Antipsychotics- Dr. Masserano

Question 1

Positive symptoms

Answer 1

• Delusion
• Hallucination
• Thought disorder

Question 2

Negative symtoms

Answer 2

• Decreased motivation

- Affective flattening

Question 3

Neurodevelopment Hypothesis of Schizophrenia

Answer 3

• Fetal disturbance (infection, hypoxia)
• Leads to abnormal neuron migration
• Excessive pruning/excessive loss of neurons

Question 4

Progressive nature of the illness

Answer 4

• Indicates that underlying cause is NOT static
• Increased glutamate
• Excitotoxicity = excited to death
• Over stimulation leads to brain damage

Question 5

Dopamine Hypothesis of Schizophrenia

Answer 5

• Increased dopa synthesis
• Increased dopa release
• Decrease in dopa breakdown
• Inhibition of reuptake

Question 6

Chlorpromazine

Answer 6

• Has a low affinity for D2 receptors

- So a higher dose is needed in order to control schizophrenia

Question 7

Treatment options for schizophrenia

Answer 7

• First generation antipsychotics (FGA)
• Second generation antipsychotics (SGA)
• All are dopamine D2 receptor antagonists

Question 8

Examples of FGAs

Answer 8

• Chlorpromazine (Thorazine)

- Haloperidol (Haldol)

Question 9

Which type(s) of symptoms do FGA control?

Answer 9

• Extrapyramidal symptoms
• Hyperprolactinemia
• Neuroleptic malignant syndrome
• Anticholinergic
• Antihistamine
• Adrenergic antagonist

Question 10

About Chlorpromazine (Thorazine)

Answer 10

• Developed as a pre anesthetic medication
• Found to be effective in psychosis
• Helped to release schizophrenics

Question 11

About Adasuve (Loxapine)

Answer 11

• Inhaler
• Approved for treatment of acute agitation in patients with bipolar disorder or schizophrenia
• 10min onset

Question 12

Chlorpromazine antiemetic effect

Answer 12

-D2 receptor antagonist

Question 13

Scopolamine antiemetic effect

Answer 13

-ACh receptor antagonist

Question 14

Hydroxyzine and promethazine antiemetic effect

Answer 14

-Histamine receptor antagonist

Question 15

Ondansetron (Zofran) and Granisetron (Kytril) antiemetic effect

Answer 15

-5HT3 antagonist

Question 16

Possible effects of FGAs

Answer 16

• Antiemetic
• Intractable hickups
• Sedative effects
• Antipsychotic effects

Question 17

Toxicities/side effects of FGAs

Answer 17

• Decreased seizure threshold
• Postural hypotension
• Anticholinergic effects
• Potentiate CNS depressants
• Hyperprolactinemia
• Neuroleptic Malignant Syndrome
• Torsades de pointe
• Extrapyramidal syndromes

Question 18

Serotonin (5-HT) receptor function

Answer 18

-Helps with negatve symptoms in schizophrenia
-5HT1A: postsynaptic neurons
agonist
-5HT2a: Presynaptic neurons
Antagonist

Question 19

What symptom(s) do SGA treat

Answer 19

-Both positive and negative symptoms

Question 20

Possible side effects of SGAs

Answer 20

• Weight gain
• Diabetes mellitus
• Cholesterol levels

Question 21

Which atypical antipsychotic leads to the most weight gain and increases cholesterol levels

Answer 21

-Olanzapine

Question 22

Black box warnings of Clozapine (Clozaril)

Answer 22

• Agranulocytosis
• Seizures
• Myocarditis
• Other cardio/vascular effects
• Increased mortality in elderly patients with dementia

Question 23

Side effects of most atypical antipsychotics

Answer 23

• QT prolongation
• Increased mortality in elderly patients with dementia
• Suicide warning in young adults

Question 24

Which SGAs have a high incidence of weight gain

Answer 24

• Olanzapine

- Clozapine

Question 25

Which SGAs have a moderate incidence of weight gain

Answer 25

- Quetiapine - Risperidone - Iloperidone

Question 26

Which SGAs have a low/ no incidence of weight gain

Answer 26

- Aripiprazole - Paliperidone - Ziprasidone - Lurasidone

Question 27

Brexpiprazole (Rexulti)

Answer 27

- Partial agonist of 5HT1A - Partial agonist of D2 - Antagonist of 5HT2A/B

Question 28

Approved therapies for Brexpiprazole (Rexulti)

Answer 28

- Major depressive disorder (add on) | - Treatment of schizophrenia

Question 29

Black box warnings with Brexpiprazole (Rexulti)

Answer 29

- Increased mortality in elderly with dementia | - Increased suicidal thoughts in young adults

Question 30

Cariprazine (Vraylar)

Answer 30

- Partial agonist of D2 - Partial agonist of 5HT1A - Antagonist of 5HT2A receptor - Partial D2 antagonist

Question 31

Approved therapies for Cariprazine (Vraylar)

Answer 31

- Schizophrenia | - Acute treatment of manic or mixed episodes associated with bipolar disorder

Question 32

Black box warning with Cariprazine (Vraylar)

Answer 32

-Increased mortality in elderly patients with dementia related psychosis

Question 33

SGA or FGA?

Answer 33

- Positive symptoms (BOTH) - Weight gain (SGA) - Negative symptoms (SGA) - Movement disorders (FGA) - Hyperprolactinemia (FGA)

Question 34

Antipsychotic drugs in pregnancy

Answer 34

- NOT contraindicated | - Do NOT abruptly stop antipsychotic medications

Question 35

Quetiapine (Seroquel) Abuse

Answer 35

- Not a controlled substance - Prescribed off label for insomnia - Sedation (H1 antagonist)