Antipsychotics

Question 1

chlorpromazine

Answer 1

1st generation/typical anti-psychotic
PRL, OHTN, urticaria, dermatitis, photosensitivities
low potency, PRL, OHTN, skin issues

Question 2

fluphenazine

Answer 2

1st generation/typical anti-psychotic

high EPS, PRL. potent

Question 3

perphenazine

Answer 3

1st generation/typical anti-psychotic

higher EPS/PRL. potent

Question 4

haloperidol

Answer 4

1st generation/typical anti-psychotic
potent, lowers seizure threshold
high EPS, PRL

Question 5

trifluperazine

Answer 5

1st generation/typical anti-psychotic

Question 6

clozapine

Answer 6

2nd generation/atypical anti-psychotic

little PRL increase, weight gain, metabolic syndrome

Question 7

risperidone

Answer 7

2nd generation/atypical anti-psychotic
5-HT/D2 antagonist
limited EPS at low doses. PRL increase.
Metabolized to paliperidone (active metabolyte.

Question 8

olanzapine

Answer 8

2nd generation/atypical anti-psychotic
little PRL increase
low potency, similar to clozapine, weight gain, metabolic syndrome

Question 9

Quetiapine

Answer 9

2nd generation/atypical anti-psychotic

NO PRL increase

low potency, similar to clozapine

Question 10

Ziprasidone

Answer 10

2nd generation/atypical anti-psychotic

limited EPS

Question 11

Aripiprazole

Answer 11

2nd generation/atypical anti-psychotic

partial D2/5HT1A agonist

lower AE

NO PRL increase

Question 12

Lurasidone

Answer 12

2nd generation/atypical anti-psychotic

EPS risk

5-HT partial agonist

Question 13

low vs high potency

typical vs atypical

Answer 13

Low = low EPS

high = high EPS

Typical = D2 blockers, EPS, PRL elevation, vary in potency. For positive symptoms only.

Atypical = D2 & 5HT antagonism. 5HT reduces EPS, improved efficacy for negative symptoms.

Question 14

effect of antipsychotics on cortex

Answer 14

lower seizure threshold

Question 15

site of antipsychotic fx

Answer 15

Limbic system. Co-administered anticholinergics do not block this, but do block EPS.

Question 16

action of antipsychotics on hypothalamus

Answer 16

increase PRL, avoid in BrCA

Question 17

N/V with antipsychotics

Answer 17

reduced b/c of DA antagonism

Question 18

relation between EPS and antimuscarinic potency

Answer 18

inverse

Question 19

acute dystonia

Answer 19

1st 5 days

spasms, grimace, torticolis, oculogyric crisis

tx: anticholinergic, antiparkinsons D2 blocker

Question 20

Akathesia

Answer 20

5-60 days

feelings of distress or discomfort. ants in the pants

tx: D2 blocker, anxiolytic/propranolol

Question 21

parkinsonian syndrome

Answer 21

D2 blockers & amantadine

Question 22

neuroleptic malignant syndrome

Answer 22

rare. Fever, parkinsonism & catatonia. coarse tremor, autonomic instability, elevated CrK, myoglobinemia, 10% mortality.

cessation, supportive care, dantroline or bromocriptine

Question 23

perioral tremor

Answer 23

rabbit syndrome

anticholinergics, cessation

Question 24

tardive dyskinesia

Answer 24

Mos-yrs, chronic D2 excess. Receptor upregulation.

no adequate tx. medically induced huntington’s

Question 25

atypical antipsychotics with high and low metabolic sydrome rates

Answer 25

clozapine, olanzapine (high)

zisprazidone, aripiprazole (low)