08a_Antipsychotic Medications

Question 1

Two classes of medications most commonly provided in medical specialty offices

Answer 1

Antipsychotics

Antimanics

Question 2

Antipsychotic Drugs:

Also known as…

Answer 2

Tranquilizers

Neuroleptics

Question 3

Traditional Antipsychotics:

Uses

Answer 3

Schizophrenia Positive symptoms

Major Depressive Disorder with psychosis

Organic psychoses

Question 4

Four Traditional Antipsychotics

Answer 4

Chlorpromazine (Thorazine)

Fluphenazine (Prolixin)

Thiothixine (Narvane)

Haloperidol (Haldol)

Question 5

Traditional Antipsychotics:

Mechanism of Action

Answer 5

Block dopamine receptors D1

Question 6

Dopamine Hypothesis

Answer 6

Schizophrenia related to excessive dopamine or oversensitivity of dopamine receptors

Question 7

Support for Dopamine Hypothesis

Answer 7

Amphetamines raise dopamine levels and can produce psychosis in all individuals

Low doses of exacerbate positive symptoms for those with Schizophrenia

Question 8

Traditional Antipsychotics Side Effects:

Anticholinergic Effects

Answer 8

Dry mouth

Blurred vision

Urinary retention

Constipation

Tachycardia

Delayed ejaculation

Question 9

Anticholinergic Effects Onset and Course

Answer 9

Symptoms appear early

Tolerance ordinarily developed in a few weeks or months

Question 10

Four main Extrapyramidal side effects

Answer 10

Parkinsonism

Akithisia (restlessness)

Acute Dystonia (muscle spasms)

Tardive Dyskinesia

Question 11

Tardive Dyskinesia:

Symptoms

Answer 11

Involuntary rhythmic movements of the jaw, lips, tongue, and extremities

Similar to Huntington’s Disease

Question 12

Tardive Dyskinesia:

Onset and Prevalence

Answer 12

Late-occurring

More common in females and older patients

Question 13

True or False?

Tardive Dyskinesia is Irreversible

Answer 13

False.

Recent studies show symptoms improve when drug is gradually withdrawn

Also alleviated by benzodiazepine / GABA agonist

Question 14

Extrapyramidal side effects:

Cause and Worst offender

Answer 14

Effects of Traditional Antipsychotics on dopamine receptors in caudate nucleus

Haldol (Halperidol)

Question 15

Neuroleptic Malignant Syndrome:

Overview

Answer 15

Rapid onset of motor, mental, and autonomic symptoms

Potentially fatal side effect of antipsychotic drugs

Question 16

Neuroleptic Malignant Syndrome:

Symptoms

Answer 16

Rigidity

Tachycardia

Hyperthermia

Altered consciousness

Question 17

Neuroleptic Malignant Syndrome:

Treatment

Answer 17

Immediately discontinue antipsychotic medication

Question 18

Four Atypical Antipsychotic Drugs

Answer 18

Clozapine (Clozaril)

Risperidone (Risperdal)

Olanzapene (Zyprexa)

Quetiapine (Seroquel)

Question 19

Atypical Antipsychotic Drugs:

Uses

Answer 19

Schizophrenia

Bipolar disorder non-responsive to mood stabilizers

Depression and suicidality

Alcohol and drug addiction

Hostility

Movement disorders (Parkinson’s, Huntington’s)

Question 20

Atypical Antipsychotic Drugs:

Mechanism of Action

Answer 20

D4 dopamine receptors

Glutamate and serotonin receptors

Question 21

Atypical Antipsychotic Drugs:

Pros and Cons of Treatment Effects

Answer 21

Pro: Alleviate both positive and negative symptoms of schizophrenia

Con: Slower onset of therapeutic effects than traditional antipsychotics

Question 22

Atypical Antipsychotic Drugs:

Pros and Cons of Side Effects

Answer 22

EPS much less common, except for akithisia

Much less likely to cause Tardive Dyskinesia

Con: Risk of agranulocytosis; can also cause neuroleptic malignant syndrome

Question 23

Atypical Antipsychotic Drugs:

Common Side Effects

Answer 23

Anticholinergic effects

Lowered seizure threshold

Sedation