Antipsychotics

Question 1

positive symptoms of Schizophrenia

Answer 1

Hallucinations, delusions, disorganized speech and behavior

Question 2

negative symptoms of Schizophrenia

Answer 2

apathy, lack of motivation, difficulty speaking

Question 3

cognitive symptoms of Schizophrenia

Answer 3

deficits in working memory, central processing, social cognition, problem solving

Question 4

conventional; typical (Neuroleptic) effects of antipsychotic drugs

Answer 4

• induce EPS
• increase circulating [Prolactin]
• block D2 receptors (and many other receptors)
• sedation and autonomic effects

Question 5

atypical effects of antipsychotic drugs

Answer 5

• less EPS
• block DA and 5-HT1,5-HT2,6,7 receptor subtypes;some have partial agonist activity; variable blockade of other receptors
• variable effect of [prolactin]

Question 6

effects of low potency antipsychotics

Answer 6

more sedation and autonomic effects

Question 7

effects of high potency antipsychotics

Answer 7

more EPS; less sedation and hypotension

Question 8

clozapine has greater usefulness in treating

Answer 8

resistant pts

Question 9

AE of atypical antipsychotics

Answer 9

-hypotension, seizures, weight gain, hyperglycaemia, hyperlipidemia

Question 10

what are the 4 major dopamine pathways

Answer 10

1. Nigrostriatal (pars compacta; Parkinsons)
2. Mesocortical; mesolimbic (frontal cortex)
3. tuberoinfundibular (-prolactin)
4. chemoreceptor trigger zone (emesis)

Question 11

what are pharmacologic effects of typical agents

Answer 11

• CNS (sedation; dec. seizure threshold)
• extrapyramidal rxn (acute dystonia, parkinsonism, Akathisia, Tardive dyskinesia)
• Neuroleptic malignant syndrome

Question 12

what is neuroleptic malignant syndrome

Answer 12

• relatively rare rxn associated w/ antipsychotic agents, especially parenterally administered high-potency drugs
• mortality rate ~5%

Question 13

what is neuroleptic malignant syndrome associated w/

Answer 13

hyperthermia, diffuse muscular rigidity, autonomic dysfunction and fluctuating levels of consciousness

Question 14

what lab values does neuroleptic malignant syndrome alter

Answer 14

• elevate creatine kinase
• leukocytosis
• elevate hepatic transaminase
• increase myoglobin

Question 15

which antipsychotics are long-acting

Answer 15

Fluphenazine Decanoate
Haloperidol Decanoate
Risperidone

Question 16

who are long acting antipsychotics useful in

Answer 16

noncompliant pts

Question 17

what autonomic effects do antipsychotics have

Answer 17

• hypotension (orthostatic) from alpha receptor blockade
• anticholinergic effects (dry mouth, tachcardia, blurred vision, urinary retention, constipation, confusion/toxic delirium)
• impairment of thermoregulation

Question 18

cardiac effects of antipsychotics

Answer 18

• direct negative inotropic and quinidine-like effects (phenothiazines)
• Q-T prolongaion: thioridazine, mesoridazine, pimazide, haloperidol, ziprasidone)

Question 19

neuroendocrine effects of antipsychotics

Answer 19

-hyperprolactinemia which may cause galactorrhea (women) and gynecomastia (men)

Question 20

other AE of antipsychotics

Answer 20

• edema, weight gain; delayed ovulation, menstruation, amenorrhea; sexual dysfunction
• rare ophthalmic, hepatic, and hematologic effects

Question 21

clozapine

Answer 21

-minimal risk of extrapyramidal effects

Question 22

what SE have been reported with Clozapine

Answer 22

• akathisia, muscle stiffness, NMS
• agranulocytosis, benign hyperthermia, seizures, hypersalivation; weight gain; sedation, dizziness
• tachycardia; orthostatic hypotension

Question 23

what are the atypical antipsychotics

Answer 23

• Risperidone
• Olanzapine
• Quetiapine
• Ziprasidone
• Aripiprazole
• Asenapine
• Iloperidone

Question 24

SE of Risperidone

Answer 24

movement disorders; sexual dysfunction

Question 25

SE of Olanzapine

Answer 25

weight gain; glucose intolerance; hyperlipidemia

Question 26

SE of Quetiapine

Answer 26

cataracts

Question 27

SE of Ziprasidone

Answer 27

prolong QT interval; less weight gain

Question 28

what are the label warnings for Atypicals

Answer 28

-increased risk of weight gain, glucose intolerance/diabetes mellitus, and hyperlipidemia

Question 29

pharmacokinetics of antipsychotics

Answer 29

• half life 10-35 hrs

- metabolized by hepatic oxidation

Question 30

Asenapine and Olanzapine are primarily cleared by

Answer 30

glucuronidation

Question 31

what are the drug interactions of antipsychotics

Answer 31

• block a-recptors
• potentiate CNS (and respiratory depression)
• may potentiate cardiovascular depression
• competitive inhibitor of CYP2D6 and/or 3A4

Question 32

clinical uses of antipsychotics

Answer 32

• acute phase schizophrenia

- maintenance phase schizophrenia

Question 33

other psychiatric uses

Answer 33

Mania
Schizoaffective disorder
Delusional disorder
Major depression with psychotic features
Delirium, brief reactive psychoses, sensory deprivation syndromes, rage reactions
Organic mental syndromes
Pervasive developmental disorder (autism)
Agitated behavior associated w/mental retardation or dementia
Borderline personality disorder

Question 34

what effects do antipsychotics have in the elderly

Answer 34

-increase morality

Question 35

what are non-psychiatric uses of antipsychotics

Answer 35

Tourette's syndrome        
Chorea of Huntington's disease
Ballism
Intractable hiccups
Emesis