antipsychotics

Question 1

dopamine pathway that causes positive symptoms of schizophrenia via excess dopamine release

Answer 1

mesolimbic

Question 2

dopamine pathway that causes negative symptoms of schizophrenia via reduced dopamine release

Answer 2

mesocortical

Question 3

dopamine pathway involved in movement disorders

Answer 3

nigrostriatal

Question 4

dopamine pathway responsible for suppression of prolactin

Answer 4

tubuloinfundibular

Question 5

effect of 5HT2A and 5HT1A receptors

Answer 5

2A = prevents DA release 
1A = accelerated DA release

Question 6

MOA of FGAs, used to treat

Answer 6

block DA release in mesolimbic pathway (decrease positive symptoms)

Question 7

8 types of ADRs of FGAs

Answer 7

worsening of negative sx
increased prolactin
anticholinergic 
antihistaminic
a1 blockers
lower seizure threshold
EPS (4)
neuroleptic malignant syndrome

Question 8

4 types of EPS

Answer 8

4 hour dystonia
4 day akathisia
4 week bradykinesia/muscle rigidity
4 month tradeoff dyskinesia

Question 9

preferred treatment of dystonia

Answer 9

anticholinergic (benztropine)

Question 10

preferred treatment of akathisia

Answer 10

benzos

Question 11

preferred treatment of bradykinesia/rigidity

Answer 11

anticholinergic and adjust med dose

Question 12

risk for tradeoff dyskinesia increases with (2)

Answer 12

age and long term use of medication

Question 13

what are the presenting symptoms of NMS?

Answer 13

Fever, encephalopathy, vitals unstable, enzymes (CPK), rigidity

Question 14

NMS can occur secondary to-

Answer 14

FGAs or SGAs

Question 15

3 steps to treating NMS

Answer 15

stop med, give dantrolene, give DA agonist (bromocriptine)

Question 16

which 2 FGAs have the most significant side effects?

Answer 16

chlorpromazine

thioridazine

Question 17

what are the 2 unique SE of chlorpromazine?

Answer 17

corneal deposits, severe antihistaminic

Question 18

what are the 2 unique SE of thioridazine?

Answer 18

retinal deposits, QT prolongation

Question 19

FGA with more neurologic effects (2)

Answer 19

haloperidol, fluphenazine

Question 20

MOA of SGAs (3), used to treat

Answer 20

Block DA receptors (+)
block 5HT2A receptors (+)
partial 5HT1A agonists (-)
(treat positive and negative symptoms)

Question 21

2 perceived benefits of SGAs over FGAs

Answer 21

lower incidence of EPS and lower prolactin levels

Question 22

2 disadvantages for SGA vs FGA

Answer 22

more expensive, increased endocrine SE

Question 23

6 main ADRs of SGAs

Answer 23

endocrine
EPS
QT prolongation
anticholinergic 
antihistaminic
a1 blockade

Question 24

SGAs and dementia

Answer 24

use of SGAs increase mortality in elderly patients with dementia

Question 25

most notable SE of clozapine

Answer 25

agranulocytosis

Question 26

3 severe ADRs of clozapine

Answer 26

agrnulocytosis, myocarditis, seizures

Question 27

3 aspects of clozapine monitoring

Answer 27

plasma drug levels WBC/ANC obesity/DM

Question 28

SGA with biggest incidence of galactorrhea

Answer 28

risperidone

Question 29

SGA with biggest risk of QT prolongation (2)

Answer 29

ziprasidone and iloperidone

Question 30

SGA with significantly high risk of weight gain, DM, HLD

Answer 30

olanzapine

Question 31

MOA of aripiprazole, consequences?

Answer 31

partial D2 and 1A agonist properties = less SE (lowest incidence of endocrine SE)

Question 32

unique, common SE of aripiprazole

Answer 32

akathisia