Antipsychotic Drugs

Question 1

First Generation Agents

Examples (4) Mechanisms of Action (4)

Answer 1

Chlorpromazine
Fluphenazine
Thioridazine
Haloperidol

Block post-synaptic D2 receptors
Block Muscarinic, alpha-1 and H-1 receptors

Question 2

First Generation Agents Broad Categories
Low Potency (2) High Potency (2) with Side Effects (2/2)

Answer 2

Low Potency:
Chlorpromazine and Thioridazine
Sedation and hypotension

High Potency:
Fluphenazine and Haloperidol
EPS and Hyperprolactinemia

Question 3

First Generation Agents

Dopamine Side Effects (3) with Treatments (3/2)

Answer 3

Extrapyramidal Symptoms:
Benztropine and Trihexyphenidyl (anticholinergic)
Diphenhydramine (antihistamine)

Tardive Dyskinesia:
VMAT2 inhibitors
Valbenazine and Deutetrabenazine

Hyperprolactinemia

Question 4

Drugs causing the least weight gain, diabetes and hypercholesterolemia

FGA’s (2) SGA’s (4)

Answer 4

Fluphenazine
Haloperidol

Aripiprazole
Cariprazine
Lurasidone
Ziprasidone

Question 5

Drugs causing the most weight gain, diabetes and hypercholesterolemia

FGA’s (1) SGA’s (3)

Answer 5

Chlorpromazine

Clozapine
Olanzapine
Quetiapine

Question 6

Drugs causing the least EPS, TD and hyperprolactinemia

FGA’s (1) SGA’s (5)

Answer 6

Chlorpromazine
(Thioridazine also have very little EPS/TD)

Aripiprazole
Clozapine
Olanzapine
Quetiapine
Ziprasidone

Question 7

Drugs causing the most EPS, TD and hyperprolactinemia

FGA’s (2) SGA’s (1)

Answer 7

Fluphenazine
Haloperidol
(Thioridazine also has lots of hyperprolactinemia)

Risperidone

Question 8

Drugs causing the least sedation

FGA’s (1) SGA’s (4)

Answer 8

Fluphenazine

Aripiprazole
Cariprazine
Risperidone
Ziprasidone

Question 9

Drugs causing the most sedation

FGA’s (2) SGA’s (1)

Answer 9

Chlorpromazine
Thioridazine

Clozapine

Question 10

Drugs causing the least anticholinergic effects and orthostatic hypotension

FGA’s (2) SGA’s (5)

Answer 10

Fluphenazine
Haloperidol

Aripiprazole
Cariprazine
Lurasidone
Risperidone
Ziprasidone

Question 11

Drugs causing the most anticholinergic effects and orthostatic hypotension

FGA’s (2) SGA’s (1)

Answer 11

Chlorpromazine
Thioridazine

Clozapine

Question 12

Drugs causing the least QTc prolongation

FGA’s (1) SGA’s (3)

Answer 12

Fluphenazine

Aripiprazole
Cariprazine
Lurasidone

Question 13

Drugs causing the most QTc prolongation

FGA’s (2) SGA’s (1)

Answer 13

Chlorpromazine
Haloperidol

Ziprasidone

Question 14

Second Generation Agents MOA’s with Examples

Antagonists (3) Partial Agonists (1) Combination (1) Multi-Acting (3)

Answer 14

5HT-2A/DA Receptor Antagonists:
Lurasidone
Risperidone
Ziprasidone

Partial DA/5HT-1A Receptor Agonists:
Aripiprazole

Combination Antagonist and Partial Agonist:
Cariprazine

Multi-Acting Receptor-Target Agents:
Clozapine
Olanzapine
Quetiapine

Question 15

Rare Second Generation Side Effects with Drugs (3)

Answer 15

Agranulocytosis:
Caused by Clozapine

Drug Reaction with Eosinophilia and Systemic Symptoms
Caused by Olanzapine

Neuroleptic Malignant Syndrome:
Caused by any SGA
Cured by Dantrolene

Question 16

Antipsychotic Baseline Monitoring Factors (6)

Answer 16

Serum glucose
Fasting lipid panel
BMI
Blood pressure
Waist circumference
FH of metabolic and cardiovascular disease

Question 17

Long Acting Injectable Agents

FGA’s (2) SGA’s (4)

Answer 17

Haloperidol
Fluphenazine

"ROAP"
Risperidone
Olanzapine
Aripiprazole
P
*the P is a nontestable drug*

Question 18

Pimavanserin

Mechanism of Action, Indication

Answer 18

Inverse Serotonin Agonist/Antagonist

Parkinson’s Psychosis