Anti-Psychotics Sang

Question 1

What are the 2 classes of anti-psychotics?

Answer 1

ATYPICAL

TYPICAL

Question 2

What are the ATYPICAL anti-psychotics?

Answer 2

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

Question 3

What are the Typical Antipsychotics? (3)

Answer 3

“T for typical, HC”

1) Thioridazine
2) Haloperidol
3) Chlorpromaxine

Question 4

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

Answer 4

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

Question 5

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

Answer 5

1) EPS2) Akathisia3) Dystonia

Question 6

What is Akathisia?

Answer 6

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

Question 7

What is dystonia?

Answer 7

Neurological movement disorder: - sustained muscle contractions -> twisting and repetitive movements or abnormal postures.

Question 8

What is the most likely mechanism of Antipsychotic drugs?

Answer 8

Block Postsynaptic D2 receptors in the CNS. - Particularly the mesolimbic-frontal system

Question 9

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

Answer 9

1) Dystonia2) Very painful

Question 10

What drugs are given to treat Dystonia? (2)

Answer 10

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

Question 11

What is the MOST IMPORTANT unwanted effect of antipsychotic drugs?

Answer 11

Tardive Dyskinesias

Question 12

What is Tardive dyskinesias?

Answer 12

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

Question 13

What is Choreoathetosis?

Answer 13

Occurence of involuntary movements in a combination of 1) Chorea: Irregular migrating contractions2) Athetosis: Twisting and Writhing

Question 14

How does one develop Tardive Dyskinesia?

Answer 14

After several years of antipsychotic drug use. - Some have it as early as 6 months.

Question 15

How do you treat Tardive Dyskinesia? (3)

Answer 15

1) Discontinue or reduce dose of current antipsychotic2) Eliminate all drugs with central anticholinergic action3) Add diazepam (high dose if necessary) to enhance GABAergic activity

Question 16

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

Answer 16

Greatest: ThioridazineWeaktest: Haloperidol

Question 17

What causes AUTONOMIC side effects? (2)

Answer 17

Due to blockade of 1) Peripheral ALPHA-ADRENERGIC receptors2) MUSCARINIC receptors

Question 18

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

Answer 18

1) Postural Hypotension2) Failure to ejaculate

Question 19

AUTONOMIC Side Effects of Muscarinic Blockade. (3)

Answer 19

1) Atropine-like effects2) Antimuscarinic CNS effects3) Urinary retention

Question 20

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

Answer 20

Most AytpicalsException: Ariprprazole, Ziprasidone

Question 21

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

Answer 21

Greatest: Clozapine, OlanzapineWeakest: Ziprasidone, Aripiprazole

Question 22

What are the METABOLIC side effects: (4)

Answer 22

1) Significant weight gain2) Hyperglycemia3) Hyperlipidemia may occur4) Some my develop DM

Question 23

What are specific side effects of ENDOCRINE toxicity:

Answer 23

D2 receptor blockade in pituitary: 1) Hyperprolactinemia2) Gynecomastic3) Amenorrhea-galactorrhea syndrome4) Infertility

Question 24

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

Answer 24

1) Thioridazine2) Clozapine3) Most atypicals except - Ziprasidone - Aripiprazole

Question 25

Which drug is most highly associated with Hyperprolactinemia side effects?

Answer 25

Risperidone