Antipsychotics

Question 1

What are the cardiac conduction abnormalities found with typical and atypical antipsychotics respectively? Why?

Answer 1

Typical = QRSd and QTc prolongation (Na and K blocking)
Atypical = QTc prolongation (K blocking)

Question 2

What pathway is responsible for the movement disorders associated with antipsychotic use?

Answer 2

Nigrostriatal pathway

Question 3

What is the basis for using anticholinergics in treated acute dystonic reactions?

Answer 3

Dopamine acts as an inhibitor to movement, which involves ACh. If block ACh, then similar to what dopamine does normally

Question 4

What type of symptoms are atypical antipsychotics better at treating?

Answer 4

Negative symptoms

Question 5

What is the classic side effect of chlorpromazine?

Answer 5

Agranulocytosis

Question 6

What is the classic side effect of Loxapine

Answer 6

Seizures

Question 7

What is the classic side effect of Haldol

Answer 7

NMS

Question 8

What is the classic side effect of Clozapine

Answer 8

Agranulocytosis

Question 9

What is the classic side effect of Olanzapine

Answer 9

DM, DKA

Question 10

What is unique about asenapine, and what role does this play in an overdose?

Answer 10

given SL since not absorbed through the GI tract. If swallowed as an attempt to OD, then little to no effect

Question 11

What is the classic side effect of Risperidone

Answer 11

Unusual arrhythmias

Question 12

What is the classic side effect of Quetiapine

Answer 12

Sedation

Potent alpha blocker

Question 13

What is the classic side effect of ziprasidone

Answer 13

QTc prolongation

Question 14

What is the classic side effect of Iloperidone

Answer 14

QTc prolongation

Question 15

What is the classic side effect of Lurasidone

Answer 15

Hypotension

Question 16

Which atypical antipsychotic does not significantly prolong the QTc?

Answer 16

Brexpiprazole

Question 17

What classic sign of Parkinson’s is not seen with neuroleptic induces parkinsonism?

Answer 17

Pill-rolling tremor

Question 18

What is the Vd and protein binding of antipsychotics, and what is the clinical relevance of this?

Answer 18

High Vd and high protein binding = no dialysis

Question 19

What is the relationship between dose/blood levels of antipsychotics, and s/sx in OD?

Answer 19

No correlation

Question 20

What two systems are mostly affected with antipsychotic ODs?

Answer 20

CV

Neuro

Question 21

What are the hemodynamic effects of antipsychotic ODs? (2)

Answer 21

hypotension from alpha blocking

Direct myocardial depression

Question 22

What are the major CNS s/sx of antipsychotic OD?

Answer 22

sedation to coma

Peripheral anti-cholinergic effects

Question 23

What is the treatment for antipsychotic overdose? (hypotension, arrhythmias)

Answer 23

NE for hypotension

Lidocaine for ventricular arrhythmias

Question 24

What classes of antiarrhythmics should be avoided in cases of antipsychotic overdose? Why?

Answer 24

Type I and III, since these block Na and Na/K channels respectively, which will only worsen the arrythmia

Question 25

Compare serotonin syndrome and NMS in terms of: onset

Answer 25

NMS = slow (days to weeks)

Serotonin syndrome = fast (hours)

Question 26

Compare serotonin syndrome and NMS in terms of: muscular findings

Answer 26

NMS = rigidity
SS = Clonus, hyperreflexia

Question 27

What are the two major precipitating events associated with NMS?

Answer 27

Medication changes

Depot form of drug

Question 28

What lab is classically elevated with NMS?

Answer 28

CPK

Question 29

What is the treatment for NMS?

Answer 29

Supportive, BDZ, decrease muscle use

Question 30

What is the treatment for hyperprolactinemia?

Answer 30

Bromocriptine

Question 31

What is the receptor that is defunct with malignant hyperthermia?

Answer 31

Ryanodine receptor

Question 32

What is the treatment for malignant hyperthermia?

Answer 32

Dantrolene and cooling

Question 33

What are the two drugs that are used to treat acute dystonic reaction?

Answer 33

Diphenhydramine

Benztropine

Question 34

What is the treatment for akathisia?

Answer 34

Anticholinergics

BDZs

Question 35

What is oculogyric crisis?

Answer 35

Inability to move eyes

Question 36

What is the new drug that is approved to treat tardive dyskinesia? MOA?

Answer 36

• Valbenazine
• VMAT inhibitor–“Although the exact cause of tardive dyskinesia is unknown, it is hypothesized that it may result from neuroleptic-induced dopamine hypersensitivity. By selectively reducing the ability of VMAT2 to load dopamine into synaptic vesicles,[6] the drug reduces overall levels of available dopamine in the synaptic cleft, ideally alleviating the symptoms associated with dopamine hypersensitivity”