Anti-Psychosis

Question 1

What are the ATYPICAL anti-psychotics?

Answer 1

1) Clozapine
2) Olanzapine
3) Risperidone
4) Ziprasidone
5) Aripiprazole
6) Quetiapine

Question 2

What are the Typical Antipsychotics? (3)

Answer 2

1) Thioridazine
2) Haloperidol
3) Chlorpromaxine

THC - hah

Question 3

SIDE EFFECTS: Which drug has the greatest and least Extra Pyramidal Symptoms (EPS)

Answer 3

Greatest: Haloperidol (High affinity for D2 in Nigrostriatal tract)
Least: Clozapine (Low affinity for D2)

Question 4

Which are REVERSIBLE neurologic toxic effects of Anti-Psychotics? (3)

Answer 4

1) EPS
2) Akathisia
3) Dystonia

Question 5

What is Akathisia?

Answer 5

A state of agitation, distress, and restlessness. “Unable to sit still”

Question 5

What is dystonia?

Answer 5

Neurological movement disorder:

- sustained muscle contractions -> twisting and repetitive movements or abnormal postures.

Question 6

What is the most likely mechanism of Antipsychotic drugs?

Answer 6

Block Postsynaptic D2 receptors in the CNS.

- Particularly the mesolimbic-frontal system

Question 7

Which of the REVERSIBLE neurologic toxic effects should be treated IMMEDIATELY and why?

Answer 7

1) Dystonia

2) Very painful

Question 8

What drugs are given to treat Dystonia? (2)

Answer 8

1) Diphenhydramine (Sedative Antihistamine with anticholinergic)
2) Benztropine (Anti-Muscarinic)

Question 9

What is the MOST IMPORTANT unwanted effect of antipsychotic drugs?

Answer 9

Tardive Dyskinesias

Question 10

What is Tardive dyskinesias?

Answer 10

Choreoathetoid movements of the muscles of the lips and buccal cavity and may be IRREVERSIBLE.

Question 11

What is Choreoathetosis?

Answer 11

Occurence of involuntary movements in a combination of

1) Chorea: Irregular migrating contractions
2) Athetosis: Twisting and Writhing

Question 12

How does one develop Tardive Dyskinesia?

Answer 12

After several years of antipsychotic drug use.

- Some have it as early as 6 months.

Question 13

How do you treat Tardive Dyskinesia? (3)

Answer 13

1) Discontinue or reduce dose of current antipsychotic
2) Eliminate all drugs with central anticholinergic action
3) Add diazepam (high dose if necessary) to enhance GABAergic activity

Question 14

SIDE EFFECTS: Which drug has the greatest and least AUTONOMIC symptoms

Answer 14

Greatest: Thioridazine
Weaktest: Haloperidol

Question 15

What causes AUTONOMIC side effects? (2)

Answer 15

Due to blockade of

1) Peripheral ALPHA-ADRENERGIC receptors
2) MUSCARINIC receptors

Question 16

AUTONOMIC Side Effects of Alpha-Adrenergic receptor blockade: (2)

Answer 16

1) Postural Hypotension

2) Failure to ejaculate

Question 17

AUTONOMIC Side Effects of Muscarinic Blockade. (3)

Answer 17

1) Atropine-like effects
2) Antimuscarinic CNS effects
3) Urinary retention

Question 18

SIDE EFFECTS: Which drugs have an INTERMEDIATE autonomic effect? Exception?

Answer 18

Most Aytpicals

Exception: Ariprprazole, Ziprasidone

Question 19

SIDE EFFECTS: Which drug has the greatest and least METABOLIC effects?

Answer 19

Greatest: Clozapine, Olanzapine
Weakest: Ziprasidone, Aripiprazole

Question 20

What are the METABOLIC side effects: (4)

Answer 20

1) Significant weight gain
2) Hyperglycemia
3) Hyperlipidemia may occur
4) Some my develop DM

Question 21

What are specific side effects of ENDOCRINE toxicity:

Answer 21

D2 receptor blockade in pituitary:

1) Hyperprolactinemia
2) Gynecomastic
3) Amenorrhea-galactorrhea syndrome
4) Infertility

Question 22

Which drugs cause Atropine-like effects (Antimuscarinic Autonomic Side effect)

Answer 22

1) Thioridazine
2) Clozapine
3) Most atypicals except
- Ziprasidone
- Aripiprazole

Question 23

Which drug is most highly associated with Hyperprolactinemia side effects?

Answer 23

Risperidone