Pharm - Antipsychotics

Question 1

list the first gen agents

Answer 1

1) chlorpromazine
2) fluphenazine
3) haloperidol
4) thioridazine

Question 2

MOA FGA

Answer 2

block dopamine type 2 post-synaptic receptors

Question 3

what other receptors do FGAs block, causing adverse side effects

Answer 3

muscarinic, histaminic, alpha-adrenergic, and D2 in nigrostriatal (EPS) and tuberoinfundibular (prolactin) pathways

Question 4

describe the dopamine-associated side effects of FGAs

Answer 4

1) hyperprolactinemia –> amenorrhea, galactorrhea, gynecomastia, decreased libido
2) extrapyramidal sx (EPS) –> tardive dyskinesia, akathisia, dystonia, parkinsonism-like rigidity

Question 5

list the low-potency FGAs and their side effects

Answer 5

1) chlorpromazine
2) thioridazine

sedation, hypotension, and seizure-threshold reduction

Question 6

list the high-potency FGAs

Answer 6

1) fluphenazine
2) halperidol

more movement (EPS) and endocrine effects (prolactin)

Question 7

what are the treatments for EPS sx when using FGAs

Answer 7

1) anticholinergic agents: benztropine and trihexyphenidyl

2) antihistamine agents: diphenhydramine

Question 8

what are the treatments for tardive dyskinesia sx when using FGAs

Answer 8

selective VMAT2 inhibitors: valbenazine and deutetrabenazine

Question 9

MOA SGAs

Answer 9

block dopamine type 2 post-synaptic receptors AND 5-HT-2A

Question 10

compare FGA and SGA on how they block D2 and 5-HT receptors

Answer 10

FGA: D2&raquo_space;> 5-HT

SGA: 5-HT&raquo_space;> D2

Question 11

what drug is used for hallucinations and delusions in a parkinsons pt

Answer 11

pimavanserin

Question 12

what is the suffix for SGAs that are 5-HT-2A/DA receptor antagonists

Answer 12

• idone

lurasidone, risperidone, ziprasidone

Question 13

what is the suffix for SGAs that are partial DA/5-HT-1A receptor agonists

Answer 13

• prazole

aripiprazole

Question 14

what is the suffix for SGAs that are multi-acting receptor target agents

Answer 14

• apine

clozapine, cariprazine, olanzapine, quetiapine

Question 15

list the SGAs that are inverse serotonin agonist/antagonists

Answer 15

pimavanserin

Question 16

common side effects of SGAs

Answer 16

• weight gain

- metabolic effects –> hyperglycemia, insulin resistance, hyperlipdemia

Question 17

rare side effects of SGAs

Answer 17

• QTC prolongation/ECG changes
• stroke
• agranulocytosis
• DRESS
• NMS

Question 18

what agent can cause agranulocytosis

Answer 18

clozapine

Question 19

what agent can cause drug reaction w/ eosinophilia and systemic symptoms (DRESS)

Answer 19

olanzapine

Question 20

describe DRESS

Answer 20

drug reaction w/ eosinophilia and systemic sx

• rare, life-threatening drug induced hypersensitivity rxn
• skin eruption, hematologic abnormalities, lymphadenopathy

Question 21

describe NMS

Answer 21

neuroleptic malignant syndrome

- rare but potentially fatal, severe parkinson’s-like movement disorder w/ wide-spread muscle contraction

Question 22

treatment for NMS

Answer 22

dantrolene

Question 23

what labs do you need before prescribing any anti-psychotics

Answer 23

• serum glucose
• lipids
• weight (BMI)
• blood pressure

Question 24

what labs do you need before prescribing clozapine

Answer 24

WBC

Question 25

what anti-psychotic should you use in multi-drug resistance disease

Answer 25

clozapine

Question 26

what anti-psychotic should you use in psychotic pts w/ anti-suicidal thoughts/behaviors

Answer 26

clozapine

Question 27

what agents should you prescribe to pts with non-compliance

Answer 27

long-acting injectable agents (LAIAs) every 2-12 weeks

Question 28

list the LAIAs used for non-compliant patients

Answer 28

1st gen:

• haloperidol decanoate
• fluphenazine decanoate

2nd gen:

• risperidone
• olanzapine
• aripiprazole lauroxil