Exam 4 - Antipsychotics

Question 1

What are 4 typical antipsychotics?

Answer 1

1. Chorpromazine
2. Haloperidol
3. Fluphenazine
4. Thiothixene

Question 2

What are 5 atypical antipsychotics?

Answer 2

1. Clozapine
2. Risperidone
3. Olanzapine
4. Quetiapine
5. Aripiprazole

Question 3

Which med is a mood stabilizer?

Answer 3

Lithium

Question 4

What are 3 stimulants?

Answer 4

1. Amphetamine
2. Methylphenidate
3. Modafinil

Question 5

Chlorpromazine (Thorazine)

Answer 5

Class: Typical antipsychotic, low potency
MOA: D2 antagonist
SE: Very sedative (H1 antagonist), orthostatic hypotension (a1 adrenergic antagonist), wt gain, extrapyramidal effects (movement disorders)

Question 6

Haloperidol (Haldol)

Answer 6

Class: Typical antipsychotic, high potency
MOA:
SE: Sig extrapyramidal effects, orthostatic hypotension, mild sedation, wt gain
*MC used antipsychotic

Question 7

Fluphenazine

Answer 7

Class: Typical antipsychotic, high potency
MOA:
SE: Sig extrapyramidal effects, lower orthostatic hypotension, lower sedative effects, wt gain

Question 8

Thiothixene

Answer 8

Class: Typical antipsychotic
MOA:
SE: Extrapyramidal effects, orthostatic hypotension, wt gain

Question 9

Clozapine (Clozaril)

Answer 9

Class: Atypical antipsychotic
MOA: 5-HT2 antagonist, D4 receptor antagonist, weak D2 antagonist
SE: wt gain and hyperlipidemia/hyperglycemia, seizures, agranulocytosis, sedation, constipation, orthostatic hypotension, sexual side effects
Uses: Refractory schizophrenia

Question 10

Risperidone (Risperdal)

Answer 10

Class: Atypical antipsychotic
MOA: 5-HT2 antagonist, D2 antagonist
SE: elevated prolactin, small increase in wt/lipids, extrapyramidal side effects, sexual side effects
Uses: bipolar disorder, adjunct for PTSD

Question 11

Olanzapine (Zyprexa)

Answer 11

Class: Atypical antipsychotic
MOA: 5-HT2 antagonist, D2 antagonist, H1 antagonist, a1 antagonist, D4/D1 antagonist
SE: wt gain, increased lipids, hyperglycemia/DM, decreased seizure threshold, slight sedation, sexual side effects

Question 12

Quetiapine (Seroquel)

Answer 12

Class: Atypical antipsychotic
MOA: 5-HT2 antagonist, D2 antagonist, a1, M1,3 & H1 antagonist
SE: prolonged QTc interval, int wt gain, low risk of extrapyramidal effects or tardive dyskinesia
Uses: bipolar disorder

Question 13

Aripiprazole (Ability)

Answer 13

Class: Atypical antipsychotic
MOA: 5-HT2 antagonist, D2 partial antagonist, D4, a1. H1, D1 antagonist
SE: small increase in wt and lipids

Question 14

Lithium

Answer 14

Class: Mood stabilizer
MOA: blocks phosphoinositide metabolism
Slow onset (5-7d)
SE: fine hand tremor, mental fatigue, cognitive at high doses, EEG changes, wt gain (increased appetite), polydipsia, polyuria, edema (Na retention), decreased thyroid function, thyroid enlargement

low therapeutic index > serum levels must be monitored regularly
Elimination: renal >adjust for renal pts (diuretics, ACE inhibitors effects elimination)
Uses: tx of manic and acute phase of bipolar disorder and prevent recurrences

Question 15

Amphetamine (Adderall)

Answer 15

Class: Stimulant
MOA: releases catecholamines and 5-HT
-Stimulating the release of norepinephrine, dopamine and serotonin from
presynaptic nerve terminals, and inhibit the uptake of neurotransmitter into
the synaptic vesicles and reverse the monoamine transporters responsible
for the reuptake of the catecholamines and serotonin.
*Onset 20-60min, up to 6hr duration, 10hr (Adderall XR)
Uses: narcolepsy, ADHD

Question 16

Methylphenidate (Ritalin, Methylin)

Answer 16

Class: Stimulant
MOA: releases catecholamines and 5-HT
SE: insomnia, abdominal pain, wt loss, suppression of growth in children
*onset 30-60min, duration 5hrs
Uses: narcolepsy, ADHD

Question 17

Modafinil (Provigil)

Answer 17

Class: Stimulant
MOA: inhibits NET/DAT, increases synaptic concentrations of NE, DA, 5-HT
SE: mild increase in BP/HR
Uses: Narcolepsy

Question 18

What are side effects of antipsychotics?

Answer 18

1. Movement disorders – due to blockade of D2 receptors in the basal ganglia
   a. Parkinson-like symptoms – also called “extrapyramidal side effects”, reversible with
   lowered dose.
   Symptoms - Bradykinesia, rigidity, variable tremor, mask facies, shuffling gait
   b. Akathisia - Subjective and objective restlessness
   c. Acute dystonia - Spasm of muscles of tongue, face, neck, back
   d. Neuroleptic malignant syndrome – resembles severe form of Parkinsonism. Extreme
   rigidity, fever, unstable blood pressure, myoglobinemia; can be fatal
   e. Tardive dyskinesia: can be irreversible – involuntary movement (tic-like) of face, lips,
   tongue and eyelids. This is due to supersensitivity of the D2 receptors after prolonged
   receptor blockade.
2. Sedation – due to H1 and/or muscarinic receptor antagonism.
3. Orthostatic hypotension – due to 1 adrenergic receptor antagonism
4. Hyperprolactemia – blockade of dopamine inhibition of prolactin release.
   Excess prolactin will inhibit the release of GnRH and the hypothalamic-pituitary- gonad axis.
   This can result in amenorrhea, breast engorgement, galactorrhea, and sexual dysfunction
   and infertility in women and men.
5. Metabolic syndrome - Weight gain stimulates appetite, diabetes, dyslipidemia (elevated
   triglycerides).
6. Anticholinergic (muscarinic antagonist) – dry mouth, constipation, urinary retention, blurred
   vision
7. Cardiovascular – ventricular arrhythmias and sudden cardiac death due to prolonged QTc.
   Primarily due blockade of IKr.
8. Sexual Dysfunction – decrease libido, erectile dysfunction, delayed ejaculation, anorgasmia.

Question 19

What are S&S of overdose of an overdose on Lithium?

Answer 19

Acute toxicity and overdose: vomiting, profuse diarrhea, coarse tremor, ataxia, coma and convulsions and is dependent on serum concentrations. Severe toxic symptoms include mental confusion, hyperreflexia, gross tremor, dysarthria, seizures, and cranial nerve and focal neurological signs, progressing to coma and death.

Question 20

What are SE of Adderall?

Answer 20

Elation and euphoria, enhance wakefulness, elevate mood, self-confidence, ability to concentrate, increase motor and speech activities and decrease fatigue.

Increase the rate and depth of respiration though stimulation of the medullary respiratory centers. Decrease appetite and decrease food intake. At high doses amphetamines can produce sterotyed behavior similar to high doses of cocaine. High doses of amphetamine will produce alterations in perception and psychotic effects which are probably due to the release of serotonin.

Amphetamines also increase diastolic and systolic blood pressure and a reflex bradycardia. At high doses arrhythmias may occur.

Following extended use of amphetamines or large doses, individuals may be depressed and fatigued and sleep.