Antipsychotics

Question 1

Extrapyramidal symptoms.

Answer 1

Parkinson’s symptoms, akathisia, dystonia, tardive dyskinesia

Question 2

About 1st and 2nd generation antipsychotics for schizophrenia.

Answer 2

1st: txs positive schizophrenia symptoms (mainly D2 receptor for +)
2nd: txs negative schizophrenia symptoms (mainly 5HT2A receptor for -)

Question 3

1st gen antipsychotics and potencies.

Answer 3

Low: Chlorpromazine, Methotrimeprazine
Intermediate: Loxapine, Perphenazine, Zuclopenthixol
High: Fluphenazine, Haloperidol, Pimozide, Thiothixene, Trifluoperazine

Question 4

Phenothiazines side chains accounts for what activities?

Answer 4

sc containing Piperazine derivative for greater potency and N for highest pharmacological activity

Question 5

The only antipsychotic for tx resistant schizophrenia, not first line tx. SE?

Answer 5

Clozapine SE: Agranulocytosis- monitor blood

Question 6

Clozapine Olanzapine and Risperidone SEs.

Answer 6

C and O: Weight gain, hyperlipidemia
C: risk of diabetes, ortho hypotension
O: least hyperlactenemia, EPS esp. akathisia
R: high hyperlactenemia, EPS (do not split tabs)

Question 7

Quetiapine SEs.

Answer 7

Risk of diabetes, hyperlipidemia (inc. TG), dec. thyroid hormone levels, least EPS

Question 8

What is Akathisia? Tx?

Answer 8

Inability to stay still, inner restlessness.

If dose reduction not effective, Beta blockers (Propranolol)

Question 9

What is dystonia? Tx.

Answer 9

Involuntary muscle contraction or repetitive motion, may resemble tremors.
IM Benztropine or diphenhydramine (acute) followed by dose reduction or SGA switch

Question 10

Neuroleptic malignant symptoms.

Answer 10

Fever muscle rigidity autonomic disturbance fluctuations in BP tachh elevated WBC and CK
Tx by Dantrolene or bromocriptine

Question 11

1st gen with the highest sedation?

Lowest weight gain?

Answer 11

• Chlorpromazine

- Haloperidol

Question 12

Clozapine SEs highest and lowest.

Answer 12

Atypical 2nd gen with the highest sedation and weight gain, lowest tardive dyskinesia and EPS (also Quetiapine)

Question 13

Lowest SEs of Quetiapine and Risperidone?

Answer 13

Q- lowest sexual dysfunction, EPS

R- lowest sedation

Question 14

Which 2nd gen antipsychotic is not the tx for resistance?

Risperidone tx which symptoms?

Answer 14

• Olanzapine

- both for positive and negative symptoms

Question 15

For severe psychosis (schizophrenia) or bipolar disorder, add what drugs?

Answer 15

Valproic acid or carbamazepine (mood stabilizers)

Question 16

Continue for how long for 1 and 2 episodes?

Answer 16

1 episodes: 1-2y

2 episodes: 2-5y

Question 17

Do not use in antipsychotic-naive patients.

Answer 17

Zuclopenthixol

Question 18

Haloperidol with this IM drug for acute phase, what SE?

Answer 18

Lorazepam; QT prolongation