Antipsychotic agents

Question 1

Name the low potency first-generation antipsychotic agents, their halflife and side effects

Answer 1

Chlorpromazine (24h)- sedation and orthostatic hypotension are very common; Thioridazine (24h)- higher incidence of cardiac disturbances, retinitis pigmentosa; Mesoridazine (30h)- Cardiac arrhythmias (torsade de pointe)

Question 2

Name the medium potency first-generation antipsychotic agents, and their halflife

Answer 2

Molindone (12h); Loxapine (8h)

Question 3

Name the high potency first-generation antipsychotic agents, their halflife and any notable side effects

Answer 3

Haloperidole (24h)- EPS very common; Fluphenazine (18h); Trifluoperazine (18h); Thiothixene (34h); Perphenazine (12h); Pimozide (55h)

Question 4

Clozapine: class, site of action, halflife, side effects, lab tests needed?

Answer 4

Second-generation antipsychotic agent, serotonin-dopamine antagonist; 5-15h; agranulocytosis, anticholinergic side effects, weight gain, sedation, NMS; CBC with differential weekly for 6 months then biweekly.

Question 5

Risperidone: class, site of action, halflife, side effects?

Answer 5

Second-generation antipsychotic agent, serotonin-dopamine antagonist; 3h for fast metabolizers, 120 in poor metabolizer; Extrapyramidal syndrome, postural hypotension, increased prolactin, weight gain, sedation, decreased concentration, breast milk passage.

Question 6

Olanzapine: class, site of action, halflife, side effects, lab tests necessary?

Answer 6

Second-generation antipsychotic agent, serotonin-dopamine antagonist; 31h; Increased prolactin, orthostatic hypotension, anticholinergic side effects, weight gain, somnolence; ALT

Question 7

Quetiapine: class, site of action, halflife, side effects, lab tests necessary?

Answer 7

Second-generation antipsychotic agent, serotonin-dopamine antagonist; 7h; Orthostatic hypoension, somnolence, transient increase in weight, cataracts in high risk; slitlamp exam every 6 months for those at risk.

Question 8

Ziprasideone: class, site of action, halflife, side effects, lab tests necessary?

Answer 8

Second-generation antipsychotic agent, serotonin-dopamine antagonist; 7h; dose-related QT prolongation, postural hypotension, sedation, breast milk passage; measure baseline K and Mg.

Question 9

Ariprazole: class, site of action, halflife, side effects?

Answer 9

Second-generation antipsychotic agent, partial agonist at dopamine and serotonin-1A receptors and antagonist at postsynaptic serotonin-2A receptors; 75h; headache, nausea, anxiety, insomnia, somnolence.