Antipsychotic drugs

Question 1

What is the mechanism of action of first-gen antipsychotics?

Answer 1

They are D2-antagonists and also block other receptors (H1, M, a1 receptors)

Question 2

What is the mechanism of action of second-gen antipsychotics?

Answer 2

They are D2-antagonists and 5-HT2A antagonists

Question 3

What is an example of first-generation antipsychotics?

Answer 3

Haloperidol (or anything ending in -azine)

Question 4

What are acute (short-term) adverse effects of first-gen antipsychotics?

Answer 4

• Extrapyramidal symptoms: dystonia (sudden and sustained involuntary muscle contractions), akathisia (ants in pants), parkinsonian syndrome (bradykinesia, rigidity, resting tremor)

Question 5

What are long term adverse effects of first-gen antipsychotics?

Answer 5

• Extrapyramidal symptoms: tardive dyskinesia (involuntary repetitive movements in facial region)
• Irreversible and limited effective treatment

Question 6

What are rare adverse effects of first-gen antipsychotics?

Answer 6

• Extrapyramidal symptoms: neuroleptic malignant syndrome (muscle rigidity, fever, sweating, delirium, autonomic instability)
• Very dangerous

Question 7

What are additional adverse effects seen with first-gen antipsychotics?

Answer 7

Orthostatic hypotension, anticholinergic effects, sedation, weight gain (d/t increased appetite)

Question 8

What contraindication is there with first-gen antipsychotics?

Answer 8

BBW in elderly patients with dementia –> increases mortality in these patients

Question 9

What are examples of second-gen antipsychotic?

Answer 9

Quetiapine and aripiprazole (either end in -pine, -prazole, or -idone)

Question 10

Clozapine (the best & the worst bc??)

Answer 10

• Second-gen antipsychotic
• Best: No EPS and effective against negative sxs
• Worst: can cause agranulocytosis (increased infections) and seizures so reserved for refractory cases (also causes salivation or wet pillow syndrome)

Question 11

Olanzapine

Answer 11

• Second-gen antipsychotic
• Most problematic for weight gain and metabolic changes

Question 12

Ziprasidone

Answer 12

• Second-gen antipsychotic
• Causes QT prolongation

Question 13

Risperidone

Answer 13

• Second-gen antipsychotic
• Worse in terms of increasing prolactin secretion and causing EPS

Question 14

Quetiapine

Answer 14

• Second-gen antipsychotic
• Less adverse effects

Question 15

Aripiprazole

Answer 15

• Second-gen antipsychotic
• Partial D2 agonist and 5-HT antagonist
• Less adverse effects

Question 16

What is lithiums mechanism of action?

Answer 16

Inhibits multiple enzymes involved in generation of second messengers (poorly understood)

Question 17

What is lithium used to treat in this case?

Answer 17

Bipolar disorder

Question 18

What are the side effects seen in lithium?

Answer 18

Movement problems (tremor), Nephrogenic diabetes insipidus (interferes w ADH), hypothyroidism, pregnancy
- Also can cause N/V and kidney dysfunction (long term use)

Question 19

What is lithium contraindicated in?

Answer 19

-Pregnancy, renal disease, and thyroid dysfunction (check renal and thyroid function regularly, as well as lithium)
- BBW for serum lithium concentration monitoring

Question 20

What are other treatment options for bipolar disorder?

Answer 20

Antiseizure medications: valproic acid, carbamazepine, lamotrigine
Second generation antipsychotics: ziprasidone, olanzapine, risperidone, aripiprazole, quetiapine

Question 21

T/F: Lithium is not good for maintenance therapy for bipolar disorder

Answer 21

False, lithium is the best maintenance agent in this disease