Antipsychotics

Question 1

Positive symptoms of psychosis/schizophrenia include:

Answer 1

Delusions, hallucinations, disorganized speech, catatonic behavior
(hyperactivity of the mesolimbic dopaminergic pathway=excess dopamine)

Question 2

Negative symptoms of psychosis/schizophrenia include

Answer 2

Flat affect, alogia (lack of speech), avolition

hypoactivity of mesocortical dopaminergic pathway=insufficient dopamine

Question 3

MOA Typical Antipsychotics:

Answer 3

Antagonize D2 receptors in the CNS

=Decreased positive s/s

Question 4

On target AE of Typical Antipsychotics:

Answer 4

(d/t D2 antagonism)

• EPS- Parkinsonian s/s
• Tardive dyskinesia (chronic use- rep. involuntary movements of the face, arms, trunk)
• Neuro Malignant Syndrome
• Increased prolactin secretion (women- amenorrhea, galactorrhea, false + preg test, men- gynecomastia, decrease libido)

Question 5

Off target AE of Typical Antipsychotics:

Answer 5

Muscarinic: anticholinergic effects
a-antagonism: Orthostatic hypotension, failure to ejaculate
H1-sedation

Question 6

Which AE are more common with high potency typical antipsychotics?

Answer 6

Higher potency= more D2 related AE vs off target effects

Lower potency= more off target effects

Question 7

Atypical antipsychotics are more effective at treating what type of symptoms?

Answer 7

Negative

Question 8

What atypical antipsychotic that is effective at treating both negative and positive symptoms?

Answer 8

Resperidone (more effective than Haldol at tx of positive symptoms

Question 9

MOA of Atypical Antipsychotics:

Answer 9

5HT2 and D2 antagonism

Question 10

Why do atypical antipsychotics have less EPS?

Answer 10

They dissociate relatively fast from D2 receptors (this is why they are not generally used to treat positive symptoms)

Question 11

What is Neuroleptic Malignant Syndrome?

Answer 11

Similar to serotonin syndrome but more severe (life-threatening)
Fever, muscle rigidity, increase CPK, myoglobin, delirium

Question 12

Clozapine is what type of antipsychotic and when is it used?

Answer 12

Atypical antipsychotic

Used as last line for treatment-resistant patients

Question 13

Clozapine AE(serious):

Answer 13

Life-threatening agranulocytosis

**monitor CBC weekly for 6mos, biweekly 6mos, qmonth)

Question 14

Clozapine AE:

Answer 14

Orthostatic hypotension
Weight gain
Hyperglycemia
Sedation
Constipation

Question 15

Paliperidone(Invega) is the primary active metabolite for what atypical antipsychotic?

Answer 15

Risperidone

Question 16

Which patients is paliperidone preferred in?

Answer 16

Those who have hepatic dysfunction (safter than risperiodone which has to be metabolized by liver). Mostly renally excreted
No identified DI
*osmotic delivery capsule, do not crush or chew

Question 17

What is the MOA of Aripiprazole (Abilify)

Answer 17

Atypical antipsychotic
Partial agonist at D2 rc
Partial agonist at 5HT1a rc 
Antagonist at 5HT2a, H1, alpha 1 rc
(*Partial agonism leads to unpredictable levels of rc activity- not used with other antipsychotics)

Question 18

Olanazapine (Zyprexa) is what type of antipsychotic?

Answer 18

Atypical

Question 19

What is special about Olanazapine’s metabolism?

Answer 19

Metabolized by CYP1A2, smoking increases this metabolism

Question 20

Can Olanzapine tablets be cut?

Answer 20

If cut they must be taken immediately, drug oxidizes in are

Question 21

Quetiapine (Seroquel)is this type of antipsychotic and can be use for _____ at low doses?

Answer 21

Atypical Antipsychotic
Sleep aid
**causes weight gain

Question 22

Quetiapine (Seroquel) has a ______ dosing range.

Answer 22

Wide, few clinically significant drug interactions

Question 23

Respiradone can be given ____ every two weeks.

Answer 23

IM (continue oral for at least 3wks

Question 24

Aripiprazole, olanzapine, and risperidone can all be given as _____ to avoid patients ‘cheeking’ meds.

Answer 24

ODT

Question 25

Typical antipsychotics include:

Answer 25

Chlorpromazine Thioroidazine Haloperidol (Haldol) Fluphenazine

Question 26

Atypical Antipsychotics include:

Answer 26

``` Risperidone Quetiapine (Seroquel) Apiprazole (Abilify) Olanzapine (Zyprexa) Clozapine (Clorazil) ```

Question 27

Main side effect of Olanzapine (Zyprexa)?

Answer 27

Weight gain | also hyperglycemia

Question 28

Last line atypical antipsychotics include:

Answer 28

Chlorpromazine Thioridazine Mesoridazine

Question 29

What do Haloperidol, Fluphenazine, and thiothixene have in common?

Answer 29

Typical antipsychotics High potency= More EPS Weaker H1, M1 antagonists

Question 30

Eszoplicone(Lunesta):

Answer 30

Site of action= GABA receptors | Used for insomnia

Question 31

Zolpidem(Ambien):

Answer 31

Effects reversed by Flumazenil Site of action= GABA receptors Used for insomnia

Question 32

Ramelteon is different than other sleep aids because it:

Answer 32

carries no risk of tolerance of dependency | Acts on melatonin receptors, used for insomnia

Question 33

Barbiturates:

Answer 33

Extensively met by CYP Used for insomnia Used for anesthesia and seizures

Question 34

Benzos:

Answer 34

Effects reversed with Flumazenil Site of action= GABA receptors USed for insomnia Used for anesthesia and Seizures