1st Generation Antipsychotics

Question 1

There are 10 1st generation agents. 5 of them end in what suffix?

Answer 1

• azine

Question 2

What 5 agents end in -azine?

Answer 2

Chlorpromazine
Fluphenazine
Perphenazine
Thioridazine
Trifluoperazine

Question 3

What 5 agents do NOT end in -azine?

Answer 3

Haloperidol
Loxapine
Molindone
Pimozide
Thiothixene

Question 4

What is the MOA for the 1st generation agents?

Answer 4

Block Dopamine (D2) post-synaptic receptors

Question 5

What is the MOA for the 1st generation agents?

Answer 5

Block Dopamine (D2) post-synaptic receptors

Question 6

The 1st generation agents can also block a few other receptors that can result in side effects. What are they?

Answer 6

1. Histamine
2. Muscarinic
3. Alpha1 Adrendergic
4. D2 in the Nigrostriatal pathway and in the Tuberoinfundibular pathway

Question 7

The 1st generation agents can also block other receptors that lead to side effects. What are those receptors and effects?

Answer 7

1. Histamine –> Sedation
2. Muscarinic –> Anticholinergic
3. Alpha1 Adrenergic –> Cardiovascular
4. D2 in the nigrostriatal pathway –> EPS
5. D2 in the tuberofundibular pathway –> Prolactin elevation

Question 8

What are 2 LOW potency agents?

Answer 8

Chlorpromazine

Thioridazine

Question 9

What are 2 LOW potency agents?

Answer 9

Chlorpromazine

Thioridazine

Question 10

What general effects do the LOW potency agents cause?

Answer 10

(Chlorpromazine, Thioridazine)

= Sedation, ECG effects and Hypotension

Question 11

What side effect can Thioridazine cause?

Answer 11

Torsade de pointes or cardiac death

Question 12

What are 2 HIGH potency agents?

Answer 12

Fluphenazine

Haloperidol

Question 13

What are 2 HIGH potency agents?

Answer 13

Fluphenazine

Haloperidol

Question 14

What general effects do the HIGH potency agents cause?

Answer 14

(Fluphenazine, Haloperidol)
= More movement and Endocrine effects
==> EPS and Prolactin elevation

Question 15

What 3 Extrapyramidal Symptoms can be caused by 1st generation agents?

Answer 15

Dystonia
Akathisia
Parkinsonism

Question 16

What 3 Extrapyramidal Symptoms can be caused by 1st generation agents?

Answer 16

Dystonia
Akathisia
Parkinsonism

Question 17

What are the symptoms of Dystonia?

Answer 17

Sustained muscle contractions

Question 18

If Dystonia occurs within a few hours/days, what are the antidotes?

Answer 18

Anticholinergics

= Benztropine, Diphenhydramine, Trihexyphenidyl

Question 19

If Dystonia occurs within a few hours/days, what are the antidotes?

Answer 19

Anticholinergics

= Benztropine, Diphenhydramine, Trihexyphenidyl

Question 20

What are the symptoms of Akathisia?

Answer 20

CONSTANT movements – cannot stay still

Question 21

If Akathisia occurs within a few days/weeks, what are the antidotes?

Answer 21

3 B’s

= Beta blocker (propranolol), Benzodiazepine (lorazepam), Benztropine

Question 22

If Akathisia occurs within a few days/weeks, what are the antidotes?

Answer 22

3 B’s

= Beta blocker (propranolol), Benzodiazepine (lorazepam), Benztropine

Question 23

What are the symptoms of Parkinsonism?

Answer 23

Bradykinesia
Tremor
Rigidity

Question 24

If Parkinsonism occurs in weeks/months, what are the antidotes?

Answer 24

Benztropine (Anticholinergic)

Amantadine (Dopamine enhancer)

Question 25

If Parkinsonism occurs in weeks/months, what are the antidotes?

Answer 25

Benztropine (Anticholinergic) | Amantadine (Dopamine enhancer)

Question 26

Besides Extrapyramidal Symptoms, what other movement disorder can occur with the use of 1st generation agents?

Answer 26

Tardive Dyskinesia

Question 27

What are the signs of Tardive Dyskinesia?

Answer 27

Repetitive uncontrollable movements

Question 28

Repetitive uncontrollable movements with the use of 1st generation agents?

Answer 28

Tardive Dyskinesia

Question 29

If Tardive Dyskinesia occurs, what are the antidotes and their MOA?

Answer 29

VMAT2 (-)'s | - end in BENAZINE

Question 30

If Tardive Dyskinesia occurs, what are the antidotes and their MOA?

Answer 30

VMAT2 (-)'s | - end in BENAZINE

Question 31

If a drug is given with the BENAZINE suffix, what is it treating?

Answer 31

Tardive Dyskinesia

Question 32

What endocrine adverse effect can occur with the use of 1st generation agents?

Answer 32

Hyperprolactinemia

Question 33

If Hyperprolactinemia occurs, what are the signs?

Answer 33

Amenorrhea Galactorrhea Gynecomastia

Question 34

Fluphenazine and Haloperidol are ___ potency agents

Answer 34

HIGH

Question 35

Chlorpromazine and Thioridazine are ___ potency agents

Answer 35

LOW

Question 36

What are the 5 agents that end in -azine?

Answer 36

``` Chlorpromazine Fluphenazine Perphenazine Thioridazine Trifluoperazine ```

Question 37

What are the 5 agents that end in -azine?

Answer 37

``` Chlorpromazine Fluphenazine Perphenazine Thioridazine Trifluoperazine ```

Question 38

What are the 5 agents that do NOT end in -azine?

Answer 38

``` Haloperidol Loxapine Molindone Pimozide Thiothixene ```

Question 39

What are the 5 agents that do NOT end in -azine?

Answer 39

``` Haloperidol Loxapine Molindone Pimozide Thiothixene ```