Antipsychotics (4-21-14)

Question 1

Fluphenazine: class?

Answer 1

FGA/high potency “Fluffy-Nazi”

Question 2

Pimozide: class? risks?

Answer 2

FGA/high potency

increased risk of heart block and VT

Question 3

Haloperidol: use? class?

Answer 3

FGA/high potency “Halo-poodle”

Tourette’s

Question 4

FGA/high potency: increased risks? decreased risks?

Answer 4

increased risk: 
-EPS
decreased risk: 
-metabolic SE, 
-antihistaminic = sedation,
-hypotension,
-AntiCholinergic effects

Question 5

FGA/low potency: increased risks? decreased risks?

Answer 5

increased risk

• antihistaminic = sedation
• anticholinergic = dry, red, mad, hot, blind
• anticardiovascular = orthostasis, arrhythmias

decreased risk

• EPS
• metabolic

Question 6

Chlorpromazine: class? risk? SE?

Answer 6

FGA/low potency "color pro"
high risk
-orthostasis
-QTc prolongation 
-seizures
S/E = skin photosensitivity + blue-ish coloration

Question 7

Thioridazine: class? risk? SE?

Answer 7

FGA/low potency “Thor-Daisy”
high risk QTc prolongation
S/E = eye = retinitis pigmentosa = retinal deposits

Question 8

perphenazine: class?

Answer 8

FGA/medium potency

Question 9

trifluoperazine: class?

Answer 9

FGA/medium potency

Question 10

thiothixene: class?

Answer 10

FGA/medium potency

Question 11

loxapine: class? risks? properties?

Answer 11

FGA/medium potency
high risk of seizures
antidepressant properties

Question 12

SGA: increased risks? decreased risks?

Answer 12

increased risk: metabolic S/E

decreased risk: EPS and TD

Question 13

Aripiprazole: class? increased risk? decreased risk?

Answer 13

SGA
unique as partial (mixed) D2 agonist
increased risk: akathisia
decreased risk: weight gain

Question 14

ziprasidone: class? increased risk? decreased risk?

Answer 14

SGA
increased risk = QTc prolongation
decreased risk = weight gain

Question 15

quetiapine: class? increased risk? decreased risk?

Answer 15

SGA
increased risk = weight gain + sedation
decreased risk = worsening of PD

Question 16

Risperidone: class? increased risk? decreased risk?

Answer 16

SGA
increased risk = prolactin + EPS (high D2 affinity)
decreased risk = aggression in autistic

Question 17

Olanzapine: class? increased risk? decreased risk?

Answer 17

SGA
increased risk = weight gain, hyperglycemia, seizures
decreased risk = treatment resistant depression (it works on depression)

Question 18

Clozapine: class? benefits of use?

Answer 18

SGA
MOST effective for tx-resistant psychosis
decreased risk: suicide
less risk of TD; LEAST likely to worsen PD

Question 19

Clozapine: class? risks of use?

Answer 19

weight gain, hypersalivation, seizures, myocarditis
AGRANULOCYTOSIS (CBC all the time)
need to keep WBC > 3.5 + ANC > 2

Question 20

EPS?

Answer 20

Acute dystonia = muscle spasm in head/neck
Akathisia = can’t sit still
drug-induced Parkinsonism = TRAP

Question 21

Tx for acute dystonia?

Answer 21

anticholinergic (PO/IM)

• Benzotropine
• diphenhydramine

Question 22

Tx for akathisia?

Answer 22

beta blocker (non-selective = propranolol)
benzodiazepine

Question 23

Tx for drug-induced parkinsonism

Answer 23

anticholinergic = benztropine, trihexiphenidyl, diphenhydramine
dopamine agonist = amantadine

Question 24

Tx for tardive dyskinesia?

Answer 24

stop current meds

switch to CLOZAPINE

Question 25

Tx for neuroleptic malignant syndrome?

Answer 25

stop meds

Dantrolene “denture-lion”

Question 26

symptoms of neuroleptic malignant syndrome?

Answer 26

FEVER 
F = fever
E = encephalopathy = AMS
V = vital signs unstable
E = enzymes = high CPK, high WBC
R = rigidity (muscles)