CNS - antipsychotics

Question 1

Chlorpromazine
Fluphenazine
Thioridazine

1. Mechanism?
2. Uses? (4)
3. Adverse effects? (5)

Answer 1

1. Phenothiazines - D2&raquo_space; 5-HT-2 blockage
   (also block alpha, M and H1)
2. Schizophrenia
   Bipolar disorder (manic phase)
   Antiemesis
   Preop sedation
3. Extrapyramidal, autonomic, hyperprolactinemia
   Sedation, decreased seizure threshold

Question 2

Haloperidol

1. Mechanism?
2. Uses? (4)
3. Adverse effect?

Answer 2

1. Blocks D2&raquo_space; 5HT2 receptors (some alpha block)
2. Schizoprenia
   Bipolar disorder (manic phase)
   Huntington’s
   Tourette’s
3. Major extrapyramidal symptoms

Question 3

Aripiprazole
Clozapine
Olanzapine
Quetiapine
Risperidone
Ziprasidone

1. Mechanism?
2. Uses? (4)
3. Adverse effects? (3)

Answer 3

Atypical antipsychotics:

1. Blocks 5HT&raquo_space; D2 receptors
   M block (Clozapine, Olazapine)
   alpha block (Clozapine, risperidone, ziprasidone)
   Variable H1 block
2. Schizophrenia (+/-)
   Bipolar disorder (Olanzapine, risperidone)
   Major depression (aripiprazole)
   agitaiton in Alzheimer’s/Parkinson’s
3. Agranulocytosis (Clozapine)
   Diabetes, weight gain, hyperprolactinemia
   Prolonged QT

Question 4

Lithium

1. Mechanism?
2. Uses? (2)
3. Adverse effects?

Answer 4

1. Uncertain, supresses IP3 and DAG signalling
2. Bipolar affective disorders
   Prevents mood swings
3. hypothyroidism, renal dysfunction
   Tremor, edema, diabetes insipidus
   Pregnancy category D

Renal elimination

Question 5

Carbamazepine
Lamotrigine
Valproic acid

1. Mechanism?
2. Uses? (4)
3. Adverse effects? (3)

Answer 5

Alternatives for bipolar disorder:

1. Unclear actions in bipolar disorder
2. Valproic acid is first choice in bipolar (+- Lithium)
3. Hematotoxicity and CYP induction (Carbamazepine)
   Rash (Lamotrigine)
   Hepatic dysfunction and inhibition (Valproic acid)