antipsychotics

Question 1

haloperidol, pimozide, -azines (trifluoperazine, chlorpromazine, fluphenazine, thioridazine)

Answer 1

typical antipsychotics, block D2 receptors

Question 2

typical antipsychotics usage

Answer 2

for schizophrenia (primarily for + symptoms), OCD, Tourette syndrome, delirium, psychosis, Huntington disease, BPD.

Question 3

“Hal tries to fly high” and effects

Answer 3

haloperidol, trifluoperazine, fluphenazine are high potency antipsychotics with more extrapyramidal side effects

Question 4

“cheating thieves are low” and effects

Answer 4

chlorpromazine, thioridazine are low potency antipsychotics with more anticholinergic, antihistaminergic, and alpha 1 blockage effects

Question 5

range of side effects of typical antipsychotic drugs (organ systems)

Answer 5

endocrine, metabolic, cardiac, ophthalmologic and extrapyramidal symptoms

Question 6

endocrine side effects of typical antipsychotics

Answer 6

acts on dopamine receptors leading to hyperprolactinemia causing galactorrhea, oligomenorrhea and gynecomastia

Question 7

cardiac side effects of typical antipsychotics

Answer 7

QT prolongation

Question 8

ophthalmologic side effects of typical antipsychotics

Answer 8

chlorpromazine causes corneal deposits and thioridazine cause retinal deposits

Question 9

Metabolic side effects of typical antipsychotics

Answer 9

Hyperlipidemia, weight gain and hyperglycemia

Question 10

Other side effects (antihistamine, antimuscarine, alpha1 blockade, extrapyramidal symptoms…)

Answer 10

Antihistamine: sedation
Antimuscarine: dry mouth, constipation
Alpha1 blockade: orthostatic hypotension
Extrapyramidal symptoms: ADAPT- Acute Dystonia( hours to days) treated with benztropine or diphenhydramine, Akathisia or restlessness (days to months) treated by beta blockers, benztropine and benzodiazepines, Parkisonism or bradykinesia (days to months) treated with benztropine and amantadine, Tardive dyskinesia (months to years) causing chorea orofacially treated with atypical antipsychotics like clozapine, valbenazine and deutetrabenazine.
OTHERS: neuroleptic malignant syndrome

Question 11

Names of atypical antipsychotics and usage

Answer 11

Aripiprazole, -apines (asenapine,clozapine,olanazapine,quetiapine), -peridone (iloperidone,paliperidone,risperidone), -sidones (lurasidones, ziprasidone)
Used for schizophrenia, OCD, BPD, anxiety disorders, depression, mania, Tourette syndrome,
Clozapine used for treatment resistant schizophrenia or schizoaffective disorder and for suicidality in schizophrenia

Question 12

Side effects of atypical antipsychotics

Answer 12

All->prolong QT, fewer extrapyramidal and anticholinergic side effects than typical
-apines cause same metabolic as typicals +clOpazine and Olanzapine cause Obesity
Clozapine cause agranulocytosis and seizures
Risperidone cause hyperprolactinemia as typicals

Question 13

Parkinson disease therapy drugs

Answer 13

BALSA Bromocriptine, Amantadine, Levodopa with carbidopa, Selegiline with COMT inhibitors and Antimuscarinics

Question 14

bromocriptine (ergot) + pramipexole and ropinirole (non-ergot) mechanism and toxicity

Answer 14

dopamine agonist
toxicity: nausea, impulse control disorder like gambling, confusion, hallucination and postural hypotension

Question 15

amantadine mechanism and toxicity

Answer 15

increase dopamine availability by decreasing reuptake and increasing release
toxicity: livedo reticularis, ataxia, peripheral edema

Question 16

carbidopa/levodopa mechanism and side effects

Answer 16

used in Parkinson disease mechanism: L-dopa can cross the BBB and there is converted by dopa decarboxylase and carbidopa is given with L-dopa to increase its bioavailability in the brain and decrease peripheral side effects
side effects: nausea, hallucinations, postural hypotension, in progressive disease it can lead to on-off phenomenon which leads to improved mobility in the on phase and impaired motor function in the off phase

Question 17

selegiline, rasagiline

Answer 17

mechanism: selectively inhibit the MAO-B increasing the dopamine availability
used with L-dopa
side effects: increase those of L-dopa

Question 18

tolcapone

Answer 18

crosses the BBB and blocks conversion of dopamine to 3-methoxytyramine (3-MT) in the brain by inhibiting central COMT

Question 19

benztropine and trihexyphenidyl

Answer 19

antimuscarinic drugs for Parkinson disease by improving tremors and rigidity but has little effect on bradykinesia