Psychiatry: Antipsychotics

Question 1

What is another name for 1st generation antipsychotics

Answer 1

Typicals

Question 2

What are the common 1st generation antipsychotic drugs

Answer 2

Haloperidol
“-azines”
-chlorpromazine
-trifluoperazine
-fluphenazine
-thioridazine
Pimozide

Question 3

What is the primary antipsychotic effect of 1st generation antipsychotics

Answer 3

D2 receptor blockade

Question 4

What Neurotransmitter change is associated with Parkinson’s Disease

Answer 4

Decreased CNS Dopamine

Question 5

What are the characteristic features of Parkinson’s Disease

Answer 5

Motor dysfunction
tremors
rigidity

Question 6

What are the all neurotransmitter blockades achieved by 1st generation antipsychotics

Answer 6

Dopamine blockade

serotonin blockade

Histamine blockade

Acetylcholine (Muscarinic) blockade

Epinephrine (a-1) Blockade

Question 7

What are side-effects of the Dopamine blockade with 1st generation antipsychotics

Answer 7

Parkinsonian effects
-extrapyramidal

Hyperprolactinemia
-Gyno
-Galactorrhea
-Amenorrhea

Anti-emetic

Question 8

What are the Ach (muscarinic) blockade effects of 1st generation antipsychotics

Answer 8

Dry mouth
Constipation
Urinary retention
Tachycardia
Sexual dysfunction

Question 9

What are the a-1 receptor blockade effects of 1st generation antipsychotics

Answer 9

Hypotension

Question 10

what are the histamine receptor blockade effects of 1st generation antipsychotics

Answer 10

Sedation

Weight gain

Question 11

Describe the Pyramidal system

Answer 11

Corticospinal tract runs in the medullary pyramids

Question 12

What results from damage to the Pyramidal system

Answer 12

Weakness

Question 13

Describe the Extrapyramidal system

Answer 13

Basal Ganglia nuclei and associated tracts

Question 14

What does the Extrapyramidal system regulate

Answer 14

Modulation of movment

Question 15

What results from damage to the Extrapyramidal system

Answer 15

Movement disorders

Question 16

What are the common Extrapyramidal Symptoms (EPS)

Answer 16

Movement side effects
-dystonia
-akathisa
-bradykinesia
-Tardive Dyskinesia

Question 17

What causes EPS

Answer 17

Response to dopamine receptor blockade

Question 18

What is Dystonia

Answer 18

Involuntary contraction of muscles
-stiffness
-spasm

Question 19

How long does it take Dystonia to occur

Answer 19

within hours/days

Question 20

What are the treatment options for Dystonia

Answer 20

Benztropine
-anticholinergic

Diphenhydramine
-antihistamine

Question 21

What is Akathisia

Answer 21

Restlessness, urge to move

Question 22

How long does it take Akathisia to occur

Answer 22

within days

Question 23

How to treat Akathisia

Answer 23

Lower dose

Benzodiazepines

Propranolol

Question 24

What is the most common EPS adverse effect of 1st generation antipsychotics

Answer 24

Akathisia

Question 25

What is Bradykinesia

Answer 25

Slow movements line in Parkinson

Question 26

When Does Bradykinesia occur

Answer 26

weeks after starting the drug

Question 27

What is the 1st line treatment for Bradykinesia

Answer 27

Benztropine

Question 28

What is the 2nd line treatment for Bradykinesia

Answer 28

Amantadine

Question 29

What is Tardive Dyskinesia

Answer 29

Choreoathetosis of the mouth, tongue, face, limbs Smacking lips, grimacing

Question 30

How long does it take Tardive Dyskinesia to occur

Answer 30

months to years after starting the drug

Question 31

What is Chorea

Answer 31

irregular migrating contractions

Question 32

What is Athetosis

Answer 32

Twisting and writhing

Question 33

What is the only FDA approved drug to try and treat Tardive Dyskinesia

Answer 33

Valbenazine

Question 34

What is the MOA of Valbenazine

Answer 34

Inhibits VMAT2 to deplete dopamine storage in the presynaptic vesicles

Question 35

What are the high potency 1st generation antipsychotics

Answer 35

Haloperidol Fluphenazine Pimozide

Question 36

What adverse affects are most associated with High potency 1st generation antipsychotics

Answer 36

EPS

Question 37

What are the lower potency 1st generation antipsychotics

Answer 37

Thioridazine Chlorpromazine

Question 38

What adverse effects are most associated with low potency 1st generation antipsychotics

Answer 38

Non-neurologic adverse sedating dry mouth

Question 39

What is Neuroleptic Malignant Syndrome (NMS)

Answer 39

fever and rigid muscles Mental status changes -encephalopathy Elevated Ck -muscle damage Myoglobinura -acute renal failure -rhabdo

Question 40

How long after starting a drug does NMS typically occur

Answer 40

7 to 10 days

Question 41

What drugs are NMS most commonly associated with

Answer 41

High-potency 1st generation antipsychotics -Haloperidol -Fluphenazine

Question 42

What are the treatment options for NMA

Answer 42

Dantrolene -Muscle relaxant Bromocriptine -Dopamine agonist

Question 43

How can 1st generation antipsychotics lead to a prolonged QT interval

Answer 43

Block cardiac K channels

Question 44

What 1st generation antipsychotic is most associated with a prolonged QT interval

Answer 44

IV Haloperidol

Question 45

What 1st generation antipsychotic is most associated with Retinal Deposits

Answer 45

Thioridazine

Question 46

What 1st generation antipsychotics are associated with Corneal Deposits

Answer 46

Thioridazine Chlorpromazine

Question 47

What Typical antipsychotics are associated with Retinal Deposits and Corneal deposits

Answer 47

Thioridazine Chlorpromazine

Question 48

How do Retinal deposits from typical antipsychotics present

Answer 48

Browning of vision

Question 49

What typical antipsychotic is associated with Blue-gray skin pigmentation

Answer 49

Chlorpromazine

Question 50

What typical antipsychotic is associated with Cholestatic Jaundice

Answer 50

Chlorpromazine

Question 51

What typical antipsychotics are commonly used for Acute agitation/confusion

Answer 51

Haloperidol

Question 52

What typical antipsychotics are commonly used for N/V

Answer 52

Prochlorperazine Chlorpromazine

Question 53

What is another name for 2nd generation antipsychotic drugs

Answer 53

Atyicals

Question 54

What are the common Atypical antipsychotic drugs

Answer 54

"-pines" -clozapine -olanzapine -quetiapine -asenapine "-dones" -iloperidone -risperidone -lurasidone -ziprasidone

Question 55

What is the defining feature of Atypical Antipsychotics

Answer 55

Less EPS adverse Effects

Question 56

What major neurotransmitter is effected by Atypical Antipsychotics

Answer 56

Serotonin

Question 57

What is metabolic syndrome

Answer 57

Weight gain Hyperglycemia Hyperlipidemia

Question 58

What drugs are associated with metabolic syndrome

Answer 58

Atypical Antipsychotics -especially clozapine and olanzapine

Question 59

What atypical antipsychotic is associated with the highest risk of QT interval prolongation

Answer 59

Ziprasidone

Question 60

What is a major side effect associated with Clozapine

Answer 60

Agranulocytosis also seizures

Question 61

What must you monitor if using Clozapine

Answer 61

WBCs -weekly at start -every few wks thereafter

Question 62

At what WBC level would you stop Clozapine

Answer 62

<1500

Question 63

What atypical antipsychotic is not used first line due to its adverse effects

Answer 63

Clozapine

Question 64

What is the most common drug-induced cause of Hyperprolactinemia

Answer 64

Antipsychotics

Question 65

What antipsychotics have the highest rates of Hyperprolactinemia

Answer 65

Risperidone Paliperidone Fluphenazine Haloperidol

Question 66

What is the MOA of Aripiprazole

Answer 66

D2 partial agonist

Question 67

What is the most common adverse effect of Aripiprazole

Answer 67

Akathisia

Question 68

What is the key adverse affect associated with Aripiprazole

Answer 68

loss of impulse control -pathologic gambling -binge eating -shopping sprees