Antipsychotic drugs

Question 1

What are the major EPS symptoms of antipsychotic drugs?

Answer 1

1) Dystonia (onset-minutes to hours)
2) Akathisia ( 7 days- weeks)
3) Parkinsonianism (1 week- months)
4) Tardive dyskinesia (months to years-can be irreversible)

Question 2

Which antipsychotic should be used in cases that are refractory to other drugs?

Answer 2

Clozapine (Clozaril)

Question 3

Which antipsychotic should be used in cases of acute psychosis and what are its major side effects?

Answer 3

Olanzapine (Zyprexa) => weight gain, metabolic syndrome, and seizures
-Risperidone (Risperdal) is also a good choice

Question 4

After what dosage does Risperidone begin to show weight gain and EPS symptoms?

Answer 4

8mg

Question 5

Which antipsychotic is better for patients with Parkinsons?

Answer 5

Quetiapine (seroquel) => Does not affect the D2 receptors that are affected in Parkinsons

Question 6

What is the major side effect of quetiapine?

Answer 6

Somnolence and sedation

Question 7

What antipsychotic can also be used to help with depression?

Answer 7

Aripiprazole (Abilify)

Question 8

Which antipsychotic should be avoided in patients with dementia?

Answer 8

Aripiprazole (Abilify)

Question 9

Which antipsychotic is weight neutral/doesn’t cause weight gain?

Answer 9

Ziprasidone (Geodon)

Question 10

Which class of antipsychotics is associated with weight gain?

Answer 10

Atypicals

Question 11

Which antipsychotic is the least expensive and most often used for acute psychosis?

Answer 11

Haloperidol

Question 12

Which antipsychotic drug is associated with cardiac arrhythmias due to QT prolongation?

Answer 12

Ziprasidone (Geodon)

Question 13

How do neuroleptics (antispychotics) cause hyperprolactinemia?

Answer 13

Neuroleptics block the tuberoinfundibular tract which causes increased prolactin leading to: gynecomastia, galactorrhea, and menstrual irregularities

Question 14

How do neuroleptics (antipsychotics) cause EPS?

Answer 14

Neuroleptics block the nigrostriatal tract which leads to the EPS of: tremor, slurred speech, akathisia, dystonia, and tardive dyskinesia.

Question 15

Which drugs treat EPS?

Answer 15

• Dystonia => benztropine (cogentin), benydryl
• Parkinsonism/Akinesia => Benztropine, Benadryl (anti-cholinergic agents)
• Akathisia => beta blockers (propranolol), benzodiazepines

Question 16

What is neuroleptic malignant syndrome?

Answer 16

Often due to high potency antipsychotics:

• change in mental status
• autonomic changes (high fever, elevated BP, tachycardia)
• rigidity
• sweating
• elevated CPK
• leukocytosis
• metabolic acidosis
• If these symptoms are seen, stop the offending agent

Question 17

How do high potency and low potency typical antipsychotics differ in side effects?

Answer 17

• High potency => more EPS (bind D2 more tightly)

- Low potency => more anticholinergic/cardiotoxic side effects (tend to block muscarinic receptors more)

Question 18

What is the difference in the mechanism of action of typical vs atypical antipsychotics?

Answer 18

Typical => block D2

Atypical => less D2 blockade, more 5HT2a blockade

Question 19

What are some high potency typical anti-psychotics?

Answer 19

Fluphenazine, Trifluoperizine, Thiothixene, Haloperidol, Pimozide
- medium-low sedation, high EPS, low anti-cholinergic side effects

Question 20

What are some low potency typical anti-psychotics?

Answer 20

Chlorpromazine, Thioridazine

- medium-high sedation, low EPS, high anti-cholinergic/cardiac (QT prolongation) side effects

Question 21

Why are EPS caused?

Answer 21

cholinergic/dopamine imbalance

- Decreased dopamine, increased Ach

Question 22

What anti-cholinergic side effects are associated with typical anti-psychotics?

Answer 22

• Dry mouth, blurred vision, constipation, urinary retention, sedation, tachycardia, confusion, delirium, mydriasis, cycloplegia

Question 23

What other side effects ( a part from anti-cholinergic and EPS) are caused by typical anti-psychotics?

Answer 23

Neutropenia
Seizures
Cardiac arrhythmias
Hyperthermia
Cataracts
Priapism

Question 24

What is the ranking of metabolic syndrome risk in the atypical anti-psychotics?

Answer 24

Clozapine (highest risk) > Olanzapine > Quetiapine, Risperidone > Ziprasidone, Aripiprazole (lowest risk)

Question 25

What is the mechanism of action of Aripiprazole/Abilify?

Answer 25

Unique mechanism of action as a D2 partial agonist (at low doses only)

Question 26

How is Aripiprazole different from other atypical antipsychotics in terms of side effect profile?

Answer 26

Low EPS, no/minimal QT prolongation or weight gain, low sedation

Question 27

What is Quetiapine/Seroquel most commonly used as?

Answer 27

Anti-psychotic with sedation

Question 28

What are the main side effects of Quetiapine/Seroquel?

Answer 28

• Transaminitis

- Orthostatic hypotension

Question 29

Which atypical anti-psychotic functions more like a typical anti-psychotic?

Answer 29

Risperidone/Risperdal ( especially >6mg)

Question 30

What atypical is most likely to induce hyperprolactinemia, weight gain, and sedation?

Answer 30

Risperidone/Risperdal

Question 31

What atypical anti-psychotic must be taken with food as it increases absorption (nearly 100%)?

Answer 31

Ziprasidone/Geodon

Question 32

What are the major side effects of Ziprasidone/Geodon?

Answer 32

Vomiting/Nausea

Question 33

Which atypical antipsychotic has its blood levels reduced by smoking and causes transaminitis in a small minority of patients?

Answer 33

Olanzapine/Zyprexa

Question 34

Which atypical is the only drug known to reduce suicide risk in patients with schizophrenia?

Answer 34

Clozapine

Question 35

What are the major side effects of Clozapine/clozaril?

Answer 35

• Agranulocytosis => monitor weekly for first 6 months (weekly blood tests)
• Increased risk of seizures
• Myocarditis
• Associated with most sedation, weight gain, orthostasis, and transaminitis
• Metabolic syndrome

Question 36

What atypical is least likely to cause EPS?

Answer 36

Clozapine