Exam 11: Antipsychotics

Question 1

4 Phenothiazines

Answer 1

-Azines
Chlorpromazine
Fluphenazine
Prochlorperazine
Trifluoperazine

Question 2

Name 1 Butyrophenone

Answer 2

Haloperidol

Question 3

6 Second Generation (Atypical) Antipsychotics

Answer 3

Clozapine
Olanzapine
Risperidone
Ariprazole
Quetiapine
Ziprasidone

Question 4

What kind of symptoms are 1st generation antipsychotics (Phenothiazines and haloperidol) good at treating?

Answer 4

Positive symptoms of schizophrenia

Question 5

General effects of typical/1st gen antipsychotics

Answer 5

Decreased initiation of behavior, flattened affect

Question 6

What is a major problems with the use of antipsychotics that affects their use?

Answer 6

their effects are perceived as unpleasant by the patient

Question 7

What effect occurs before the antipsychotic effects in treatment?

Answer 7

Sedation

Tolerance develops to the though in time

Question 8

CNS side effect of antipsychotics

Answer 8

Lowered seizure threshold

Question 9

Which antipsychotic is also an especially good antiemetic?

Answer 9

Prochlorperazine

Question 10

Autonomic side effect of antipsychotics

Answer 10

Anticholinergic

Question 11

2 Cardiovascular side effects of antipsychotics

Answer 11

1. Orthostatic hypotension

2. Tachycardia

Question 12

Endocrine side effects of typical antipsychotics

Answer 12

Increased prolactin due to dopamine antagonism
Gynecomastia, lactation, menstrual problems
May affect other GH, corticosteroids, gonadotropins, insulin

Question 13

Common unwanted side effect of antipsychotics

Answer 13

Weight gain, metabolic disturbances

Question 14

How safe are antipsychotics

Answer 14

Very large margin of safety, but there is a small risk of idiosyncratic and allergic reactions that can be serious

Question 15

Neuro side effects of antipsychotics

Answer 15

Extrapyramidal

Can be severe and limit their use

Question 16

Mechanism of antipsychotics

Answer 16

Inhibition of DA receptors
Typical inhibit D2
Others may affect other DA receptors/other neurotransmitters

Question 17

Which DA pathway is involved in psychosis

Answer 17

Mesolimbic and mesocortical systems

Question 18

Tardive dyskinesia

Answer 18

too much dopamine activity relative to cholinergic activity

opposite of parkinson’s

Question 19

Aliphatic phenothiazine

Answer 19

Chlorpromazine

Question 20

3 piperazine phenothiazines

Answer 20

trifluoperazine
fluphenazine
prochlorperazine

Question 21

Trifluoperazine

Answer 21

Phenothiazine
More potent than chlorpromazine
less sedation/anticholinergic
More extrapyramidal problems

Question 22

Fluphenazine

Answer 22

Phenothiazine

Comes in long acting injections (decanoate and enathate), good for compliance

Question 23

Prochlorperazine

Answer 23

Phenothiazine

Commonly used as an antiemetic

Question 24

Haloperidol

Answer 24

Butyrophenone
Less anticholinergic than chlorpromazine
more extrapyramidal side effects
less sedation
Available in long acting form

Question 25

Clozapine

Answer 25

2nd gen antipsychotic blocks D4 and 5-HT2 receptors Can cause granulocytopenia and agranulocytosis*** Can cause weight gain and type 2 diabetes** Strongly anticholinergic Few extrapyramidal side effects Very expensive

Question 26

Olanzapine

Answer 26

2nd gen antipsychotic like clozapine, but doesnt cause bone marrow toxicity Also causes weight gain and hyperglycemia

Question 27

Risperidone

Answer 27

2nd gen antipsychotic Blocks DA and serotonin receptors More extra pyramidal side effects than clozapine/olanzapine, but less than the typicals

Question 28

Quetiapine and Zirprasidone

Answer 28

2nd ben antipsychotics mechanism similar to clozapine metabolic side effects (fewer with quetiapine)

Question 29

Aripiprazole

Answer 29

2nd gen antipsychotic Partial agonist at D2 and 5-HT1 receptors No extrapyramidal problems Also approved for refractory depression

Question 30

general pharmacokinetics of antipsychotics

Answer 30

metabolized in liver, excreted in kidney | Long half lives

Question 31

Most effective antipsychotic. Problem?

Answer 31

Clozapine | 2nd line due to it's potential toxicity

Question 32

General rule of thumb about side effects of antipsychotics

Answer 32

high potency drugs have fewer cardiovascular and anticholinergic effects, but more extrapyramidal effects the opposite is true of lower potency drugs.