Antipsychotic Agents and Lithium

Question 1

Typical (Classical) Antipsychotics

Answer 1

Phenothiazines (Chlorpromazine, Thioridazine, Fluphenazine)
Thioxanthenes (Thiothixene)
Butyrophenones (Haloperidol)

Question 2

Atypical Antipsychotics

Answer 2

Heterocyclics (Clozapine, Loxapine, Olanzapine, Risperidone, Quetiapine, Ziprazidone, Aripiprazole)

LAHAT NG MAY -PINE at -DONE

Question 3

_____ Potency:

fewer extrapyramidal effects, more H1, Alpha1 and muscarinic blocking effects

Answer 3

Low

i.e. Chlorpromazine, Thioridazine, Mesoridazine

Question 4

_____ Potency:

more extrapyramidal effects, less H1, Alpha1 and muscarinic blocking effects

Answer 4

High

i.e. Haloperidol, Fluphenazine, Droperidol

Question 5

These Dopamine ___ receptors are the target of older antipsychotics

Answer 5

D2 receptors in the caudate putamen, nucleus accumbens, cerebral cortex and hypothalamus

Question 6

Identify the Dopaminergic Tract:

Regulates mentation and mood

Answer 6

Mesocorticcal - Mesolimbic

Question 7

Identify the Dopaminergic Tract:

Extrapyramidal function

Answer 7

Nigrostriatal

Question 8

Identify the Dopaminergic Tract:

Control of PRL release

Answer 8

Tuberoinfundibular

Question 9

Identify the Dopaminergic Tract:

Eating behavior

Answer 9

Medullary-Periventricular

Question 10

Identify the Dopaminergic Tract:

Anticipatory motivational phase of copulatory behavior

Answer 10

Incertohypothalamic

Question 11

Antipsychotic that decreases incidence of suicide

Answer 11

Clozapine

Question 12

Antipsychotic Toxicities

Answer 12

Constipation, dry mouth, loss of accomodation
Orthostatic hypotension, impotence
Toxic-confusional state
Weight gain
Hyperprolactinemia

Question 13

Hallucinogenic Receptors

Answer 13

5HT2A/2C

Question 14

Antipsychotics that can improve + symptoms but not - symptoms

Answer 14

Typical/Classical

Question 15

Antipsychotics that can improve both + and - symptoms

Answer 15

Atypical

PERO SOBRANG MAHAL

Question 16

Tx for Acute Dystonia

Answer 16

Diphenhydramine

Question 17

Tx for Parkinsonism

Answer 17

Benztropine

Question 18

Tx for Rabbit Syndrome

Answer 18

Benztropine

Question 19

Tx for Tardive Dyskinesia

Answer 19

None

Question 20

Tx for Akathisia

Answer 20

Diphenhydramine

Question 21

Tx for Neuroleptic Malignant Syndrome

Answer 21

Withdraw drug, Dantrolene

Question 22

Typical Antipsychotics

Blocks D2 receptors»5HT2

Answer 22

Chlorpromazine
Thioridazine
Haloperidol

LAHAT NG -ZINE

Question 23

Atypical Antipsychotics

Blocks 5HT2»D2

Answer 23

Clozapine
Olanzapine
Quetiapine
Risperidone
Ziprazidone
Aripiprazole

LAHAT NG -PINE at -DONE

Question 24

Sx of Neurleptic Malignant Syndrome

FEVER

Answer 24

Fever
Encephalopathy
Vitals Unstable
Elevated CPK
Rigidity

Question 25

Prototype typical antipsychotic SE: CORNEAL AND LENS Deposits, failure of ejaculation, marked sedation, neuroleptic malignant syndrome, contact dermatitis

Answer 25

Chlorpromazine | Phenothiazine

Question 26

Typical antipsychotic for anti-emesis SE: RETINAL deposits, failure of ejaculation, cardiotoxicity (arrhythmia) Strongest AUTONOMIC EFFECTS

Answer 26

Thioridazine | Phenothiazine

Question 27

Only antipsychotic with Fatal Overdose

Answer 27

Thioridazine | Phenothiazine

Question 28

``` Typical antipsychotic Drug for Huntington, Tourette's SE: EPS (major), Neuroleptic Malignant Syndrome Weakest AUTONOMIC EFFECTS Least sedating ```

Answer 28

Haloperidol | Butyrophenone

Question 29

Prototype atypical antipsychotic Drug for refractory schizophrenia, suicidal SE: AGRANULOCYTOSIS, weight gain, hyperglycemia, hyperlipidemia, myocarditis, seizures, ileus, hypersalivation

Answer 29

Clozapine

Question 30

Atypical antipsychotic for Bipolar disorder, anorexia nervosa, depression SE: weight gain, hyperglycemia, hyperlipidemia

Answer 30

Olanzapine

Question 31

Atypical antipsychotic | SE: Somnolence, Fatigue, Sleep paralysis, Hypnagogic hallucinations, cataracts, priapism

Answer 31

Quetiapine

Question 32

Atypical antipsychotic for intractable hiccups, Tourette's syndrome SE: Hyperprolactinemia, Photosensitivity Only antipsychotic approved for schizophrenia in the youth

Answer 32

Risperidone

Question 33

Atypical antipsychotic SE: Postural hypotension, QT prolongation (Torsades) Little or not tendency to cause hyperglycemia, hyperprolactinemia or weight gain Increased mortality in elderly patients with dementia-related psychosis

Answer 33

Ziprasidone PUSO

Question 34

``` Atypical antipsychotic Least sedating atypical antipsychotic no atropine like effects Little or not tendency to cause hyperglycemia, hyperprolactinemia or weight gain Very good safety profile ```

Answer 34

Aripiprazole

Question 35

Sx of Neuroleptic Malignant Syndrome

Answer 35

``` Fever Encephalopathy Vitals Unstable Elevated CPK Rigidity ```

Question 36

Tx of Bipolar disorder Used with antidepressants during maintenance therapy Slow onset of action Protective versus suicide and self-harm

Answer 36

Lithium

Question 37

Mood stabilizer that decreases cAMP, Inhibits Inositol1phosphate SE: Thyroid enlargement, Nephrogenic DI, Edema, Leukocytosis, Teratogen, Ebstein's Anomaly, Bradycardia Contraindicated in Sick Sinus Syndrome

Answer 37

Lithium

Question 38

Tx of Lithium overdose

Answer 38

Hemodialysis

Question 39

Threshold for Lithium Toxicity

Answer 39

2 mEq/L

Question 40

Sx of Lithium Overdose

Answer 40

Neuromuscular excitability, tremors, twitching, agitation, weakness, ataxia, leukocytosis, bradycardia, hypotension