E1- Antipsychotics and Mood Stabilizers

Question 1

What causes “positive” symptoms like hallucinations, delusions, catatonic behavior, disorganized speech and thinking?

Answer 1

Over-active dopamine pathways in limbic system

Question 2

What causes “negative” symptoms like apathetic behavior, withdrawn, anti-social, lack of motivation, and depressed?

Answer 2

Under-active dopamine pathways in in frontal cortex

Question 3

What is the mesolimbic pathway? What is it associated with?

Answer 3

Ventral Tegmental Area (VTA) to limbic system (emotion)

Question 4

What is the mesocortical pathway? What is it associated with?

Answer 4

Ventral Tegmental Area (VTA) to frontal cortex (cognition, emotion)

Question 5

What is the nigrostriatal pathway? What is it associated with?

Answer 5

Substantia Nigra (SN) to striatum (motor control)

Question 6

What is the tuberoinfundibular pathway? What is it associated with?

Answer 6

Hypothalamus to pituitary (prolactin)

Question 7

What are general effects of antipsychotics?

Answer 7

Decrease aggression, restlessness, and anxiety
Slow psychomotor function
Sedation
Block muscarinic, alpha, and histamine receptors

Question 8

Which antipsychotic has antiemetic effects?

Answer 8

Prochlorperazine

Question 9

What are general SE of antipsychotics?

Answer 9

“BAE WAX PANTS”
B- bruxism
A- anticholinergic effects
E- Extrapyramidal symptoms
W- weight gain
A- alpha blocker effects
X- xerostomia
P- prolactin secretion
A- antihistamine effects
N- neuroleptic malignant syndrome
T- tardive dyskinesia
S- seizure threshold

Question 10

How is Parkinson’s like tremor (extrapyramidal symptom) treated?

Answer 10

Benztropine (anticholinergic)

Question 11

What are choreiform, uncontrollable, jerky movements of face and limbs? Which drugs are least likely to cause this?

Answer 11

Tardive dyskinesia

Clozapine and Olanzapine

Question 12

What is a life threatening SE of antipsychotics that causes muscle rigidity and hyperpyrexia?
How is it treated?

Answer 12

Neuroleptic Malignant Syndrome

Dantrolene and Bromocriptine

Question 13

What are possible drug interactions with antipsychotics?

Answer 13

Anticholinergics
Sedative-hypnotics
TCAs
Inducers of CYP450s (Carbamazepine, smoking)
Antihypertensives

Question 14

What are the drugs classified as classical antipsychotics? (3)

Answer 14

Chlorpromazine
Fluphenazine
Haloperidol

Question 15

What is the MOA of classical antipsychotics?

Answer 15

Block DA D2 receptors; target the mesolimbic system (alleviate “positive” sx)

Question 16

What are the uses of Chlorpromazine?

Answer 16

Psychosis associated with mania and drugs of abuse

Pre-anesthetic

Question 17

Do classical or atypical antipsychotics tend to cause more extrapyramidal sx?

Answer 17

Classical

Question 18

Which classical antipsychotic has the highest anticholinergic effects and lowest incidence of EPS?

Answer 18

Chlorpromazine

Question 19

What classical antipsychotic may cause retinal deposits “browning of vision?”

Answer 19

Chlorpromazine

Question 20

What is the use of Haloperidol?

Answer 20

Acute situations (can be injected)

Question 21

Which classical antipsychotic has no anticholinergic effects and high incidence of EPS?

Answer 21

Haloperidol

Question 22

What is the MOA of atypical antipsychotics?

Answer 22

Block 5-HT2A and DA D4 receptors; target the Mesocortical and Mesolimbic system (alleviate both negative and positive sx)

Question 23

What is the first-line drugs for psychosis?

Answer 23

Risperidone

Question 24

Which 2 antipsychotics can prolong QT interval?

Answer 24

Risperidone and Ziprasidone

Question 25

Which antipsychotic is drug of last choice due to risk of agranulocytosis?

Answer 25

Clozapine

Question 26

Which antipsychotic causes hyperglycemia and can lead to Type II DM?

Answer 26

Olanzapine

Question 27

Which antipsychotic can also be used for bipolar disorder?

Answer 27

Olanzapine

Question 28

Which antipsychotic is used to promote sleep onset and maintenance?

Answer 28

Quetiapine

Question 29

Which 2 antipsychotics do not elevate prolactin?

Answer 29

Quetiapine and Aripiprazole

Question 30

Which antipsychotic has some antidepressant activity?

Answer 30

Ziprasidone

Question 31

What are the uses of Ziprasidone?

Answer 31

Tourette’s syndrome | Acute mania

Question 32

What is the MOA of Lurasidone?

Answer 32

Partial agonist for 5-HT1A; antagonist for D2 and 5-HT2A

Question 33

What drugs are classified as atypical psychotics?

Answer 33

``` “ZAC QORL” Z- ziprasidone A- aripiprazole C- clozapine Q- quetiapine O- olanzapine R- risperidone L- lurasidone ```

Question 34

What is the use of Lurasidone?

Answer 34

Depression with bipolar disorder

Question 35

What are SE of Lurasidone?

Answer 35

Agranulocytosis, neutropenia

Question 36

What antipsychotic is a DA stabilizer?

Answer 36

Aripiprazole Dopaminergic tone is low- DA receptors are activated Dopaminergic tone is high- DA receptors are blocked

Question 37

What are SE of Aripiprazole?

Answer 37

Hyperglycemia | Decreased esophageal motility

Question 38

What is the treatment of Bipolar Affective Disorder

Answer 38

Lithium or anticonvulsants

Question 39

What is the MOA of lithium?

Answer 39

Suppresses 2nd messengers (IP3)

Question 40

Lithium is competes with what for reabsorption by the PT in the kidney?

Answer 40

Na+

Question 41

How do low levels of Na+ affect Li?

Answer 41

Li absorption increases (toxicity)

Question 42

How do high levels of Na+ affect Li?

Answer 42

Li absorption decreases (excretion increases)

Question 43

How do high levels of Li affect Na+?

Answer 43

Na+ absorption decreases (hyponatremia)

Question 44

What is important about the SE and toxicity potential for Lithium?

Answer 44

Li has a small therapeutic window

Question 45

What are SE of Lithium?

Answer 45

Hypothyroidism | Diabetes insipidus

Question 46

Should Lithium be used in pregnancy?

Answer 46

No

Question 47

What are some possible drug interactions of Lithium?

Answer 47

Antidepressants Diuretics NSAIDs Sodium

Question 48

Lithium does not have drug interactions with what two classes of drugs?

Answer 48

BZs and antipsychotics

Question 49

Which 2 anticonvulsants are used for rapid cycling manic/depressive phases? (alternative to Li for tx of Bipolar)

Answer 49

Valporic Acid | Gabapentin

Question 50

Which anticonvulsant is used for refractory bipolar disorder or in combination with Lithium?

Answer 50

Carbamazepine

Question 51

Which anticonvulsant is used for prevention of relapse, depressive state following mania, and acute mania? (alternative to Li for tx of Bipolar)

Answer 51

Lamotrigine