CNS DRUGS - ANTIPSYCHOTICS AND LITHIUM

Question 1

TYPICAL (CLASSICAL) ANTIPSYCHOTICS MOA

Answer 1

MOA: Block more D2 receptors > 5HT 2A receptors

Question 2

TYPICAL OR ATYPICAL?

Addresses positive symptoms (Hallucinations) of schizophrenia but not much effect on negative symptoms (emotional blunting, social withdrawal, lack of motivation)

Answer 2

TYPICAL (CLASSICAL) ANTIPSYCHOTICS

Question 3

High potency typical antipsychotics (i.e. Haloperidol, droperidol): higher chances of causing ______

Answer 3

extrapyramidal symptoms (EPS)

Question 4

Low potency typical antipsychotics (i.e. Thioridizine, Chlorpromazine): lower chances of causing EPS, more likely to cause _______

Answer 4

sedation and postural hypotension (due to alpha receptor blockade)

Question 5

ATYPICAL ANTIPSYCHOTICS MOA

Answer 5

MOA: Block 5HT 2A receptors > D 2 receptors

Question 6

Atypical antipsychotics address both ________

Answer 6

positive and negative effects of schizophrenia

Question 7

TYPICAL OR ATYPICAL?

lesser propensity to cause EPS compared to its typical counterparts, but has a higher propensity in causing metabolic derangements (weight gain, endocrine problems)

Answer 7

ATYPICAL ANTIPSYCHOTICS

Question 8

schizophrenia is caused by a relative _____ of dopamine in specific neuronal tracts in the brain

EXCESS OR LACK?

Answer 8

EXCESS

Question 9

Typical antipsychotics (Phenothiazine)

Answer 9

CHLORPROMAZINE [C]

THIOTHEXENE [C] (Thioxanthene), FLUPENTIXOL (Thioxantene), PROMETHAZINE, PROCHLORPERAZINE [C], LEVOMEPROMAZINE

Question 10

typical antipsychotic that can cause Corneal and lens deposits

Answer 10

CHLORPROMAZINE [C]

Question 11

Typical antipsychotic (Piperdine)

Answer 11

THIORIDAZINE [C]

FLUPHENAZINE [C], PERPHENAZINE [C], TRIFLUOPERAZINE [C]

Question 12

typical anti psychotic that can cause Retinal Deposits

Answer 12

THIORIDAZINE [C]

Question 13

_________ has the most muscarinic blockade therefore has the least EPS amongst the typical antipsychotics

Answer 13

THIORIDAZINE [C]

Question 14

differentiate CHLORPROMAZINE AND CHLORPROPAMIDE

Answer 14

CHLORPROMAZINE - typical anti psychotic

CHLORPROPAMIDE - surfonylurea

Question 15

Typical antipsychotic (butyrophenone)

Answer 15

HALOPERIDOL [C]

DROPERIDOL [C]

Question 16

_______ causes the most extrapyramidal symptoms and neuroleptic malignant syndrome of all typical anti-psychotics

Answer 16

HALOPERIDOL [C]

Question 17

DOC for refractory and suicidal schizophrenia

Answer 17

CLOZAPINE [B]

Question 18

Atypical antipsychotic (Dibenzodiazepine)

Answer 18

CLOZAPINE [B]

Question 19

highest tendency to cause weight gain amongst your atypicals

Answer 19

Clozapine and Olanzapine

Question 20

Only antipsychotic that reduces the risk of suicide

Answer 20

CLOZAPINE [B]

Question 21

feared complications of clozapine

Answer 21

Agranulocytosis and seizures

Question 22

cause MINIMAL or NO increases in prolactin and has a reduced rish of EPS (reflected by minimal D2 antagonism)

Answer 22

Olanzapine, Quetiapine and Aripiprazole

Question 23

atypicals that are LEAST LIEKLY to cause tardive dyskinesia

Answer 23

Quetiapine and Clozapine

Question 24

Drug used for sleep maintenance and promotion

Answer 24

QUETIAPINE

Question 25

compared to all the other atypicals, has the highest propensity for causing hyperprolactinemia (amenorrhea, galactorrhea)

Answer 25

RISPERIDONE [C]

Question 26

Only antipsychotic approved for schizophrenia in the youth

Answer 26

RISPERIDONE [C]

Question 27

atypical antipsychotic that has the greatest risk for **QT prolongation** (and hence don’t combine with drugs that will have the same effect i.e thioridazine, class I and III anti arrhythmics)

Answer 27

ZIPRASIDONE [C]

Question 28

Least sedating atypical antipsychotic

Answer 28

ARIPIPRAZOLE [C]

Question 29

What are the features of **neuroleptic malignant syndrome?** Mnemonic: “FEVER”

Answer 29

Fever Elevated CPK Rigidity Encephalopathy Vitals unstable

Question 30

give examples of **ATYPICAL ANTIPSYCHOTICS**

Answer 30

Amisulpride **Aripiprazole** Asenapine Blonanserin Carpipramine Clocapramine Clotiapine **Clozapine** Iloperidone Lurasidone Mosapramine **Olanzapine** Paliperidone Perospirone **Quetiapine** Remoxipride **Risperidone** Sertindole **Ziprasidone** Zotepine

Question 31

drug that causes **EBSTEIN ANOMALY**

Answer 31

LITHIUM

Question 32

DOC for bipolar disorder

Answer 32

Lithium

Question 33

Lithium mnemonic lifted from USMLE: ## Footnote **"LiTHIUM"**

Answer 33

**L**ow **T**hyroid hormone, **H**eart (Ebstein anomaly), **I**nsipidus (nephrogenic diabetes insipidus, **U**nintentional **M**ovement (tremor)

Question 34

NEWER AGENTS USED FOR **BIPOLAR DISORDER**

Answer 34

Carbamazepine Lamotrigine Valproic Acid / Divalproex