Antipsychotics

Question 1

dopamine

CNS function

Answer 1

reward, emotion, cognition, memory, motor activity

Question 2

increased dopamine

Answer 2

schizophrenia

over stimulates sensory cortex

Question 3

decreased dopamine

Answer 3

parkinsons

less stimulation of motor cortex

Question 4

endocrine function dopamine

Answer 4

regulate prolactin secretion from pituitary gland

Question 5

dopamine

cardio

Answer 5

N.E./E. release

low con = vasoDILATION
high con = vasoCONSTRICTION

Question 6

schizophrenia pathophys

Answer 6

excessive dopamine

5HT2A agonism

Glutamate antagonism

Question 7

positive symptoms of schizophrenia

Answer 7

increased DA to sensory cortex

hallucinations, delusions, paranoia

Question 8

negative symptoms of schizophrenia

Answer 8

decrease DA to frontal cortex

social withdrawal, lack of personal hygiene

Question 9

which antipsychotic is good for POSITIVE symptoms

Answer 9

first generation and second generation antipsychotics effective

Question 10

which antipsychotic for NEGATIVE symptoms

Answer 10

second generation antipsychotics

Question 11

antipsychotic BBW

Answer 11

elderly patients with dementia psychosis are at higher risk of death

Question 12

FGA antipsych

have more ____, less ___

Answer 12

more extrapyramidal symptoms (EPS) and tardive dyskinesia

doesn’t block negative symptoms

Question 13

SGA MOA

Answer 13

blocks 5TH2 receptors – reducing negative symptoms

Question 14

antipsychotic

anticholinergic side effects

Answer 14

dry mouth
constipation
blurred vision
urinary hesitancy

Question 15

antipsychotic system side effects (8)

Answer 15

• sedation
• orthostatic hypotension
• anticholinergic
• EPS
• endocrine
• weight gain
• sexual dysfunction
• QT prolongation
• agranylocytosis

Question 16

EPS symptoms

Answer 16

1. parkinsonism
2. dystonia
3. akathisia
4. tardive dyskinesia

Question 17

parkinsonism

Answer 17

bradykinesia, rigidity, tremor, akinesia

respond to anticholinergics (benadryl)

Question 18

dystonia

Answer 18

torticollis, larynogospasm

anticholinergics

difficult movements

Question 19

akathisia

Answer 19

somatic restlessness
inability to stay calm

reduce antipsychotic dose or switch age

beta blockers work

Question 20

tardive dyskinesia

Answer 20

abnormal, involuntary orofacial movements “lip smacking”

can be irreversible with continued drug exposure

DON’T GIVE ANTICHOLINERGICS

Question 21

endocrine effects of antipsychotics

Answer 21

prolactin secretion

galactorrhea, menstrual changes

Question 22

rare but severe side effect of antipsychotics

Answer 22

agranulocytosis

Question 23

neuroleptic malignant syndrome

Answer 23

dopamine antagonism drugs

significant fever (103-108)
absence of GI 
elevated CK (muscle rigidity/cell lysis) --> kidney dysfunction

Question 24

NMS treatment

Answer 24

dantrolene IV skeletal muscle relaxant to prevent

Question 25

FGAs

Answer 25

1. Chlorpromazine
2. Fluphenazine
3. Haloperidol (Haldol)
4. Loxapine
5. Perphenazine
6. Pimozide
7. Thiothizene
8. Thioridazine
9. Tricluroperazine

Question 26

IM FGAs

Answer 26

chlorpromazine
fluphenazine
haldol

Question 27

LAI FGAs

Answer 27

fluphenazine

haldol

Question 28

chlorpromazine side effects

Answer 28

hypercholestolemia/weight gain/DM

anticholinergic S.E.

orthostatic hypotension

Question 29

thiothizene S.E.

Answer 29

anticholinergics and orthostatic HTN

Question 30

MC s.e. of all FGAs

Answer 30

weight gain

EPS and prolactin

Question 31

SGA drug list

Answer 31

1. ariprprazole/abilify
2. asenapine
3. brexpiprazole
4. caripraszine
5. clozapine
6. iloperidone
7. lurasidone
8. olanzapine
9. paliperidone
10. pimacanserin
11. quetiapine
12. risperadone
13. ziprasidone

Question 32

aripiprazole

Answer 32

abilify

Question 33

olanzapine

Answer 33

zyprexa

Question 34

quetiapine

Answer 34

seroquel

Question 35

risperidone

Answer 35

risperidal

Question 36

ziprasidone

Answer 36

geodon

Question 37

LAI SGAs

Answer 37

abilify
paliperidone
risperidone

Question 38

IM SGA

Answer 38

abilify

zyprexa

Question 39

clozapine S.e.

Answer 39

weight gain and diabetes

hypercholesterolemia

anticholinergics

Question 40

olanzapine s.e.

Answer 40

weight gain and diabetes

hypercholesterolemia

Question 41

prolactin elevation and EPS symptoms of SGA

Answer 41

paliperidone

risperidone

Question 42

antipsychotics with QTC prolongations

Answer 42

IV halloo or Ziprasidone

Question 43

apriprazole

moa, brand, …

Answer 43

5HT1 partial agonist

low risk for EPS, high akathisia

abilify maintena ( long lasting injectable)

Question 44

lurasidone

Answer 44

Latuda

Question 45

lurasidone gen

Answer 45

theorized to have beneficial cognitive and anxiolytic effects (5HT1 and 5HT1 antagonism)

Question 46

Paliperidone

Answer 46

active metabolite of risperidone

available as monthly injection (Invega Sustenna)

Question 47

ridperidone unique to

Answer 47

hyperprolactinemia

watch doses – EPS

long acting (Risperdal Consta) every 2 weeks

Question 48

quetiapine

Answer 48

high histamine affinity, lowest EPS risk

preferred for parkinson’s psychosis

Question 49

agranulocytosis is common for which medication

Answer 49

clozapine

req. ANC monitoring

Question 50

clozapine

Answer 50

only use for treatment resistant schizoprehnia (lack of response in 2+ trials)

need an 8 week trial

Question 51

CATIE trial

Answer 51

difference between FGA and SGA are not as great as we thought

still SGA has less sideeffects

Question 52

PORT recommendations

Answer 52

first episode of schizophrenia

use any agent other than clozapine or olanzapine

Question 53

pregnancy special populations

Answer 53

risks for mom or baby

caution with clozapine/olanzapine with breastfeeding CROSSES into breastmilk

Question 54

geriatric special populations

Answer 54

avoid sedation, orthostatic hypotension

more prone to QTc prolongation