Anti-Psychotics

Question 1

According to the DA hypothesis of schizophrenia, do symptoms arise due to an excess or a lack of DA in the CNS?

Answer 1

Excess of DA

Question 2

What characterizes the positive symptoms of schizophrenia?

Answer 2

Hallucinations; delusions; thought disorders

Question 3

What characterizes the negative symptoms of schizophrenia?

Answer 3

Speech disorders; flat affect; amotivation; social withdrawal

Question 4

What is the MOA of “typical” antipsychotic agents?

Answer 4

Inhibition of D2 receptors in the mesolimbic system of brain

Question 5

What is the MOA of “atypical” antipsychotic agents?

Answer 5

Inhibition of 5-HT2 receptors (D2 receptors still involved to some extent)

Question 6

Give examples of typical antipsychotics

Answer 6

Haloperidol; chlorpromazine; thioridazine; fluphenazine; pimozide

Question 7

Give examples of atypical antipsychotics

Answer 7

Clozapine; risperidone; aripiprazole; olanzapine; aiprasidone; quetiapine

Question 8

Name two typical antipsychotics commonly used in the treatment of Tourette syndrome

Answer 8

1. Haloperidol

2. Pimozide

Question 9

What are Extrapyramidal symptoms (EPS)?

Answer 9

Parkinsonian-like symptoms (dystonia, rigidity, tremor, and bradykinesia); akathisia; tardive dyskinesia (TD)

Question 10

What is akathisia?

Answer 10

Motor restlessness

Question 11

What is Tardive Dyskinesia?

Answer 11

Inappropriate movements of the tongue, neck, trunk, and limbs (associated w/ long-term DA antagonist use)

Question 12

What is the mechanism of antipsychotic-induced TD?

Answer 12

Long-term DA receptor inhibition –> upregulation & supersensitivity of DA receptors –> DA over-stimulation (especially when antipsychotic has been discontinued)

Question 13

Which antipsychotics are more likely to cause EPS?

Answer 13

High potency typical antipsychotics such as haloperidol and fluphenazine secondary to their weak anticholinergic activity

Question 14

What do thioridazine and chlorpromazine have a lower EPS potential?

Answer 14

They have high anticholinergic activity

Question 15

What medications are used to treat antipsychotic-induced EPS?

Answer 15

Benztropine; amantadine; diphenhydramine (due to anticholinergic action)

Question 16

How do antipsychotics cause parkinsonian-like symptoms?

Answer 16

Inhibition of DA receptors in the nigrotriatal pathway

Question 17

How do antipsychotics cause orthostatic hypotension?

Answer 17

Inhibition of alpha-adrenergic receptors in vasculature

Question 18

How do antipsychotics cause prolactinemia?

Answer 18

Inhibition of DA receptors in the anterior pituitary

Question 19

Which two antipsychotics posses the highest antimuscarinic activity?

Answer 19

1. Chlorpromazine

2. Thioridazine

Question 20

Characterize the antimuscarinic activity of chlorpromazine and thioridazine

Answer 20

Xerostomia; blurred vision; confusion; constipation; urinary retention

Question 21

Which antipsychotic agents are more effective at treating negative symptoms?

Answer 21

Atypical antipsychotics

Question 22

Which phenothiazine antipsychotic is also used to treat intractable hiccups?

Answer 22

Chlorpromazine

Question 23

Which phenothiazine antipsychotic may cause priapism, agranulocytosis, blue-gray discoloration of the skin, and lower seizure threshold?

Answer 23

Thioridazine

Question 24

Which two typical antipsychotics can be formulated as depot IM injections that may last up to 3 wks?

Answer 24

1. Haloperidol

2. Fluphenazine

Question 25

Which atypical antipsychotic is usually reserved as a third-line agent to treat schizophrenic patients refractory to traditional therapy?

Answer 25

Clozapine

Question 26

What is the major dose-limiting side effect of clozapine?

Answer 26

Agranulocytosis

Question 27

How are patients receiving clozapine therapy monitored?

Answer 27

WBCs obtained @ baseline and weekly for the first 6 months of thearpy

Question 28

What adverse effect is more common with clozapine, agranulocytosis, or seizures?

Answer 28

Seizures

Question 29

Why is gynecomastia a common adverse effect of risperidone?

Answer 29

Risperidone induces prolactinemia (only atypical antipsychotic that significantly increases prolactin levels)

Question 30

What is a potential life-threatening adverse effect of antipsychotic medications?

Answer 30

Neuroleptic malignant syndrome (NMS)

Question 31

What characterizes NMS (Neuroleptic malignant syndrome)?

Answer 31

Hyperthermia; rigidity; altered mental status; CV instabiity

Question 32

What is the treatment for NMS?

Answer 32

Dantrolene + Bromocriptine

Question 33

What is the additional adverse effects of olanzapine?

Answer 33

Weight gain; hyperglycemia; sialorrhea

Question 34

What are the additional adverse effects of quetiapine?

Answer 34

Hypercholesterolemia; hypertriglyceridemia; weight gain; hepatotoxicity

Question 35

What is the MOA of aripiprazole?

Answer 35

Antagonist @ 5-HT2A receptors; partial agonist @ D2 & 5-HT1A receptors

Question 36

What are the additional adverse effects of aripiprazole?

Answer 36

Weight gain; rash; sialorrhea; hepatotoxicity

Question 37

Which antipsychotic has the highest incidence of sialorrhea?

Answer 37

Clozapine