Antipsychotics

Question 1

Extrapyramidal Symptoms

Answer 1

Akathisia
Acute dystonic reactions
Parkinsonism

Question 2

Akathisia

Answer 2

Sense of restlessness , agitation, SI
onset = days to weeks

Question 3

Akathisia treatment

Answer 3

Propanolol - 10mg BID, up to 30-90mg daily
Inderal - 60-80mg daily
Benzos - any of them will work

reduce dose of antipsychotic or switch

Question 4

Dystonia

Answer 4

torticollis, laryngospasm, occular crisis
occurs in minutes to hours

Question 5

Dystonia treatment

Answer 5

Benzotropine 1-2mg 1-2x/day
Diphenhydramine 50mg daily

if severe, stop antipsychotic and give above agents IM or IV once or twice to stop the dystonia, then give PO

Question 6

Parkinsonism

Answer 6

bradykinesia, rigidity, tremors, shuffling
onset = 1-2 months

Question 7

Parkinsonism treatment

Answer 7

Benzotropine 1-2mg 1-2x/day
Trihexyphenidyl 2-5mg 1-2x/day
Diphenhydramine 50mg daily

can start benzotropine at the same time as the antipsychotic if they are high risk

Question 8

Tardive Dyskinesia

Answer 8

repetitive, involuntary movements. chewing, rolling tongue, smacking lips

can be permanent
clozapine is only antipsychotic that does not cause this

Question 9

Tardive Dyskinesia treatment

Answer 9

Deutetrabenazine (austedo) 6mg bid for 1 week, than increase by 3mg bid, max 24 mg. take with food
-prolongs qtc, SI, insomnia

valbenazine (ingrezza) 40mg x 1 week, then 80mg
-prolongs qtc, SI, sedation

Question 10

Neuroleptic malignant syndrome

Answer 10

-reduced consciousness
-increased muscle tone
-autonomic dysfunction (HTN, ST, hyperpyrexia, diaphoresis, drooling)

**life threatening emergency

Question 11

Typical Antipsychotics adverse effects

Answer 11

S - sedation, sun sensitivity, sexual side effects
T - tardive dyskinesia
A - anticholinergic, agranulocytosis
N - neuroleptic malignant syndrome
C - cardiac arrhythmias
E - extrapyramidal effects, endocrine effects (^ prolactin levels)

Question 12

Alogia

Answer 12

poverty of speech

Question 13

Affective blunting

Answer 13

reduced range of emotions

Question 14

Asociality

Answer 14

reduced social drive and interaction

Question 15

Anhedonia

Answer 15

reduced ability to feel pleasure

Question 16

Avolition

Answer 16

reduced desire, motivation to complete daily tasks

Question 17

Positive symptoms come from

Answer 17

mesolimbic

Question 18

Negative symptoms come from

Answer 18

mesocortical/prefrontal cortex

Question 19

Affective symptoms come from

Answer 19

Ventromedical prefrontal cortex

Question 20

Aggressive symptoms come from

Answer 20

amygdala & orbitofrontal cortex

Question 21

Cognitive symptoms come from

Answer 21

Dorsolateral prefrontal cortex

Question 22

High Potency FGA

Answer 22

Haldol, fluphenazine

Question 23

Mid Potency FGA

Answer 23

perphenazine, loxapine

Question 24

Low potency FGA

Answer 24

chlorpromazine

Question 25

Haloperidal (Haldol)

Answer 25

FGA PO 1-15mg/day MAX 100mg usual = 1-40mg/day Decanoate

Question 26

Fluphenazine (Prolixin)

Answer 26

FGA PO 0.5 - 10mg/day MAX 40mg usual = 1-20mg/day decanoate

Question 27

Chlorpromazine (Thorazine)

Answer 27

FGA 200-800mg/day

Question 28

Loxapine (Loxitane)

Answer 28

FGA 20mg/day in 2 doses, titrate over 7-10 days to 60-100mg, max 250mg

Question 29

Perphenazine (Trilafon)

Answer 29

FGA intial = 4-8mg TID 12-24mg/day 16-64mg/day if hospitalized

Question 30

Trifluoperazine (stelazine)

Answer 30

FGA intial = 2-5 mg BID normal = 15-20 mg/day

Question 31

FGA contraindications

Answer 31

-allergic -ingestion of substances that will interact ex etoh -severe cardiac abnormality -high risk for seizure - narrow angle glaucoma -history of tardive dyskinesia caution in liver disease

Question 32

Most sedating antipsychotics

Answer 32

olanzapine clozapine seroquel

Question 33

Atypical Antipsychotics that cause EKG changes

Answer 33

ziprasidone

Question 34

Atypical Antipsychotics that cause EPS

Answer 34

risperidone (Haldol and fluphenazine for 1st gen)

Question 35

Aytpical antipsychotic that causes akathsia

Answer 35

ariprazole brexipiprazole

Question 36

antipsychotics that must be taken with food

Answer 36

geodon - 500 cals lurasidone - 350 cals

Question 37

atypical psychotics that are high risk for metabolic syndrome

Answer 37

clozapine olanzapine

Question 38

atypical psychotics that are medium risk for metabolic syndrome

Answer 38

risperidone, paliperidone, seroquel

Question 39

atypical psychotics that are low risk for metabolic syndrome

Answer 39

ziprasidone ariprazole lurasidone

Question 40

what drug increases prolactin

Answer 40

risperidone

Question 41

what drugs come in IV/IM formulation

Answer 41

haldol fluphenazine aripiprazole risperidone

Question 42

what drugs come in sublingual formulation

Answer 42

olanzapine asenapine