A Receptor Agonists

Question 18

The following list of drugs make up what category of SGAs?

Asenapine
Clozapine
Olanzapine
Quetiapine
Lumateperone

Answer 18

Multi-Acting Receptor-Target Agents

Question 19

Pimavanserin makes up what category of SGAs?

Answer 19

Inverse Serotonin Agonist/Antagonist

Question 20

What are common side effects of SGAs?

Answer 20

1) Weight gain

2) Metabolic effects (hyperglycemia/insulin resistance, hyperlipidemia)

Question 21

What are rare side effects of SGAs?

What populations are at greater risk for these side effects?

Answer 21

1) QTc prolongation (women, elderly, and those on antiarrhythmics)
2) Stroke (Elderly with dementia)

Question 22

When monitoring antipsychotics, guidelines recommend determining in all patients, what baseline items?

Answer 22

1) Serum glucose
2) Lipids
3) BMI
4) BP
5) Waist circumference
6) Family history of CV and metabolic disease

Question 23

Which SGA is associated with agranulocytosis as a side effect?

Answer 23

Clozapine

Question 24

Which SGA is associated with Drug Reaction w/ Eosinophilia & Systemic Symptoms (DRESS) as a side effect?

Answer 24

Olanzapine

Question 25

What drugs make up the SGAs?

Answer 25

``` (-idone): Iloperidone Lurasidone Paliperidone Risperidone Ziprasidone ``` (-piprazole): Aripiprazole Brexpiprazole ``` (-apine) Asenapine Clozapine Olanzapine Quetiapine ``` Pimavanserin Cariprazine Lumateperone

Question 26

Neuroleptic Malignant Syndrome (NMS) is a rare but potentially-fatal antipsychotic side effect that causes severe Parkinson’s-like movement disorder with wide-spread muscle contraction that can be treated with?

Answer 26

Dantrolene

Question 27

Non-adherence of antipsychotics can be managed with? What are these agents?

Answer 27

1) Long-Acting Injectable Agents (LAIA’s) | 2) OAR: Olanzapine, Aripiprazole, Risperidone

Question 28

Which SGA is used for recurrent suicidal behavior?

Answer 28

Clozapine

Question 29

Which SGA is used for Parkinson Disease psychosis?

Answer 29

Pimavanserin

Question 30

What adverse side effects are more commonly seen with the FGA chlorpromazine?

Answer 30

1) Tardive dyskinesia 2) Sedation 3) Anticholinergic side effects 4) Orthostatic hypotension 5) QTc prolonging

Question 31

What adverse side effects are more commonly seen with the FGA fluphenazine?

Answer 31

1) EPS 2) Tardive dyskinesia 3) Prolactin elevation

Question 32

What adverse side effects are more commonly seen with the FGA haloperidol?

Answer 32

1) EPS 2) Tardive dyskinesia 3) Prolactin elevation 4) QTc prolonging

Question 33

What adverse side effects are more commonly seen with the FGA thioridazine?

Answer 33

1) Sedation 2) Anticholinergic side effects 3) Orthostatic hypotension

Question 34

What adverse side effects are more commonly seen with the SGA cariprazine?

Answer 34

1) Sedation 2) Anticholinergic side effects 3) Orthostatic hypotension

Question 35

What adverse side effects are more commonly seen with the SGA clozapine?

Answer 35

1) Weight gain 2) Hyperglycemia 3) Hyperlipidemia 4) Sedation 5) Anticholinergic side effects 6) Orthostatic hypotension

Question 36

What adverse side effects are more commonly seen with the SGA olanzapine?

Answer 36

1) Weight gain 2) Hyperglycemia 3) Hyperlipidemia 4) Sedation

Question 37

What adverse side effects are more commonly seen with the SGA quetiapine?

Answer 37

1) Hyperlipidemia | 2) Sedation

Question 38

What adverse side effects are more commonly seen with the SGA risperidone?

Answer 38

Prolactin elevation

Question 39

What adverse side effects are more commonly seen with the SGA ziprasidone?

Answer 39

QTc prolonging

Question 40

A 42-year-old patient is treated with an antipsychotic medication to manage his schizophrenia. Which of the following agents would more likely have been prescribed if the patient experienced skeletal muscle rigidity, tremor at rest, flat facies, uncontrollable restlessness, and spastic torticollis? ``` A. Haloperidol B. Clozapine C. Olanzapine D. Chlorpromazine E. Quetiapine ```

Answer 40

A. Haloperidol

Question 41

A 36-year-old woman has had schizophrenia for several years, during which time she has received various different medications. Her current treatment is fluphenazine, and she is experiencing amenorrhea and galactorrhea. Which antipsychotic agent would be more appropriate for this patient and would have the lowest risk of her current adverse effects? ``` A. Aripiprazole B. Haloperidol C. Chlorpromazine D. Risperidone E. Clozapine ```

Answer 41

A. Aripiprazole

Question 42

A 36-year-old woman has had schizophrenia for several years, during which time she has received various different medications. Her current treatment is fluphenazine, and she is experiencing amenorrhea and galactorrhea. Which second generation agent would be least appropriate for this patient and would have a near-equal risk of her current adverse effects? ``` A. Aripiprazole B. Haloperidol C. Chlorpromazine D. Risperidone E. Clozapine ```

Answer 42

D. Risperidone

Question 43

A 35-year-old homeless man has been taking chlorpromazine for many years to control his schizophrenia. He has experienced numerous adverse effects typical of this treatment, including blurred vision, dry mouth, mydriasis, nausea, urinary retention, and constipation. These effects are caused by blockade of which receptor? ``` A. Alpha adrenergic B. Dopamine C. Nicotinic D. Serotonin E. Muscarinic ```

Answer 43

E. Muscarinic

Question 44

A patient with a history of schizophrenia is transported to the emergency department by ambulance after repeated episodes of fainting. The cause is speculated to possibly be attributed to severe drug-induced orthostatic hypotension associated with one of her medications and thought to be due to alpha-adrenergic blockade. Which antipsychotic medication that the patient could have been receiving would be the most likely cause of this side effect? ``` A. Risperidone B. Thioridazine C. Aripiprazole D. Haloperidol E. Fluphenazine ```

Answer 44

B. Thioridazine

Question 45

A patient with a history of schizophrenia is transported to the emergency department by ambulance after repeated episodes of fainting. The cause is speculated to possibly be attributed to severe drug-induced orthostatic hypotension associated new therapy with thioridazine. This side effect is caused by blockade of which receptor? ``` A. Alpha adrenergic B. Dopamine C. Nicotinic D. Serotonin E. Muscarinic ```

Answer 45

A. Alpha adrenergic

Question 46

A 22-year-old male college student with a BMI of 49 is diagnosed with schizophrenia. Which medication is a second-generation antipsychotic that would be most appropriate as first-line therapy for this patient and have the lowest impact on his BMI? ``` A. Quetiapine B. Olanzapine C. Clozapine D. Chlorpromazine E. Ziprasidone ```

Answer 46

E. Ziprasidone