PHARM - antipsychotic pharmacology

Question 1

typical antipsychotics are also known as

Answer 1

neuroleptics

Question 2

name four typical antipsychotics (DA inhibitors)

Answer 2

chlorpromazine - low potency
perphenazine - medium potency
haloperidol - high
fluphenazine - high

Question 3

dopamine theory of schizophrenia

Answer 3

• hypoactivity in the mesocortical pathway causing negative symptoms
• hyperactivity in the mesolimbic pathway causing positive symptoms

Question 4

side effects of low potency typical antipsychotics

Answer 4

• Dry mouth, blurred vision, constipation, urinary retention, hypotension, sedation, weight gain
• Less acute dystonia, NMS
• Parkinsonism, akathesia, tardive dyskinesia
• Prolactin elevation

Question 5

side effects of high potency typical antipsychotics

Answer 5

• More acute dystonia, NMS
• Parkinsonism, akathesia, tardive dyskinesia
• Prolactin elevation

Question 6

period of maximum risk for acute dystonia

Answer 6

1-5 days

Question 7

period of maximum risk for Parkinsonism

Answer 7

5-30 days

Question 8

period of maximum risk for akathisia (motor restlessness)

Answer 8

5-60 days

Question 9

period of maximum risk for tardive dyskinesia (oral-facial)

Answer 9

months to a year

Question 10

period of maximum risk for rabbit syndrome (perioral tremor)

Answer 10

months to year

Question 11

what percent of tardive dyskinesia in psych patients is due to neuroleptics?

Answer 11

about half

Question 12

major manifestations of NMS

Answer 12

fever, rigidity, increased CPK level

Question 13

minor manifestations of NMS

Answer 13

tachycardia
tachypnea
abnormal BP
altered consciousness
diaphoresis

Question 14

NMS diagnostic criteria

Answer 14

3 major or 2 major and 4 minor

Question 15

clozapine type, indication, and mechanism

Answer 15

• novel antipsychotic
• taken off market and reintroduced for treatment resistant schizophrenia
• potent serotonin and NE a2 antagonist, weak DA D2 antagonist

Question 16

clozapine benefits

Answer 16

benefits - dramatically effective for positive and some negative symptoms

• minimal EPS effects
• minimal prolactin elevation

Question 17

clozapine side effects

Answer 17

Agranulocytosis (reason for blood tests consistently)
Seizures
Myocarditis
Weight gain, glucose and lipid dysregulation 
Tachycardia, hypotension
Drooling
Sedation
Liver function changes

Question 18

clozapine is especially effective for….

Answer 18

• comorbid substance abuse with schizophrenia

- decreasing required hospitalization time to prevent suicide

Question 19

risperidone type, indication, mechanism

Answer 19

• novel antipsychotic (first one introduced post-clozapine)

- 5HT2/D2 ratio similar to clozapine

Question 20

risperidone side effects

Answer 20

• EPS at higher doses

- prolactin elevation

Question 21

risperidone benefit

Answer 21

• fewer relapses than haloperidol

Question 22

olanzapine type, indication, mechanism

Answer 22

• novel antipsychotic (second post-clozapine)

- 5HT/D2 ratio like clozapine/risperidone

Question 23

olanzapine SEs

Answer 23

• low EPS
• low prolactin elevation
• weight gain, sedation, glucose/lipid dysreg?

Question 24

quetiapine type, indications, mechanism

Answer 24

• novel antipsychotic

- 5HT/D2 ratio similar to clozapine

Question 25

quetiapine SEs

Answer 25

• few serious side effects
• low EPS
• low prolactin elevation
• cataract warning

Question 26

aripiprazole mechanism

Answer 26

• partial dopamine agonist
• Functional antagonist under conditions of dopamine hyperactivity (ie, control of positive symptoms)
• Functional agonist in conditions of dopamine hypoactivity (ie, control of negative symptoms, cognitive improvement, minimal motor effects)

Question 27

aripiprazole SEs

Answer 27

• low weight gain
• low EPS
• no prolactin elevation
• insomnia

Question 28

d-cycloserine mechanism and effects

Answer 28

• partial agonist at glycine modulatory site
• modestly decreases negative symptoms when combined with typical antipsychotic
• when added to clozapine, no effect or worsening of symptoms