Ch 31 Drugs for Schizophrenia (antipsychotics)

Question 1

___ is the principal indication for antipsychotic

drugs, although many are also used for bipolar disorder.

Answer 1

Schizophrenia

Question 2

Schizophrenia is a chronic illness characterized by:

Answer 2

disordered thinking and reduced comprehension of reality.

Positive symptoms include hallucinations, delusions, and agitation.

Negative symptoms include blunted affect, poverty of speech, and social withdrawal.

Cognitive dysfunction manifests as disordered thinking, reduced ability to focus attention, plus learning and memory difficulties.

Question 3

Antipsychotic drugs fall into two major groups:

Answer 3

first generation antipsychotics (FGAs) and
second-generation antipsychotics (SGAs).

The drugs in both groups are equally effective at treating
schizophrenia.

Question 4

Despite initial impressions, the SGAs are no safer than

FGAs—they simply produce different ___.

Answer 4

adverse reactions.

FGAs carry a high risk of extrapyramidal symptoms (EPS). SGAs carry a high risk of metabolic effects.

Question 5

Drugs in both generations increase the risk of mortality

in __.

Answer 5

older adult patients with dementia-related psychosis

Question 6

Therapeutic responses to antipsychotic drugs develop __.

Answer 6

slowly, often taking several months to exert maximal effects

Question 7

___ are thought to relieve symptoms of schizophrenia by causing strong blockade of D2 receptors.

Answer 7

First-generation antipsychotics

Question 8

___ are thought to relieve symptoms of schizophrenia by causing moderate blockade of D2 receptors and strong blockade of 5-HT2 receptors.

Answer 8

Second-generation antipsychotics

Question 9

The major concern with FGAs is production of __.

Answer 9

EPS, which can occur early in treatment (acute dystonia,
parkinsonism, and akathisia) or late in treatment (tardive
dyskinesia)

Question 10

Acute dystonia and parkinsonism respond to ___. Akathisia is harder to treat but may respond to (3).

Answer 10

anticholinergic drugs (e.g., benztropine)

anticholinergic drugs, benzodiazepines, or beta blockers

Question 11

Tardive dyskinesia (TD) has no reliable treatment. For
patients with severe TD, switching to an \_\_ may help.

Answer 11

SGA

Question 12

The risk of early EPS is much greater with ___, whereas the risk of TD (tardive dyskinesia) is ___.

Answer 12

high-potency FGAs than with low-potency FGAs;

equal with both groups

Question 13

The risk of __(3)__ is greater with the low-potency FGAs than with the high-potency FGAs.

Answer 13

sedation, orthostatic hypotension, and anticholinergic effects

Question 14

FGAs can cause ___. Deaths have occurred.

__(2)__ are used for treatment.

Answer 14

neuroleptic malignant syndrome, characterized by muscular rigidity, high fever, and autonomic instability

Dantrolene and bromocriptine

Question 15

Antipsychotic drugs can increase levels of circulating

__.

Answer 15

prolactin (by blocking the inhibitory action of dopamine

on prolactin release)

Question 16

Levodopa can counteract the beneficial effects of FGA

drugs, and vice versa, because __.

Answer 16

levodopa activates dopamine receptors,

whereas FGAs block dopamine receptors.

Question 17

__ is the prototype of the high potency FGAs.

Answer 17

Haloperidol [Haldol]

Question 18

Second-generation antipsychotics differ from FGAs in three important ways:

Answer 18

(1) they block receptors for serotonin in addition to receptors for dopamine;
(2) they carry a lower risk of EPS, including TD; and
(3) they carry a higher risk of serious metabolic effects—weight gain, diabetes, and dyslipidemia—that can lead to adverse cardiovascular events and premature death.

Question 19

Tardive dyskinesia (TD)

Answer 19

repetitive, involuntary movements, such as grimacing and eye blinking

Question 20

Among the SGAs, the risk of metabolic effects is greatest
with _(2)_.

Answer 20

clozapine and olanzapine

Question 21

___, the first SGA, is the most effective antipsychotic drug available.

Answer 21

Clozapine

Question 22

Clozapine can cause potentially fatal ___.

Answer 22

agranulocytosis.

Hence, regular blood tests are mandatory and the drug
should be reserved for patients who have not responded
to other antipsychotics.

Question 23

Antipsychotic depot preparations (e.g., haloperidol decanoate, fluphenazine decanoate) are used for ___..

Answer 23

long-term maintenance therapy of schizophrenia