antipsychotics

Question 1

What is the indication for clozapine?

Answer 1

recurrent suicidal behavior

multi-drug resistant disease

Question 2

What is the indication for pimavanserin?

Answer 2

hallucinations/delusions associated with parkinson disease psychosis

Question 3

Positive symptoms of schizophrenia are related to what pathway

Answer 3

overactivity of the mesolimbic pathway

Question 4

Negative symptoms of schizophrenia are related to what pathway

Answer 4

mesocortical pathway dysfunction

Question 5

What are the positive symptoms of schizophrenia

Answer 5

hallucinations, delusions, disorganized speech/thinking, agitation, abnormal motor behavior

Question 6

What are the negative symptoms of schizophrenia

Answer 6

apathy, avolition (decreased motivation), alogia (complete lack of speech), cognitive deficits, social withdrawal

Question 7

Nigrostriatal pathway

Answer 7

projections from substantia nigra to basal ganglia

• -stimulation of purposeful movement
• -D2 antagonism induces extrapyramidal symptoms (pseudoparkinsonism & tardive dyskinsea)

Question 8

Tuberoinfundibular pathway

Answer 8

projections from hypothalamus to infundibular region

• -dopamine is released & tonically inhibits prolactin release
• -D2 antagonism increases prolactin levels

Question 9

How long must therapy be before evaluating for response

Answer 9

2-3 weeks

remission may take several months

Question 10

First generation antipsychotics block what

Answer 10

dopamine type-2 post synaptic receptors

also, block muscarinics, histaminics, alphas, D2s in nigrostriatal & tuberoinfundibular pathways

Question 11

1st gen SEs

Answer 11

dry mouth, constipation, urinary retention, blurred vision
ortho hypotension, dizziness/syncope
sedation
risk of QTc prolongation & seizure activity
hyperprolactinemia
extrapyrimidal symptoms (movement)

Question 12

Which are the 1st gen low potency agents

Answer 12

chlopromazine
thioridazine
more sedation, hypotension, & seizure-threshold reducation

Question 13

Which are the 1st gen high potency agents

Answer 13

fluphenazine
haloperidol
more movement & endocrine effects

Question 14

What are the treatments for the extrapyramidal symptoms

Answer 14

1. anticholinergic agents: benztropine & trihexyphenidyl

2. antihistamine agents: diphenhydramine

Question 15

What are the treatments for tardive dyskinesia

Answer 15

1. selective vesicular monoamine transporter 2 inhibitors: valbenazine & deutetrabenazine

Question 16

What receptors do the 2nd gen antipsychotics block

Answer 16

D2 & 5HT2A

–stronger serotonin blockers than dopamine

Question 17

List the SGA 5HT-2A/DA receptor antagonists

Answer 17

lurasidone (partial 5HT-1A agonist)
risperidone
ziprasidone

Question 18

List the SGA partial DA/5HT-1A receptor agonists

Answer 18

aripiprazole

brexpiprazole

Question 19

List the SGA multi-acting receptor target agents

Answer 19

clozapine
olanzapine
quetiapine

Question 20

What does pimavanserin do

Answer 20

inverse serotonin agonist/antagonist

used for parkinson’s psychosis

Question 21

MOA of cariprazine

Answer 21

5HT-2A/DA antagonist & partial DA/5HT-1A agonist

Question 22

SEs of SGAs

Answer 22

weight gain, hyperglycemia/insulin resistance, hyperlipidemia
QTc prolongation/EKG changes

Question 23

rare SE of clozapine

Answer 23

agranulocytosis

Question 24

rare SE of olanzapine

Answer 24

drug reaction w/ eosinophilia & systemic symptoms–skin eruption, hematologic abnormalities, lymphadenopathy & internal organ involvement

Question 25

Neuroleptic malignant syndrome

Answer 25

severe parkison’s like movement disorder with widespread muscle contraction

• AMS
• muscle rigidity, increased muscle metabolism, rhabdo
• hyperthermia
• dehydration

Question 26

treatment of neuroleptic malignant syndrome

Answer 26

dantrolene (malignant hyperthermia)

Question 27

1st gen SGAs we have to know

Answer 27

chlorpromazine
fluphenazine
haloperidol
thioridazine

Question 28

Before giving antipsychotics, check these

Answer 28

serum glucose, lipids, weight, BP, waist circumference & personal/family history of metabolic & CV disease

Question 29

What are the long-acting injectable agents?

Answer 29

risperidone
olanzapine
aripiprazole lauroxil
paliperidone palmitate