Antipsychotics Wolters

Question 1

What generation are shown to be effective for positive and negative symptoms of schizophrenia, respectively?

What about with cognitive functioning?

Answer 1

+ = 1st gen and 2nd gen

• =second gen

cognitive= none

Question 2

What generation are typical or conventional anti psychotics?

What generation are atypical antipsychotics?

Answer 2

1st gen - typical

2nd gen - atypical

Question 3

What is the BBW for antipsychotics in the elderly with dementia

Answer 3

increased risk of death

Question 4

What are some general side effects with antipsychotic medications? 7

Answer 4

Sedation

Anticholinergic side effects

Orthostatic hypotension

Caution with elderly patients, dehydration

Extrapyramidal symptoms

endocrine - dopamine and prolactinemia

wt gain

sexual dysfunction

Question 5

What is Parkinsonism?

Answer 5

Bradykinesia, Rigidity, Tremor, Akinesia

Question 6

What medications is good at treating Parkinsonism?

Answer 6

diphenhydramine, trihexyphenidyl, benztropine

Question 7

Dystonia?

Answer 7

Torticollis, larynogospasm

responds to Anticholinergics

Question 8

Akathisia

Answer 8

Somatic restlessness, inability to stay calm

Reduce antipsychotic dose or switch agent

Responds poorly to anticholinergics

Beta blockers: propranolol, nadolol; benzodiazepines

Question 9

Tardive dyskinesia

Answer 9

Abnormal, involuntary orofacial movements – can be irreversible with continued drug exposure

Lower antipsychotic dose or change agents

Anticholinergics – should not be given!

May worsen tardive dyskinesia

Question 10

Neuroleptic Malignant Syndrome (NMS)

Answer 10

Any drug with dopamine antagonism
FGA, SGA, antiemetics (metoclopramide, promethazine)

Hyperthermia (103-108°F), muscle rigidity, encephalopathy, autonomic instability (tachycardia, high BP)

ELEVATED CK - RHABDO

Question 11

What do you give to treat NMS?

Answer 11

Dantrolene

IV skeletal muscle relaxant – Reduction of heat production and muscle

Question 12

Haloperidole

Answer 12

Haldol

Question 13

What first generation antipsychotics are given IM? 3

What second generations are given IM?

Answer 13

chlorpromazine
fluphenazine
haloperidol

Aripiprazole - abilify
Olanzapine - zyprexa
ziprasidone- geodon

Question 14

What first generation anti-psych can be given by inhalation?

Answer 14

loxapine

Question 15

What 2 first generation anti-psychotic meds have the most anticholinergic side effects and the most orthostatic hypertension problems?

Answer 15

chlorpromazine

thiothixene - also QT prolongation

Question 16

Aripiprazole

Answer 16

Abilify

Question 17

Olanzapine

Answer 17

zyprexa

Question 18

Quetiapine

Answer 18

seroquel

Question 19

Risperidone

Answer 19

Risperdal

Question 20

Ziprasidone

Answer 20

Geodon

Question 21

Clozapine’s leading side effects

Answer 21

wt gain
hypercholestremia
 sedation
anti-cholinergic s/e
orthostatic hypertension

Question 22

Iloperidone’s strong side effect?

Answer 22

orthostatic hypotension

Question 23

Olanzapines leading side effects (2)

Answer 23

wt gain, hypercholestremia

Question 24

Risperidones leading side effects? (3)

Answer 24

wt gain, EPS/TD, prolactin elevation

Question 25

Aripiprazole

MOA:
Low risk of
High risk of

Answer 25

Dopamine D2/5HT1 partial agonist, 5HT2 antagonist

low risk of EPS
High risk of akathisia

LONG ACTING IM - for those with poor compliance

Question 26

What drug is similar to clozapine but without the agranulocytosis risk?

Answer 26

olanzapine

Question 27

IV use of what antipsychotic is not approved by the FDA but is used in clinical practice? What is the side effect?

Answer 27

IV Haldol

QTC prolongation

Question 28

How do you treat akathisia?

Answer 28

propranolol - beta blcoker

Question 29

Lurasidone/latuda has a nice side effect profile and can also be beneficial for what 2 symptoms?

Answer 29

cognitive function and anxiolytics/anxiety

Question 30

What drug is not associated with agranulocytosis?

Answer 30

olanzapine

Question 31

What is the active metabolite of risperidone?

Answer 31

Paliperidone

Question 32

What is the monthly injection of paliperidone called?

Answer 32

invega sustenna

Question 33

Risperidone and paliperidone have what unique side effect?

Answer 33

hyperprolactenemia

Question 34

What drug is preferred for Parkinson’s psychosis?

Answer 34

quetiapine

Question 35

What unique warning comes with ziprasidone ?

Answer 35

DRESS - drug reaction with eosinophilia and systemic symptoms

Question 36

What is a unique warning for clozapine?

Answer 36

agranulocytosis - A&C monitoring

Question 37

What drug is only given to those with resistant schizophrenia?

Answer 37

clozapine

Question 38

What are adjunctive antipsychotic meds? 4

Answer 38

Lithium
Carbamazepine
Valproic Acid
Benzodiazepines

Question 39

What 8 meds are deemed to be effective in treating agitation?

Answer 39

FGA
Haloperidol
Droperidol (not currently available)
Fluphenazine
Chlorpromazine

SGA
Aripiprazole
Olanzapine
Risperidone (PO)
Ziprasidone

Use with benzodiazepines!

Question 40

For the first episode of schizophrenia what are the 2 main drugs you DO NOT want to use?

Answer 40

clozapine and olanzapine

Question 41

What second generation antipsychotics seem important to be able to recognize? 7

Answer 41

aripiprazole - abilify
clozapine- clozaril
lurasidone - latuda 
olanzapine - zyprexa
quetipine - seroquel 
paliperidone - Invega
risperidone - risperdal

Question 42

What first generation anti-psychotic meds seem important to be able to recognize? 4

Answer 42

chlorpromazine
fluphenazine
Haloperidol-Haldol
Loxapine - inhalation
thiothixene

Question 43

What 2 anti-psychotics need to avoided in breast feeding women?

Answer 43

olanzapine and clozapine