Neuroleptics / Anti-Psychotics

Question 1

What class of drugs do chlorpromazine and haloperidol belong to, and what 2 diseases are they used to treat?

Answer 1

First generation anti-psychotics; for schizophrenia and Huntington’s

Question 2

What class of drugs do fluphenazine, trifluoperazine, and perphenazine belong to, and what disease are they used to treat?

Answer 2

First generation anti-psychotics; schizophrenia (fluphenazine also treats movement disorders in Huntington’s)

Question 3

What class of drugs do thioridizine, thiothixine, and loxapine belong to, and what disease are they used to treat?

Answer 3

First generation anti-psychotics; schizophrenia

Question 4

What is the most important side effect shared by all the first generation anti-psychotics? Describe this syndrome.

Answer 4

NMS: muscle + ANS + brain problems
(Muscle rigidity, cramps, tremors, rhabdomyolysis, elevated serum creatine kinase and WBCs; malignant hyperthermia, autonomic instability, diaphoresis; and cognitive changes, catatonia, stupor)

Question 5

What is the mechanism of action of the first generation anti-psychotics?

Answer 5

Dopamine receptor antagonism leading to catalepsy (trance, muscle rigidity, lack of voluntary movement)

Question 6

Of the first generation anti-psychotics, which three are used to treat movement disorders in Huntington’s disease (in addition to schizophrenia)?

Answer 6

Chlorpromazine, fluphenazine and haloperidol

Question 7

In addition to NMS, what are 4 side effects of the first generation anti-psychotics?

Answer 7

EPS, tardive dyskinesias, hyperprolactinemia, and sexual dysfunction (all related to DA depletion)

Question 8

Which anti-phychotic drugs are generally effective at treating positive symptoms of schizophrenia and mania but not negative symptoms?

Answer 8

All first generation anti-psychotics

Question 9

There are two subclasses of second generation anti-psychotics; what are they?

Answer 9

Tricyclic and non-tricyclic

Question 10

What kind of drugs are clozapine, olanzapine, and quetiapine?

Answer 10

Tricyclic second generation anti-psychotics

Question 11

What kind of drugs are risperidone, ziprazidone, paliperidone,and aripiprazole?

Answer 11

Non-tricyclic second generation anti-psychotics

Question 12

Clozapine, olanzapine, quetiapine, risperidone, ziprazidone, and paliperidone all belong to what class of drugs, and all act on what receptors?

Answer 12

They are all 2nd gen anti-psychotics; D2 and 5HT-2 receptors (antagonists)

Question 13

Which second generation anti-psychotic is the active metabolite of risperidone after P450 metabolism?

Answer 13

Paliperidone

Question 14

Which second generation antipsychotic is a partial D2 and D3 receptor agonist, 5HT-1a agonist, and 5HT-2a antagonist?

Answer 14

Aripiprazole

Question 15

How effective is aripiprazole for treating schizophrenia? What other condition is it used to treat?

Answer 15

Not as effective as other first or second generation anti-psychotics for schizophrenia; used to treat severe bipolar disease

Question 16

Which neuroleptic is used for treatment-resistant psychoses (including schizophrenia), decreases risk of suicide, and can be used in pregnancy? What is the only other neuroleptic that can be used in pregnant women (because it is also FDA class B)?

Answer 16

Clozapine; lurasidone

Question 17

Of the following SGAs, which can cause somnolence and which can cause insomnia: olanzapine, quetiapine, risperidone, paliperidone, and ziprazidone?

Answer 17

Somnolence: olanzapine, quetiapine, and ziprazidone
Insomnia: risperidone, paliperidone

Question 18

What anti-psychotic drug will not cause catalepsy, but has other dangerous side effects including agranulocytosis, seizures, and myocarditis?

Answer 18

Clozapine

Question 19

What class of drugs do asenapine, lurasidone, and iloperidone belong to?

Answer 19

Atypical anti-psychotics

Question 20

Which class of SGAs causes more metabolic side effects: tricyclics or non-tricyclics?

Answer 20

The tricyclics have more metabolic side effects (ex. weight gain, hyperglycemia, hyperlipidemia, type 2 diabetes)

Question 21

If a schizophrenia patient suddenly presents with NMS, what drug should they be given to provide dopaminergic agonism, and what drug should they be given to cause muscle relaxation?

Answer 21

Bromocriptine; dantrolene

Question 22

Which SGA is the most likely to cause EPS side effects, and which is the least likely?

Answer 22

Risperidone; clozapine

Question 23

Which 2 SGAs should be avoided in people with mild heart blocks, because they could exacerbate the problem?

Answer 23

Paliperidone and ziprazidone (can prolong QTc interval)