AntiPsychotics

Question 1

Most anti-psychotics function by which mechanism?

Answer 1

Blocking D2 receptors

Question 2

Positive symptoms of psychosis correlate with which type of receptor activity?

Answer 2

Hyperactivity of mesolimbic D2 receptors

Question 3

Negative symptoms of psychosis correlate with which type of receptor activity?

Answer 3

Hypoactivity of mesocortical neurons

Question 4

Typical antipsychotics influence which symptoms of schizophrenia

Answer 4

Alleviate positive but not negative symptoms of schizophrenia

Question 5

Atypical antipsychotics influence which symptoms of schizophrenia

Answer 5

Reduce positive and negative symptoms of schizophrenia

Question 6

Clozapine: mechanism & side effects?

Answer 6

Atypical anti-psychotic; Antagonist at D4 receptor; decreased risk of EPS but induces agranulocytosis (requires weekly WBC monitoring) and seizures

Question 7

How does the lipid solubility of anti-psychotics influence their pharmacokinetics?

Answer 7

Readily enter CNS; can sequester in lipid compartments increasing their duration of action

Question 8

How are anti-psychotics metabolized

Answer 8

Metabolized by P450s; metabolites not important for therapeutic action

Question 9

What is mesoridazine

Answer 9

Metabolite of thioriadazine - more active than parent compound

Question 10

How are anti-psychotics excreted

Answer 10

Bc extensively metabolized, little drugs are excreted

Question 11

Which drugs have higher risk for extrapyramidal symptoms (EPS)? How are these symptoms treated?

Answer 11

Trifluoperazine, fluphenazine, haloperidol (Try to fly high); treat via benztropine (anti-muscarinics) or diphenhydramine

Question 12

What is the most important unwanted side effect of antipsychotic drugs?

Answer 12

Tardive dyskinesias! Usually develop after several years but can be irreversible

Question 13

Which drugs have higher risk for autonomic side effects?

Answer 13

Chlorpromazine, thioridazine (Cheating thieves are low)

Question 14

Weight gain and hyperglycemia are common side effects in which anti-psychotics?

Answer 14

Atypicals - mostly clozapine and olanzapine

Question 15

Which type of drugs is neuroleptic malignant syndrome seen in? How is it treated?

Answer 15

Most severe adverse effect of typical agents. Treated by dantrolene (Ca channel blocker) and dopamine agonist (bromocriptine)

Question 16

What toxicities are associated with overdosage of anti-psychotics?

Answer 16

Usually not fatal (except thioridazine); most typicals may cause seizures

Question 17

Chlorpromazine: type of drug, adverse effects?

Answer 17

Typical; Corneal deposits, anticholinergic, anti-histamine and alpha adrenergic blockade effects

Question 18

Sedation is more common with which type of drugs

Answer 18

Phenothiazines - chlorpromazine

Question 19

Thioridazine: type of drug, adverse effects

Answer 19

Typical; reTinal deposits, anticholinergic, anti-histamine, and alpha adrenergic blockade effects

Question 20

Haloperidol: type of drug, adverse effects, clinical uses

Answer 20

Typical; neurologic effects including NMS; for delirium & dementia

Question 21

Risperidone: type of drug, adverse effects, clinical uses

Answer 21

Atypical; may increase prolactin (causing lactation & gynecomastia) –> decreased GnRH, LH, FSH (irregular menstruation and fertility issues); delirium & dementia

Question 22

Olanzapine: type of drug, adverse effects, clinical uses

Answer 22

Atypical; can cause significant weight gain, hyperglycemia, possibly diabetes; depression w/ SSRI

Question 23

Paliperidone: type of drug

Answer 23

Atypical

Question 24

Quetiapine: type of drug, clinical uses

Answer 24

Atypical; depression w/ SSRI

Question 25

Ziprasidone: type of drug, adverse effects

Answer 25

Atypical; May cause prolonged QT

Question 26

Aripiprazole: type of drug, mechanism of action

Answer 26

Atypical; Partial D2 agonist; depression w/ SSRI

Question 27

Which of the atypicals are the most weight and metabolically neutral?

Answer 27

Ziprasidone and aripiprazole

Question 28

Which drugs are used to treat mania?

Answer 28

All of the atypicals except clozapine and iloperidone