Anti-psychotics

Question 1

high potency typical

Answer 1

block D2 rec
advantages- not sedating, injectable, depot, inexpensive

disadvantages- EPS

Question 2

low potency typical

Answer 2

block D2 rec
advantages- highly sedating, inheritable, inexpensive

disadvantages- highly sedating, QT prolong, EPS risk, anti-HAM
antiH1: sedation, weight gain
anti a1- orthostatic hypotension, cardiac abnl
anti-m- dry mouth, blurry vision, constipation, urinary retain, glaucoma

Question 3

atypical

Answer 3

block D2 and 5HT2A rec

less EPS/prolactin release

Question 4

haloperidol (haldol)

Answer 4

high potency typical

depot form

Question 5

fluphenazine (prolixin)

Answer 5

high pot typical

depot form

Question 6

chlorpromazine (thorazine)

Answer 6

low pot typical
also used to tx hiccups
antiHAM

Question 7

thioridazine (mellaril)

Answer 7

low pot typical

anti HAM

Question 8

clozapine (clozaril)

Answer 8

atypical
most efficacious (tx refractory pts, substance abuse, persistent positive symptoms, suicidal/violent) but most dangerous
most metab syndrome/weight gain
antiHAM- seizures, agranulocytosis (weekly blood draw for first 6 months)
decrease risk of suicide (like Li)

least risk for EPS (tx Tardive dyskinesia)

Question 9

risperidone (risperdal)

Answer 9

atypical
depot form, sublingal disintegrating form most potent
more effective for short term tx than halloo

prolactinemia/EPS in doses >6mg/day (most similar to typical, moderate weight gain risk)

Question 10

quetiapine (seroquel)

Answer 10

atyprical
antiHAM
orthostatic hypotension, sedation, longer dose titration (9 days to max dose?)
lowest risk of EPS/TD

Question 11

olanzapine (zyprexa)

Answer 11

atypical
depot form, sublingual disintegrating form
available- fast
highest risk metal syndrome, weight gain, sedation

Question 12

ziprasidone (geodon)

Answer 12

atypical
lowest risk metal syndrome/weight gain

QT prolong, best when given with food

Question 13

aripiprazole (abilify)

Answer 13

atypical
partial agonist- longest slim half life
depot form
low risk of metab syndrome/weight gain, or sedation

more activating (akathisia) at higher doses

Question 14

paliperidone (invega)

Answer 14

atypical (expensive)
depot form
does not require hepatic metabolism (active metabolite)

Question 15

asenapine (saphris)

Answer 15

atypical (expesnive)
must be taken sublingually
risk of EPS

Question 16

FDA approved for mania

Answer 16

qrazo- quetiapine, risperidone, aripiprazole, riprasidone, olanzapine

NOT Clozapine, paliperidone, asenapine

Question 17

antiH tx

Answer 17

diphenhydramine (benadryl)

Question 18

anti-a tx

Answer 18

phenoxybenzamine

Question 19

antiM tx

Answer 19

benztropine (cogentin)

Question 20

Dopa agonist tx

Answer 20

amantadine

Question 21

antiEPS

Answer 21

akathisia- propranolol

TD- temp inc antyipsychotic dose (acute tx- suppress symptoms), benzos (acute tx), clozapine (maintenance tx)

Question 22

antiNMS

Answer 22

NMS= sudden depletion of dopa

fever- fever, encephaopathy, vitals unstable, elevated CPK, rigid muscles (lead pipe)

supportive tx lorazapam, aantadine (release dopa), bromocriptine (dopa agonist), dantrolene (muscle relaxant)

Question 23

note

Answer 23

Psychosis = increased Dopamine (DA)

Important dopaminergic systems:

1) mesolimbic/mesocortical pathway- regulates behavior (treatment goal is to block these DA receptors = reduce +/- psychotic symptoms)
2) nigrostriatal pathway- coordination of voluntary movements (block these DA receptors = basal ganglia/EPS effects)
3) tuberoinfundibular pathway- controls prolactin secretion (block these DA receptors = hyperprolactinemia)

Question 24

haloperidol, trifluoperzine, fluophenazine

Answer 24

Antipsychotics- high potency
block dopamine D2 receptors (increase cAMP)
psychosis (+symptoms of Schizophrenia), agitation
Nigrostriatal (basal ganglia/EPS- dyskinesias, parkinsonian), and Tubuloinfundibular (hyperprolactinemia)

Evolution of EPS side effects:
4hrs- acute dystonia (sudden onset sustained muscle spasms, stiffness, spasmodic torticollis, opisthotonus, oculogyric crisis)
4days- akathisia (restlessness)
4weeks- bradykinesia (parkinsonism)
4months- tardive dyskinesia (involuntary movements after chronic use)
Treat EPS with benztropine (anticholinergic)

Neuroleptic malignant syndrome (haywire DA system- fever, muscle rigidity, unstable ANS/vitals, mental status changes)
Antidote- dantrolene (refer to anti-NMJ)

Tardive dyskinesia (irreversible oral-facial movements from long term drug use)

Question 25

chlorpromazine, thioridazine

Answer 25

Antipsychotics- low potency
block dopamine D2 receptors (increase cAMP)
psychosis (+symptoms of Schizophrenia)
Non neurologic side effects- anti-muscarinic (blurry vision, dry mouth, constipation), anti-alpha1 (hypotension), and anti-H1 (sedation)
C- Corneal deposits
T- reTinal deposits

Question 26

Clozapine, Olanzapine, Quetipine (-pine)

Ziprasidone, Risperidone (-idone)

Answer 26

Atypical antipsychotics
multiple receptor effects (decrease DA related side effects due to dual 5-HT2 and DA rec. block)
psychosis (+/- symptoms of Schizophrenia)
Fewer EPS and anti-cholinergic side effects than traditional antipsychotics
C,O- metabolic syndrome (weight gain, glucose intolerance, dyslipidemia, DM)
C- reserved for treatment resistant schizo (those that failed 2 other med trials), due to risk of agranulocytosis (requires weekly WBC monitoring), and seizures
R- may increase prolactin (like 1st gen- high potency)
Z- prolong QT interval

Question 27

Aripiprazole

Answer 27

Atypical antipsychotic

different MOA- partial D2 agonist