Final: Antipsychotics

Question 1

Chlorpromazine - Typical antipsychotic

Answer 1

Dopamine receptor blocker, first gen antipsychotic

Contraindications: CNS depression, pink or brown urine, circulatory collapse, Parkinson’s disease, coronary disease, severe hypotension, prolonged QT

Adverse reactions: Sedation, weakness, tremors, drowsiness, extrapyramidal effects, dry mouth, nasal congestion, constipation, photosensitivity, orthostatic hypotension, sexual dysfunction, agranulocytosis, severe dysrhythmias, liver impairment

Drug-drug: Beta blockers, alcohol, thioridazine

Acute dystonia is emergency that occurs hours to five days after dose - use Diphenhydramine

Question 2

Clozapine - Atypical antipsychotic

Answer 2

Schizophrenia treatment, blocks both dopamine and serotonin receptors

Advantages: Fewer to no EPS(no dyskinesia), fewer anticholinergic effects

Adverse effects: Drowsiness, sedation, seizures, dizziness, syncope, headache, tachycardia, n/v, fever, neuroleptic malignant syndrome, weight gain, hypercholesterolemia, new or onset loss of glucose control

Question 3

Lithium

Answer 3

Inhibits release of norepinephrine and dopamine but not serotonin, from stimulated neurons

Used for bipolar disorder, takes 1-3 weeks to see benefits, monitor sodium because it works in kidneys

Contraindications: Renal, cardiac disease, leukemia, metabolic disorders, pregnancy, lactation

Adverse effects: CNS effects (lethargy, slurred speech, muscle weakness, fine tremor), polyuria, gastric toxicity, n/v/d progressing

Normal lithium level: 0.8-1.2 mEq/L

Get baseline EKG, thyroid levels, kidney studies, electrolyte levels and palpate thyroid