Pharm, Antipsychotics, Linger

Question 1

atypical antipsychotics

Answer 1

ariprprazole
lurasidone
olanzapine
quetiapine
risperidone
ziprasidone

Question 2

special use atypical antipsychotics

Answer 2

clozapine

Question 3

typical low potency agents for antipsychotic

Answer 3

chlorpromazine

Question 4

typical high potency agents for anitpsychotic

Answer 4

haloperidol

Question 5

chlorpromazine

Answer 5

dopamine R antagonist

Question 6

most widely used type of antipsychotic

Answer 6

atypical like clozapine

Question 7

dopamine R densities in schizophrenics

Answer 7

increased

Question 8

phenothiazine derivative

Answer 8

chlorpromazine

Question 9

butyrophenone derivative

Answer 9

haloperidol

Question 10

common pharm attribute of atypical antipsychotics

Answer 10

greater effects at 5HT2a than at D2 R

most are partial agonists at 5HT1a which is synergistic with 5 HT2a R antagonisms

Question 11

PK antipsychotics

Answer 11

first pass meatbolism
highly lipid soluble and protein bound
longer clinical duration than estimated
discontinuation well tolerated

Question 12

which antipsychotic does not have a well tolerated discontinuation

Answer 12

clozapine

cause cholinergic rebound, and movement disorders

Question 13

metabolism antipyschotics

Answer 13

cytochrone P450

Question 14

all effective antipsychotics block what R

Answer 14

D2

Question 15

atypical antipsychoitcs block what R more than D2

Answer 15

5-HT2a

Question 16

mesolimbic-mesocortical pathway

Answer 16

involved in behavior and cognitive function
cell bodies in ventral tegmental area
antipsychotic if inhibit dopaminergic acitivy in pathway

Question 17

nigrostriatal pathway

Answer 17

coordination voluntary movement
striatum
inhbition of dopaminergic activity causes extrapyramidal side effects

Question 18

tuberoinfundibular system

Answer 18

regulates prolactin release (dopamine is inhibitory)

arcuate and periventricular nucli project hypothal and post pituitary

Question 19

adverse effect if anti dopamine works in tuberinfundibular system

Answer 19

hyperprolactinemia

Question 20

d2 like dopamine R

Answer 20

D2-4

Question 21

how do d2 like R work

Answer 21

decrease cAMP via Gi and inhibit Ca Ch, open K Ch

pre and post synaptically and in caudate putamen

Question 22

typical antipsychotics need what occupancy of D2 R to be effective

Answer 22

60%

Question 23

extrapyramidal side effects from D2 antagonists occur at waht saturation

Answer 23

> 80%

Question 24

how can aripiprazole inhibit D2 with no EPS

Answer 24

partial agonist at D2

Question 25

what reduces suicide attempts in schizophrenics

Answer 25

clozapine

Question 26

nonpsych indications for antipsychotics

Answer 26

antiemesis neurleptanesthesia sleep onset and maintanence

Question 27

first line for schizoprenia

Answer 27

atypical antipsychotics (not clozapine or olanzapine)

Question 28

what is used for maintenance of uncooperative patients

Answer 28

IM formualations | haloperidol decanoate, fluphenazine decanoate, Risperdal consta

Question 29

side effect clozapine

Answer 29

agranulocytosis dose related lowering of seizure threshold myocarditis

Question 30

disadvantage to risperidone

Answer 30

EPS at high dose | hypotension at high dose

Question 31

disadvantage olanzapine

Answer 31

weight gain | dose related lowering seizure threshold

Question 32

disadvantage questiapine

Answer 32

high dose if assoc hypotension | twice day dosing from low halt life

Question 33

advantage questiapine

Answer 33

less weight gain

Question 34

disadvantage ziprasidone

Answer 34

QT prolongation

Question 35

which antipsychotics have lower weight gain

Answer 35

quistiapine ziprasidone aripiprazole

Question 36

Tx for how long before full effect

Answer 36

16-20 weeks

Question 37

electroconvulsive therapy

Answer 37

in adjunct for treating mood Sx and + Sx | can augment clozapine if max dose ineffective

Question 38

behavioral effects of antipsychotics

Answer 38

older drugs: anhedonia cannot expierieve pleasure, akinesia, toxic confusional state, sedation of antimuscarinic drugs

Question 39

early motor effects from antipsychotics

Answer 39

EPS like parkinsonism, increased acitivity (akathisia), acute dystonic reactions, dystonic reactions

Question 40

what is used to Tz early dystonic features of antispychotics

Answer 40

anticholinergic like benztropine or antihistamine antimuscarinic. NEVER levodopa

Question 41

late motor effects antipsychotics

Answer 41

tardive dyskinesia, choreathetoid movements | imabalance

Question 42

which drugs have lower risk tardive dyskinesia

Answer 42

questiapine or clozapine

Question 43

if drug change or reduction does not help with tardive dyskinesia next step is to

Answer 43

remove all drugs with central anticholinergic acivity like tricyclic antidepressants,

Question 44

which antipyschotic may cause seziures

Answer 44

clozapine

Question 45

ANS effects antipsychoics

Answer 45

older drugs that bind alpha 1 and histamine leads to anti PAN side effects: dry mouth, loss accomodation, difficulty urinating, constipation and anti alpha adrenergic side effects like orthostatic hypotensions, dizziness, sedation, impotence and failure to ejeculate

Question 46

weight gain is seen with what antipsychotics

Answer 46

majority greatest effect with clozapine and olanzapine be careful in DM because of hyperglycemia and ketoacidosis

Question 47

intermediate risk weigh gain

Answer 47

iloperidone paliperidone quetiapine risperidone

Question 48

lowest risk weight gain

Answer 48

aripiprazole lurasidone ziprasidone

Question 49

hyperprolactinemia can cause

Answer 49

amenoorhea galactorrhea infertility osteoporosis in women men: infertility, loss libido, impotence, breast enlargement

Question 50

which drugs can cause hyperPRL

Answer 50

risperidone and paliperidone

Question 51

minimal effects on PRL

Answer 51

quetiapine | olanzapine and aripiprazole

Question 52

is agranulocytosis from clozapine reversible

Answer 52

yes upon discontinuance

Question 53

what CV medications should be avoided in patients on antipsychotics

Answer 53

antiarrhythmics, and erythromycin because also prolong QT

Question 54

which antipsychotics preferred in pregnancy

Answer 54

atypical | category C

Question 55

Neuroepileptic Malignant Syndrome

Answer 55

patients sensitive to EPS rare but life threatening acute severe parkinsonism, muscl rigidity, ANS instability and HTN, hyperthermia and keukocytosis

Question 56

Tx neuroleptic Malignant Syndrome

Answer 56

mm relaxants like diazepam or dantrolene | dopamine agonists like bromocriptine

Question 57

what antipsychotic overdose is fatal

Answer 57

thioridazine- arrhythmia