antipsychotics

Question 1

classical vs atypical antipsychotic: chlorpromazine

Answer 1

classical

Question 2

classical vs atypical antipsychotic: fluphenazine

Answer 2

classical

Question 3

classical vs atypical antipsychotic: haloperidol

Answer 3

classical

Question 4

classical vs atypical antipsychotic: thioridazine

Answer 4

classical

Question 5

classical vs atypical antipsychotic: clozapine

Answer 5

atypical

Question 6

classical vs atypical antipsychotic: risperidone

Answer 6

atypical

Question 7

classical vs atypical antipsychotic: olanzapine

Answer 7

atypical

Question 8

classical vs atypical antipsychotic: quetiapine

Answer 8

atypical

Question 9

classical vs atypical antipsychotic: ziprasidone

Answer 9

atypical

Question 10

classical vs atypical antipsychotic: aripiprazole

Answer 10

atypical

Question 11

classical vs atypical antipsychotic: paliperidone

Answer 11

atypical

Question 12

classical antipsychotics

Answer 12

high potency - higher chance for EPRs

• fluphenazine
• haloperidol

low potency - more likely to cause sedation, postural hypotension

• chlorpromazine
• thioridazine

Question 13

atypical antipsychotics

Answer 13

higher affinities for receptors other than D2

commonly:

• antagnoize 5HT2a and D2
• less likely to cause tardive dyskinesia, inc prolactin
• effective in treating negative sxs

Question 14

clozapine

Answer 14

prototype for atypicals

Question 15

risperidone

Answer 15

causes EPR - rare at normal dose

Question 16

paliperidone

Answer 16

9-hydroxyrisperidone (active metabolite of risperidone)

Question 17

which antipsychotics are least likely to induce EPR

Answer 17

clozapine

quetiapine

Question 18

aripiprazole

Answer 18

patial agonist at D2 and 5HT1a

antag at 5HT2a

Question 19

all antipscyhotics except which 2 don’t have anti-emetic effects

Answer 19

aripiprazole
thioridazine

mediated via D2 blocking

Question 20

neurological AE of anti-psychotics

Answer 20

EPS = with high D2 potency
(haloperidol, fluphenazine - high D2 affinities)

also less likely with strong anticholinergics (thioridazine/chlorpromazine) and atypicals

Question 21

tx for parkinsonism AE of antipsychotics

Answer 21

benztropine
trihexyphenidyl
diphenhydramine/amantadine

never give levodopa = will aggravate psychosis

Question 22

tx for dystonia AE of antipsychotics

Answer 22

benztropine
trihexyphenidyl
diphenhydramine

Question 23

tx for akathisia AE of antipscyhotics

Answer 23

clonazepam

propranolol

Question 24

tx for tardive dyskinesia AE of antipsychotics

Answer 24

(may be due to dopamine receptor up regulation)

may be irreversible

eliminate drugs with central anticholinergic actions (anti-parkinsonian drugs and TCAs)

diazepam may help

Question 25

pt with tardive dyskinesia who require antipsychotics - what drug to use

Answer 25

clozapine

Question 26

neuroleptic malignant syndrome

Answer 26

rigidity, tremor, hyperthermia inc WBC, inc CK myoglobinemia tx: dantrolene, bromocriptine

Question 27

what causes sedation as an AE of antipsychotics

Answer 27

blockade of central H1

Question 28

autonomic AE of antipsychotics

Answer 28

orthostatic hypotension | impaired ejaculation

Question 29

which antipsychotic causes agranulocytosis

Answer 29

clozapine regular blood counts are mandatory NOT first line

Question 30

AE prolactin elevation with antipsychotics

Answer 30

blockade of D2 amenorrhea, galactorrhea loss of libido, infertility in men

Question 31

which antipsychotics can cause cardiac toxicity

Answer 31

thioridazine = QT elongation, T wave changes ziprasidone = can elongate QT

Question 32

which antipsychotics cause ocular AE

Answer 32

chlorpromazine = cornea, lens deposits thioridazine = retinal spots

Question 33

non pysch use for antipsych meds

Answer 33

nausea and vomiting droperidol used in neurolept-anesthesia

Question 34

DOC antipsychotics

Answer 34

atypical risperidone is most prescribed

Question 35

antipsych in pregnancy

Answer 35

category C only clozapine is category B risk of hyperglycemia and weight gain are greater with use atypicals