Antipsychotics

Question 1

Chlorpromazine

Answer 1

1st generation. Low potency, common sedation and orthostatic hypotension.

Question 2

Haloperidol (Haldol)

Answer 2

1st generation. High potency, half-time 24h. Extrapyramidal sx very common.

Question 3

Mesoridazine

Answer 3

1st generation. Low potency. Cardia arrhythmias, eg Torsades de pointes.

Question 4

How do 1st generation antipsychotics work and what are they useful for? Side effects?

Answer 4

Block central dopamine receptors. Effective in reducing positive sx of schizophrenia, including hallucinations and delusions. EPS, tardive dyskinesia, sedation, neuroleptic malignant syndrome (NMS), anticholinergic effects, alpha-adrenergic blockade, QT prolongation, hyperprolactinemia 2/2 D2 blockade leading to gynecomastia and galactorrhea. Sexual dysfunction.

Question 5

What are some examples of extrapyramidal symptoms?

Answer 5

Parkinsonian syndrome (bc you’re blocking D2 receptors), acute dystonias, akathisia.

Question 6

What is tardive dyskinesia?

Answer 6

Choreiform and athetoid mvmts of trunk, extremities, and mouth.

Question 7

What is neuroleptic malignant syndrome?

Answer 7

Similar to malignant hyperthermia. Typically mvmt disorder (rigidity, dystonia, agitation), high fever, sweating, tachycardia, HTN.

Question 8

Name 6 atypical (2nd generation) antipsychotics.

Answer 8

Clozapine, risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone, aripiprazole (Abilify).

Question 9

How do all but one of the atypical antipsychotics work? What’s the exception and how does it work?

Answer 9

All except Abilify are serotonin-dopamine antagonists. Abilify is a partial agonist at dopamine and serotonin-1A receptors.

Question 10

What are the two psychiatric medications that act through partial agonism?

Answer 10

Aripiprazole and buspirone.

Question 11

Name a potentially life-threatening side effect of clozapine.

Answer 11

Agranulocytosis. Also anticholinergic side effects, weight gain, and NMS.