Antipsychotics

Question 1

Typical antipsychotics examples and MOA?

Answer 1

haloperidol, fluphenazine, chlorpromazine, thioridizine

MOA: D2 receptor antagonists

Question 2

Atypical antipsychotics with MOA?

Answer 2

Quetipine, olanzapine, aripipramazole, ziprasidone, risperidone, clozipene

MOA: mainly serotonin 5HT-2 receptor antagonists + D4 dopamine receptor antagonists

Question 3

Extrapyramidal symptoms with Tx?

Answer 3

Dystonia within hours, akathisia within days, parkinsonism within weeks, tardive dyskinesia within months to years (5% increase every year)

Tx: anticholinergics (benztropine, diphenhydramine), benzodiazepines/B blockers (specific for akathisia)

Question 4

Management of metabolic syndrome?

Answer 4

Monitor BP, HbA1C/fasting blood sugar, lipid profile, weight

switch to weight-neutral med: ariprimazole or ziprasidone OR to typical antipsychotic

add metformin, exercise, good diet

Question 5

Tardive dyskinesia Tx?

Answer 5

switch to atypical
add VMAT-2 inhibitor, benzodiazepines, Vit. E, botox
symptom may persist despite withdrawal

Question 6

NMS symptom and Tx?

Answer 6

altered mental status, autonomic instability (high T, labile BP, tachycardia, tachypnea, hyporeflexia), High CK, leokocytosis, metabolic acidosis

Tx: withdraw all antipsychotics

Question 7

Mention other SE including for clozipine

Answer 7

Prolong QT, hyperprolactinemia (galactorrhea, gynocomastia, menstrual irregularities, sexual dysfunction), Irreversible retinal deposits in thioridizine, corneal and lens deposits in chlorpromazine

Clozipine: agranulocytosis, seizures, cardiomyopathy, orthostatic hypotension

antihistamine: sedation

Question 8

Which of them are injectible?

Answer 8

1st gen: haloperidol, fluphenazine
2nd gen: aripiprazole, olanzapine, risperidone