Antipsychotics

Question 1

typical antipsychotics moa

Answer 1

dopamine D2 blockers; decrease positive symptoms (hallucinations, disorganization of thought and behavior)

Question 2

atypical antipsychotics moa

Answer 2

D2 and 5-HT2A antagonism

Question 3

haloperidol moa/potency

Answer 3

D2 block; high potency

Question 4

butyrophenones

Answer 4

haloperidol

Question 5

only approved agent for children and teens

Answer 5

risperidone

Question 6

aripiprazole moa

Answer 6

D2 partial agonist, 5-HT2a antagonist; 5-HT1a partial agonist (lower incidence of side effects)

Question 7

asenapine moa

Answer 7

D1, D2, 5-HT2, alpha adrenergic and histamine receptor antagonist (low muscarinic affinity)

Question 8

anti-psychotic extrapyramidal side effects

Answer 8

acute dystonia, akathesia, parkinsonian syndrome, neuroleptic malignant syndrome, perioral tremor, tardive dyskinesia

Question 9

acute dystonia symptoms and treatment

Answer 9

symptoms: muscle spasms, facial grimacind, stiff neck, oculogyric crisis
Tx: anticholinergic antiparkinsonian agents

Question 10

akathesia symptoms and treatment

Answer 10

symptoms: strong subjective feelings of distress or discomfort often referred to the legs
Tx: decrease dose, add antiparkinsonian agent, anti anxiety agent or propranolol

Question 11

neuroleptic malignant syndrome symptoms and treatment

Answer 11

Symptoms: fever, severe parkinsonism with catatonia, fluctuations in coarse tremor intensity, autonomic instability, elevated creatinine kinase, myoglobinemia, high mortality
Tx: cessation of antipsychotic, supportive care, dantrolene or bromocriptine

Question 12

antipsychotic effects on the brainstem

Answer 12

decreased vasomotor reflexes at low doses

Question 13

antipsychotic effects on the CTZ

Answer 13

protect against N./V at low doses

Question 14

drugs that cause increased PRL

Answer 14

all typical and risperidone

little increase: clozapine, olanzapine, and ziprasidone

Question 15

likely to increase risk of type 2 DM

Answer 15

clozapine and olanzapine

Question 16

may cause jaundice

Answer 16

chlorpromazine

Question 17

agranulocytosis

Answer 17

clozapine (weekly blood counts necessary)

Question 18

cause skin reactions - urticaria, photosensitivity or dermatitis

Answer 18

phenothiazines - chlorpromazine, fluphenazine, perphenazine

Question 19

most likely to cause weight gain

Answer 19

clozapine and olanzapine

Question 20

main route of metabolism

Answer 20

hepatic microsomal oxidases and conjugation; most metabolites are inactive
typical: cyp 2D6 and 3A4 (inhibit)

Question 21

paliperidone

Answer 21

active metabolite of risperidone available for therapeutic use

Question 22

treatment of catatonia

Answer 22

benzos seem to help, if not ECT

do not give antipsychotics

Question 23

if a patient is on haliperidol for 1 week and comes back complaining of agitation and trouble sitting still (akisthesia) what should you do?

Answer 23

decrease the dose

Question 24

why do low potency typical antipsychotics have fewer EPSs?

Answer 24

they have greater antimuscarinic effects

-e.g. chlorpromazine and thiothixine

Question 25

what antipsychotic should you use in an Alzheimer's patient?

Answer 25

typical antipsychotics

Question 26

what atypical is best to prevent weight gain?

Answer 26

ziprasidone

Question 27

atypicals are most effective in treating...

Answer 27

positive symptoms

Question 28

which antipsychotic is most effective in preventing suicide and may be effective in patient who have not responded to other antipsychotics?

Answer 28

clozapine

Question 29

course of action when a patient develops an acute dystonia

Answer 29

give an injectable anticholinergic (e.g. benztropine) to counteract the DA block on the basal ganglia

Question 30

trifluoperazine side effects

Answer 30

constipation, orthostatic hypotension, mydriadasis, decreased libido

Question 31

high potency typical antipsychotics

Answer 31

haloperidol, fluphenazine, perphenazine

Question 32

low potency typical antipsychotics

Answer 32

chlorpromazine and thiothixane

Question 33

acute dystonia

Answer 33

muscle spasms, torticollis, oculogyric crisis

Question 34

antipsychotics that cause QT prolongation

Answer 34

chlorpromazine (typical), and ziprasidone (atypical)

Question 35

side effect that caused by all typicals

Answer 35

PRL release; results in sexual dysfunction, amenorrhea, gynecomastia, galactorrhea, and hypoestrogenism

Question 36

risperidone adverse effects

Answer 36

PRL secretion | weight gain, esp. in children and teens

Question 37

increase the risk of type 2 DM

Answer 37

clozapine and olanzapine and chlorpromazine

Question 38

chlorpromazine adverse effects

Answer 38

``` Anticholinergic effects and increased PRL release (same as other low-potency typicals) impaired glucose tolerance QT prolongation Jaundice Urticaria ```

Question 39

clozapine adverse effects

Answer 39

agranulocytosis increased risk for type 2 DM lowers seizure threshold