Antipsychotics

Question 1

First antipsychotic

Answer 1

Chlorpromazine (Thorazine)

Question 2

How are typical antipsychotics divided?

Answer 2

High vs Low Potency

Correlates to D2 receptor binding affinity

Question 3

What is Haldol?

Answer 3

Typical Antipsychotic

Used for agitated patients and Tourette’s Syndrome

Question 4

Formulation of Haldol

Answer 4

PO, IM, IV

Question 5

What medications can be used to counteract EPS SE?

Answer 5

Anticholinergics:
Trihexyphenidyl (artane)
Benztropine (Cogetin)
Diphenydramine (Benadryl)

Question 6

Which FGA antipsychotics are available in a long acting injectable form? What is this used for

Answer 6

Haldol
Fluphenazine (Prolixin)
Given IM q2-4wks to treat chronic schizophrenia

Question 7

Properties of Chlorpromazine (Thorazine)

Answer 7

Typical Low Potency Antipsychotic
Anticholinergic
Antihistamine
a1-adrenergic antagonist

Question 8

What is Prochlorperazine (Compazine) commonly used for?

Answer 8

Antiemetic (via D2 blockade)

Question 9

Besides as an antipsychotic, what can Chlorpromazine (Thorazine) also be used for?

Answer 9

Intractable Hiccups

Question 10

What is a serious SE of Thioridazine (Mellaril)?

Answer 10

Dose dependent QTc prolongation
Torsades
Cardiotoxicity

Question 11

Why is Clozapine (Clozaril) not used despite being a very efficacious antipsychotic?

Answer 11

Bad SE profile prevents it from being 1st line

Question 12

What antipsychotic is used to treat psychosis in Lewy Body Dementia and Parkinson’s? Why?

Answer 12

Quetiapine (Seroquel): atypical

Due to low likelihood of EPS

Question 13

Which atypical antipsychotics have highest risk of hyperprolactinemia?

Answer 13

Risperidone (Risperidal)

Paliperidone (Invega)

Question 14

Which atypical antipsychotics are available in a long acting injectable form?

Answer 14

Risperidone (Risperidal)

Paliperidone (Invega)

Question 15

Which atypical antipsychotic causes most signfiicant sedation and metabolic syndrome?

Answer 15

Olanzapine(Zyprexa)

Clozapine (Clozaril)

Question 16

Which SGA (second generation antipsychotic) has the highest risk of causing QTc prolongation?

Answer 16

Ziprasidone (Geodon)

Question 17

Which SGA causes akathisia commonly?

Answer 17

Aripiprazole (Abilify)

Partial dopamine agonist

Question 18

Which atypical antipsychotic is FDA approved for adjunct treatment in major depression?

Answer 18

Aripiprazole (Abilify)

Question 19

Which atypical antipsychotic requires slow dose titration and why?

Answer 19

Clozapine (Clozaril)

Due to risk of seizure induction

Question 20

Which SGAs are most metabolically neutral?

Answer 20

Lurasidone (Latuda)
Asenapine (Saphris)
Ziprasidone (Geodone)
Aripiprazole (Abilify)

Question 21

What is Tardive Dyskinesia and what is it caused by?

Answer 21

Repetitive, involuntary, purposeless movements

Caused more commonly by TYPICAL antipsychotics

Question 22

Patient on clozapine(clozaril) with WBC<2000 or ANC<1000

Answer 22

Do ABRUPT STOP

Question 23

Why is gradual taper preferred over abrupt stop with antipsychotics?

Answer 23

Abrupt stop -> rebound psychosis

EXCEPT when patient has WBC<2000 or ANC<1000

Question 24

What should be monitored in patients on atypical antipsychotics and why?

Answer 24

Weight, Waist Circumference, Glucose, Lipids

Due to metabolic syndrome

Question 25

Whicih antipsychotics can cause dose dependent orthostatic hypotension and via what?

Answer 25

``` a1-Adrenergic Antagonism Clozapine(Clozaril) Quetiapine (Seroquel) Iloperidone (Fanapt) Risperidone (Risperdal) Paliperidone (Invega) ``` *Problem in elderly and those at fall risk

Question 26

Why is there a blackbox warning when using antipsychotics in elderly dementia patients?

Answer 26

Risk of sudden CV death

Question 27

Which atypical antipsychotic may cause both dry mouth or excess salivation?

Answer 27

Clozapine (Clozaril)

Question 28

MOA of SGA

Answer 28

Block D2 and 5HT2A receptors

Question 29

What are positive symptoms of schizophrenia due to?

Answer 29

Hyperactivity of dopamine Mesolimbic Pathway

Question 30

Blockade of the dopamine tubuloinfundibular pathway leads to what?

Answer 30

Infertility Galactorrhea Osteopenia

Question 31

What needs to be done when switching from an antipsychotic to Aripiprazole (Abilify)? Why?

Answer 31

Need to switch slowly or have washout period | Abilify will initially act as dopamine AGONIST

Question 32

What % of D2 receptors need to be occupied for antipsychotic effect?

Answer 32

60%

Question 33

What % of D2 receptors need to be occupied to see elevated prolactin or EPS?

Answer 33

80%

Question 34

What causes NMS with antipsychotics?

Answer 34

Dopamine Antagonism

Question 35

What is though to be associated with development of negative symptoms?

Answer 35

Hypoactivity of Dopamine Mesocortical Pathway

Question 36

Which SGA has MOA of partial dopamine agonism?

Answer 36

Aripiprazole (Abilify)

Question 37

Which of the following antiemetic medicaitons are D2 blockers leading to possible EPS or Tardive Dyskinesia? Prochlorperazine (Compazine) Metoclopramide(Reglan) Droperidol (Inapsine) Promethazine (Phenergan)

Answer 37

All of them

Question 38

What does cigarette smoking in schizophrenia patients imply?

Answer 38

Smoking induces increased metabolism of antipsychotic medicaitons

Question 39

What lab finding correlates with disease severity and prognosis of NMS?

Answer 39

Creatine Kinase | NOT DIAGNOSTIC THOUGH

Question 40

Which antipsychotics are approved for treatment of Bipolar Depression?

Answer 40

Olanzapine/Fluoxetine (Symbyax) Lurasidone(Latuda) Quetiapine (Seroquel)

Question 41

What is Paliperidone(Invega)

Answer 41

Active Metabolite of Risperidone (Risperdal) Signfiicant risk of hyperprolactinemia Needs to be taken with food

Question 42

Which SGAs are available in long acting injections

Answer 42

Risperidone (Risperdal) Olanzapine (Zyprexa) Paliperidone (Invega) Airpiprazole (Abilify)

Question 43

Antipsychotic SE of sedation and weight gain are due to what?

Answer 43

Antaognism of H1 receptors

Question 44

Which demographic is at greatest risk of dystonia with antipsychotics?

Answer 44

Young Males

Question 45

What symptom of NMS most commonly present first? What are the other sx?

Answer 45

``` MENTAL STATUS CHANGE Other Sx: Hyperthermia Muscle Rigidity Autonomic Instability ```