Antipsychotics

Question 1

What is an indication for Clozapine?

Answer 1

Recurrent suicidal behavior

Question 2

What is an indication for Primavanserin?

Answer 2

hallucinations/delusions associated with parkinsons disease

Question 3

Over-activation of which system causes positive symptoms i.e. hallucinations, voices etc…

Answer 3

Mesolimbic pathway

Question 4

What are examples of positive symptoms?

Answer 4

hallucinations, delusions, disorganized speech/thinking, agitation, abnormal motor behavior

Question 5

What causes negative and cognitive symptoms?

Answer 5

Mesocortical pathway dysfunction

Question 6

What are examples of negative symptoms?

Answer 6

apathy, avolition (decreased motivation), alogia (cant speak), cognitive deficits (working memory), social withdrawal

Question 7

What is the Nigrostriatal pathway physiologically useful for?

Answer 7

stimulation of purposeful movements

Question 8

What Drugs can effect the Nigrostriatal pathway and can cause drug induced parkinsonism?

Answer 8

First generation antipsychotics > second generation antipsychotics

Question 9

First generation antipsychotics can cause pseudoparkinsonism by antagonizing this receptor?

Answer 9

D2 receptor

Question 10

What is the tuberoinfundibular pathway associated with?

Answer 10

Dopamine tonically inhibits prolactin release

Question 11

If we antagonize the D2 receptor what is the effect on prolactin levels?

Answer 11

increase

Question 12

What side effects are seen from disruption in the nigrostriatal pathway?

Answer 12

Extra Pyramidal Symptoms and Tardive Dyskinesia

Question 13

Are we more likely to use first gen or second gen antipsychotics first line?

Answer 13

Second generations are usually first because they have less EPS

Question 14

How long can it take to reach maximum benefit (remission) when using antipsychotics?

Answer 14

Several months - encourage patients to be compliant

Question 15

What is the the ending for First gen antipsychotics?

Answer 15

“-Azine”

Question 16

(star) What is the primary difference in Side effects of first generation in comparison to second gen antipsychotics?

Answer 16

SGA have less movement disorders

Question 17

What are the muscarinic side effects of First gen Antipsychotics?

Answer 17

dry mouth, constipation, urinary retention, blurred vision, sedation

Question 18

What are the alpha-adrenergic side effects of FGAs?

Answer 18

orthostatic hypotension, dizziness

Question 19

What are the histamine side effects of FGAs?

Answer 19

Sedation

Question 20

What is a cardiac risk factor of FGAs?

Answer 20

QT prolongation, Torsades de Pointe, and seizure activity

Question 21

What is an endocrine (dopamine) side effect of FGAs?

Answer 21

Hyperprolactinemia

Question 22

What are the side effects of Hyperprolactinemia?

Answer 22

F - amenorrhea, galactorrhea. M - gynecomastia, decreased libido

Question 23

What are the dopamine side effects of FGAs specifically EPS?

Answer 23

Acute akathisia (involuntary movements), acute dystonia, parkinson like symptoms

Question 24

What are the low potency FGAs?

Answer 24

Chlorpromazine and Thioridazine

Question 25

What are the High potency FGAs?

Answer 25

Fluphenazine, Haloperidol

Question 26

(star) What are two treatments for Tardive Dyskinesia? and what is their MOA?

Answer 26

Valbenazine, deutetrabenazine | MOA - VMAT2 inhibitor

Question 27

(star) What are the two treatments for EPS specifically the anticholinergic agents?

Answer 27

Benztropine and Trihexyphenidyl

Question 28

(star) What is the treatment for EPS specifically the antihistamine agents?

Answer 28

Diphenhydramine

Question 29

SGAs like FGAs block the D2 receptor but they also block this receptor?

Answer 29

5HT2A receptor - stronger than their D2 effect

Question 30

What are common side effects of SGAs?

Answer 30

Weight gain, hyperglycemia, hyperlipidemia

Question 31

What is a rare but serious side effect associated with Clozapine?

Answer 31

Agranulocytosis

Question 32

What is a rare side effect of Olanzapine?

Answer 32

DRESS - Drug reaction w/ eosinophilia and systemic symptoms

Question 33

What is Neuroleptic malignant syndrome?

Answer 33

Rare but potentially fatal, severe parkinsons like movement disorder caused by FGAs > SGAs

Question 34

What are the side effects of NMS?

Answer 34

muscle rigidity (lead pipe), Rhabdomyolysis, increased muscle metabolism, hyperthermia, dehydration

Question 35

What is the treatment for NMS? hint: it is the same for malignant hyperthermia caused by anesthetics...

Answer 35

Dantrolene - Ryanodine receptor antagonist

Question 36

(star) What are the guidelines for all patients as it relates to baseline items we must get before giving an antipsychotic?

Answer 36

Serum glucose, lipids, weight (BMI), BP, Waist circumference, personal/Family history of metabolic and CV disease

Question 37

Which SGAs has a similar risk for prolactin elevation as high dose FGAs?

Answer 37

Risperidone

Question 38

Which antipsychotic agent has the highest risk for orthostatic hypotension?

Answer 38

Thioridazine

Question 39

(star) What drugs can be used to manage non-adherence/non-compiance of antipsychotics?

Answer 39

LAIAs - Long-Acting Injectable Agents

Question 40

(star) What are the LAIAs that we need to know for the exam?

Answer 40

Risperidone, Olanzapine, Aripiprazole lauroxil, (Paliperidone palmitate - dont need to know this one) but it makes the mnemonic ROAP