Antipsychotics

Question 1

Typical Antipsychotics

Answer 1

phenothiazines, haloperidol, loxapine, pimozide, and thiothixene

Question 2

Atypical antipsychotics

Answer 2

aripiprazole, asenapine, clozapine, olanzapine, quetiapine, risperidone, paliperidone, iloperidone, lurasidone, and ziprasidone

Question 3

new generation antipsychotics

Answer 3

brexpiprazole (Rexulti), cariprazine (Vraylar), and pimavanserin (Nuplazid)

Question 4

Pimavanserin

Answer 4

is indicated for hallucinations and delusions associated with Parkinson’s disease psychosis.

Question 5

Indication for antipsychotics

Answer 5

Antipsychotics are used in the treatment of schizophrenia and other psychotic disorders; some for bipolar mania (some mood stabilizers as well)

Question 6

MOA of Typical Antipsychotics

Answer 6

Typical antipsychotics work by blocking postsynaptic dopamine receptors. They also demonstrate varying affinity for cholinergic, alpha1-adrenergic, and histaminic receptors. Antipsychotic effects may be related to inhibition of dopamine-mediated transmission of neural impulses at the synapses.

Question 7

MOA of atypical antipsychotics

Answer 7

are weaker dopamine receptor antagonists than conventional antipsychotics but are more potent antagonists of the serotonin type 2A (5HT2A) receptors. They also exhibit antagonism for cholinergic, histaminic, and adrenergic receptors.

Question 8

Antipsychotics that prolong QT interval

Answer 8

ziprasidone, thioridazine, pimozide, haloperidol, paliperidone, iloperidone, asenapine, and clozapine.

Question 9

Safety Risks for Antipsychotics

Answer 9

EPS, DM, Hyperglycemia, wt gain, hypotension/orthostatic hypotension, lowered seizure threshold, anticholinergic effects, sedation, agranulocytosis, photosensitivity, NMS, DRESS

Question 10

Drug reaction with eosinophilia and systemic symptoms (DRESS)

Answer 10

Assess for symptoms of DRESS including fever, rash, swollen lymph glands, swelling in the face.

Question 11

Neuroleptic malignant syndrome (NMS)

Answer 11

Instruct patient to report immediately any fever, muscle rigidity, diaphoresis, tachycardia.

Assess vital signs regularly, including temperature.

Assess for deteriorating mental status or any other sign of NMS.

Question 12

Hormonal side effects of antipsychotics

Answer 12

Hormonal Side Effects The following are sexual side effects that may accompany these medications:

■Decreased libido, retrograde ejaculation (the discharge of seminal fluid into the bladder rather than through the urethra); gynecomastia (men)

■Amenorrhea (women); galactorrhea