Antipsychotics

Question 1

The antipsychotic drugs fall into 2 major groups.. What are they?

Answer 1

First generation antipsychotics (FGAs)
-aka conventional antipsychotics

Second generation antipsychotics (SGAs)
-aka atpyical antipsychotics

Question 2

Which group is better: FGA or SGA?

Answer 2

They are both equally effective

Question 3

All of the FGAs produce strong blockade of receptors for ____ in the CNS. What does this result in?

Answer 3

Strong blockade of receptors for DOPAMINE in the CNS; this results in serious movement disorders

Question 4

Extrapyramidial symptoms (EPS)

Answer 4

Serious movement disorders

Question 5

What do the SGAs produce (like what blockade)?

Answer 5

Moderate blockade of receptors for dopamine; much stronger blockade of receptors for serotonin

Question 6

Which has a lower risk for EPS: FGA or SGA?

Answer 6

SGA, since the blockade of receptors for dopamine is only moderate, whereas FGA has strong blockade of receptors for dopamine

Question 7

Even thought the SGAs carry a lower risk for EPS, they cause significant risk for metabolic effects. What are some examples?

Answer 7

• Weight gain
• Diabetes
• Dyslipidemia

Question 8

Define: A chronic psychotic illness characterized by disordered thinking and a reduced ability to comprehend reality

Answer 8

Schizophrenia

Question 9

When do symptoms of schizophrenia usually emerge?

Answer 9

During adolescence or early adulthood

Question 10

What are the positive symptoms of schizophrenia?

*Positive symptoms are viewed as an exaggeration or distortion of normal function

Answer 10

Hallucinations
Delusions
Disorganized speech
Bizarre behavior

Question 11

What are the negative symptoms of schizophrenia?

*Negative symptoms can be viewed as a loss or diminution of normal function

Answer 11

Blunted affect
Poverty of thought
Loss of motivation
Inability to experience pleasure

Question 12

Do FGAs improve positive symptoms, negative symptoms, or both?

Answer 12

Positive symptoms only

Question 13

What are the 4 examples of FGAs?

Answer 13

Chlorpromazine
Haloperidol
Thiothixene
Trifuperazine

Question 14

Which is more potent? Haloperidol or chlorpromazine?

Answer 14

Haloperidol

Question 15

What does it mean when we say a drug is more potent?

Answer 15

The dose of the more potent drug (ex: haloperidol) required to believe psychotic symptoms is smaller than the required dose of the less potent drug (ex: chlorpromazine)

It DOES NOT mean that the more potent drug will produce greater effects.

Question 16

If low potency and high potency neuroleptics (another name for FGAs) are equally effective, why do we distinguish between them?

Answer 16

These agents produce identical antipsychotic effects, but they differ SIGNIFICANTLY in their side effects

Question 17

What is the primary indication for antipsychotic drugs?

Answer 17

Schizophrenia

Question 18

FGA agents are equally effective, but individual patients may respond differently from one FGA to another. So how is selection on an FGA based?

Answer 18

It’s side effects

Question 19

Do FGAs have many or few side effects?

Answer 19

Many

Question 20

Of the many side effects that FGAs may produce, what is the most troubling?

Answer 20

Extrapyramidal reactions–especially tardive dyskinesia (TD)

Question 21

What are 4 types of EPS?

Answer 21

Acute dystonia
Parkinsonism
Akathisia
Tardive dyskinesia

Question 22

Three of the 4 types of EPS occurs early in therapy. What are they? Can they be managed?

Answer 22

Acute dystonia
Parkinsonism
Akathisia
Yes, they can be managed with a variety of drugs

*The early reactions occur LESS FREQUENTLY with LOW-POTENCY agents than with high potency agents

Question 23

What is the type of EPS that occurs late in therapy? Does it have satisfactory treatment?

Answer 23

Tardive dyskinesia; No satisfactory treatment

*The risk of TD is equal with ALL FGAs

Question 24

Describe what happens in acute dystonia

Answer 24

• Muscle tightening (spasms) usually of the neck and shoulders
• Can involve the tongue and eyes
• Occur early in therapy

Question 25

Describe what happens in akathisia

Answer 25

- Literally means "can't sit" - A motor restlessness--> constant drive to move - Occurs early in therapy

Question 26

Describe what happens in Parkinsonism

Answer 26

- Exact same presentation as Parkinson's disease (tremor, shuffling gait, decreased arm swing, and mask-like facies) - Occurs early in therapy

Question 27

Describe what happens in Tardive dyskinesia

Answer 27

- Means "late movement disorder" - Occurs late in therapy - Usually permanent - Involuntary movement of tongue, eyes, lips, and face

Question 28

If a schizophrenia patient has been on FGAs for 2 years and begins showing symptoms of involuntary movement of the tongue and eyes, what kind of EPS would she have?

Answer 28

Tardive dyskinesia *Even though acute dystonia has these same characteristics, the key word of the patient having been taking the drug for 2 years already lets you know that this is TD.

Question 29

Which FGA drugs are used more often: low or high potency?

Answer 29

High; because they produce fewer side effects

Question 30

High potency FGAs causes more ____, but less ____, ____, ____.

Answer 30

More early EPS, but less sedation, orthostatic hypotension, and anticholinergic effects

Question 31

FGA: Is haloperidol low or high potency?

Answer 31

High

Question 32

FGA: What is haloperidol a preferred agent for?

Answer 32

Tourette's syndrome - It can also be used to control severe behavior problems in children - It is used more than other FGAs

Question 33

FGA: Haloperidol is a high potency drug. Based on what we know, what kind of effects may we see?

Answer 33

``` Early EPS; As well as: -less sedation -less orthostatic hypotension -less anticholinergic effects ```

Question 34

FGA: Is trifluoperazine low or high potency?

Answer 34

High potency

Question 35

FGA: is thiothixene low or high potency?

Answer 35

High potency

Question 36

FGA: is haloperidol low or high potency?

Answer 36

High potency

Question 37

FGA: is chlorpromazine low or high potency?

Answer 37

Low potency

Question 38

FGA: Chlorpromazine is a low potency drug. What sort of adverse effects may be seen here?

Answer 38

(the opposite of a high potency drug) - Sedation - Orthostatic hypotension - Anticholinergic effects

Question 39

Which antipsychotic drug class is less likely to cause EPS effects, including TD?

Answer 39

SGAs

Question 40

SGAs may have less of a risk for getting EPS, but what do SGAs carry a serious risk for?

Answer 40

Metabolic effects - Weight gain - Diabetes - Dyslipidemia (can lead to cardiovascular events and premature death) *Can also cause sedation, orthostatic hypotension, and can increase the risk of death when used to treat demential-related psychosis in older adults

Question 41

So even though SGAs and FGAs are similar in effectiveness, which one costs 10-20x more than the other

Answer 41

SGAs cost 10-20x more than FGAs

Question 42

What is the MOA of SGAs?

Answer 42

Block dopamine and serotonin

Question 43

What are the 4 types of SGAs?

Answer 43

clozapine rrisperidone olanzapine quetipine

Question 44

Do SGAs treat both positive and negative effects, or only one?

Answer 44

They treat both!

Question 45

What is the most effective SGA for schizophrenia?

Answer 45

clozapine

Question 46

What problem does clozapine cause that makes it a drug only given to patients who have not responded to safer alternatives?

Answer 46

It causes agranulocytosis

Question 47

What is agranulocytosis

Answer 47

An increased deficiency in granulocytes in the blood causing an increased vulnerability to infection

Question 48

What is NMS?

Answer 48

Neuroleptic malignant syndrome

Question 49

Is NMS more likely to occur with FGA or SGA drugs?

Answer 49

FGA

Question 50

Is NMS more likely to occur with high or low potency FGAs?

Answer 50

High potency

Question 51

What are the symptoms of NMS?

Answer 51

``` "lead pipe rigidity" Fever Encephalitis VS instability Elevated WBC & CPK Rigidity Sweating ```