Chapter 34 - Antipsychotics

Question 1

What is a ‘neuroleptic’?

Answer 1

an older name for antipsychotics that is usually used for major tranquilizers

Question 2

What are antipsychotics used for?

Answer 2

-schizophrenia
-delusional disorders
-bipolar disorder
-depressive psychoses
-drug-induced psychoses
-anti-emetic
-Tourette’s syndroma
-Huntingtons’s chorea

Question 3

Are antipsychotics used for dementia?

Answer 3

no, especially in older adults

Question 4

What are some risk factors for schizophrenia?

Answer 4

-family hx
-life experience (poverty, stress, danger)
-pregnancy and birth issues (exposure to toxins or virus)
-taking psychoactive drugs at young age

Question 5

What are the POSITIVE schizophrenia symptoms?

Answer 5

-exaggeration of normal function
-hallucinations
-delusions
-agitation
-tension
-paranoia

Question 6

What are the NEGATIVE schizophrenia symptoms?

Answer 6

-loss of normal function
-lack of motivation
-poverty of speech
-blunted affect
-poor self-care
-social withdrawal

Question 7

What are the COGNITIVE schizophrenia symptoms?

Answer 7

-disordered thinking
-impaired attention
-learning and memory difficulty
-incomprehensible thinking and speech

Question 8

How an acute schizophrenia episode present?

Answer 8

-delusions
-hallucinations

Question 9

What are the residual symptoms of schizophrenia?

Answer 9

-suspiciousness
-poor anxiety management
-diminished judgement, insight, motivation, self-care

Question 10

How does long-term schizophrenia present?

Answer 10

acute exacerbations separated by partial remission

Question 11

Possible etiology of schizophrenia: excessive activation of CNS receptors for _____________

Answer 11

dopamine

Question 12

Possible etiology of schizophrenia: insufficient activation of CNS receptors for _____________

Answer 12

glutamate

Question 13

What receptors do 1st gen antipsychotics (typical) block?

Answer 13

dopamine

Question 14

What receptors do 2nd gen antipsychotics (atypical) block?

Answer 14

serotonin (a little bit of dopamine)

Question 15

Are 1st gen antipsychotics used for positive or negative symptoms of schizophrenia?

Answer 15

positive

Question 16

Are 2nd gen antipsychotics used for positive or negative symptoms of schizophrenia?

Answer 16

negative

Question 17

What are some possible complications of 1st gen antipsychotics?

Answer 17

movement disorders:
-extrapyramidal symptoms
-neuroleptic malignant syndrome (NMS)
-increase prolactin

Question 18

Do 2nd gen antipsychotics have the same effects as 1st gen?

Answer 18

no - less EPS, less NMS, no change in prolactin

Question 19

What are inappropriate off-label uses of atypicals?

Answer 19

-controlling agitated nursing home residents
-sleep aid

Question 20

How are 1st gen (typical) antipsychotics classified?

Answer 20

potency (low, medium, high)

Question 21

What is the 1st gen low potency prototype?

Answer 21

Chlorpromazine

Question 22

What is the 1st gen high potency prototype?

Answer 22

Haloperidol (Haldol)

Question 23

Do antipsychotics block dopamine 1 or 2 receptors?

Answer 23

2

Question 24

Where do antipsychotics act?

Answer 24

mesolimbic area of the brain

Question 25

What causes adverse effects from antipsychotics?

Answer 25

blocking dopamine, ACh, serotonin, histamine, norepi

Question 26

What are extrapyramidal symptoms (EPS)?

Answer 26

-acute dystonia
-oculogyric crisis
-akathisia
-parkinsonism

Question 27

Are EPS symptoms reversible?

Answer 27

yes with anticholinergic meds (benztropine and procyclidine)

Question 28

What can EPS symptoms progress to?

Answer 28

tardive dyskinesia (is irreversible)

Question 29

What are the symptoms of tardive dyskinesia?

Answer 29

-choreoathetoid movements of tongue and face
-lip-smacking, fly-catching
-slow, worm-like movement of tongue
-involuntary limb movement

Question 30

What is neuroleptic malignant syndrome (NMS)?

Answer 30

a rare but serious adverse effect that causes rigidity, high fever, sweating, autonomic instability, dysrhythmias, BP fluctuations, altered LoC, seizures, coma

Question 31

Does NMS have a slow or fast onset?

Answer 31

slow

Question 32

How does NMS present on labs?

Answer 32

-elevated creatine kinase
-elevated creatine phosphokinase
-elevated transaminases
-leukocytosis

Question 33

How can death result from NMS?

Answer 33

-respiratory failure
-CV collapse
-dysrhythmias

Question 34

How is NMS treated?

Answer 34

-supportive measures
-drugs
-withdrawal of antipsychotics

Question 35

What drugs are used for NMS?

Answer 35

dantrolene and bromocriptine

Question 36

What are ALL the AE of antipsychotics?

Answer 36

-extrapyramidal symptoms
-tardive dyskinesia
-neuroleptic malignant syndrome
-dry mouth
-blurred vision
-photophobia
-urinary hesitancy
-constipation
-tachycardia
-orthostatic hypotension (A1 blockade)
-sedation
-gynecomastia
-sexual dysfunction
-increased prolactin levels
-seizures
-agranulocytosis
-dysrhythmias (prolonged QT interval)
-dementia
-sunburn
-menstrual irregularities

Question 37

Agranulocytosis is uncommon in ____ gen drugs?

Answer 37

1st

Question 38

What kind of drugs do antipsychotics interact with?

Answer 38

-anticholinergics (↑ effect)
-CNS depressants (↑ effect)
-levodopa and dopamine agonists (counteract effects)

Question 39

Sudden stoppage of antipsychotics can…

Answer 39

-cause some SE (restlessness, insomnia, headache, GI, sweating)