Antipsychotics

Question 1

What are the TYPICAL antipsychotics?

Answer 1

Haloperdiol + Azines + Pimozide and Thiothixene.

Question 2

What typical antipsychotics are used for antihistamine and antiemetic use?

Answer 2

Promethazine

Question 3

What are the Atypical Antipsychotics

Answer 3

It’s ATYPICAL for OLd CLOZets to QUETIly whISPER from A to Z.

Olanzepine, Clozpine, Quetiapine, Risperidone, Ariprazole, Ziprasidone

Question 4

What is the target of the first generation antipsychotics/typicals?

Answer 4

D2 receptors more than serotonin receptors.

Question 5

What is the mechanism of action of the atypicals?

Answer 5

the second generation drugs inhibit serotonin receptors.

Question 6

What are the antipsychotic actions of the antipsychotic meds?

Answer 6

reduce hallucinations and delusions by blocking dopamine receptors. Have calming effect and reduce spontaneous movement

Question 7

What are the extrapyrimadal effects of the antipsychotics

Answer 7

dystonias - involuntary movements, Parkinson-like symptoms (pill rolling), akathisia (motor restlessness), and tardive dyskinesia - involuntary movements of face and tongue (occurs with 40% of first generation drugs)

Question 8

What is the antiemetic effect of antipsychotics due to?

Answer 8

blocking D2 receptors of chemoreceptor trigger zone

Question 9

What are the anticholinergic effects of the antipsychotics?

Answer 9

blurred vision, dry mouth, confusion, constipation and urinary retention

Question 10

Other effects of antipsychotics?

Answer 10

orthostatic hypotension, light headedness, poikilothermia, prolactin elevations, sedation and sexual dysfunction

Question 11

How do antipsychotics treat schizophrenia?

Answer 11

First generation treats positive sx (movement) of schizophrenia, second generation treats negative sx (depression)

Question 12

What are other uses of antipsychotics?

Answer 12

tranquilizers to manage disruptive behavior secondary to autism,
in combination with narcotics to treat chronic pain with severe anxiety

Question 13

What is used to treat intractable hiccups

Answer 13

Chlorpromazine

Question 14

What do antipsychotics have so many SE?

Answer 14

80% of patients have adverse effects, due to drugs ability to pass BBB. Long acting injectable drugs have reduced extrapyramidal system side effects (EPS)

Question 15

What are the treatments for the SE of antipsychotics?

Answer 15

anticholinergics can reduce EPS

Beta blockers or benzos may control akathisias

Question 16

Is there treatment for tardive dyskinesia associated with antipsychotics?

Answer 16

only discontinuation of drug. TD can be irreversible and traditional anti-EPS meds can actually make it worse.

Question 17

What is neuroleptic malignant syndrome (NMS)?

Answer 17

adverse reaction to antipsychotics. FEVER
F-ever (not as high as malignant hypothermia)
E-ncephalopathy
V-vitals unstable
E-elevated enzymes (CPK)
R-rigidity of muscles

Question 18

What is treatment for NMS?

Answer 18

dantrolene or D2 agonists like bromocriptine

Question 19

What is the evolution of EPS side effects?

Answer 19

4 hrs - acute dystonia (muscle spasms etc)
4 days - akathisia (restlessness)
4 weeks - bradykinesia (parkinsonism)
4 months or more - tardive dyskinesia

Question 20

Which drugs cause significant weight gain?

Answer 20

Olanzapine and Clozapine

Question 21

Which drug causes prolonged QT interval and can lead to arrhythmia.

Answer 21

Ziprasidone

Question 22

What are other bad side effects of Clozapine?

Answer 22

lowers seizure threshold and can cause agranulocytosis

Question 23

What is a bad side effect of Risperidone?

Answer 23

increases prolactin causing lactation and gynecomastia