[PHARMA] ANTIPSYCHOTICS

Question 1

all antipsychotics act on

Answer 1

D2 receptor in mesolimbic system

Question 2

atypical pyschotics also act on

Answer 2

5HT2 in mesocortical pathway

Question 3

advantages of typical antipsychotics

Answer 3

cheaper
fast acting IMI & inhalation
long-acting injectable formula for patients struggling to adhere to therapy

Question 4

central D2 receptors targeted by typical antipsychotics are present in

Answer 4

1-mesolimbic system
2-CTZ
3-Hypothalamus & Pituitary gland
4-Basal ganglia (nigrostriatal area)

Question 5

blockade of mesolimbic D2 receptor leads to

Answer 5

antipsychotic effect:
-violent patient calms down
-1ry psychosis
-2ry psychosis

Question 6

blockade of CTZ D2 receptor leads to

Answer 6

antiemetic effect

Question 7

blockade of basal ganglia D2 receptor leads to

Answer 7

Extrapyramidal side effects (EPS)

Question 8

blockade of hypothalamus & Pituitary gland D2 receptor leads to

Answer 8

↑prolactin
↑ body weight
gynecomastia ♂
infertility ♂
galactorrhea ♀
amenorrhea ♀

Question 9

autonomic receptors include

Answer 9

H1
M
α

Question 10

blockade of H1 receptor leads to

Answer 10

sedation
↑ body weight

Question 11

blockade of M receptor leads to

Answer 11

atropine-like effects:
dry mouth
confusion
constipation
urine retention

Question 12

blockade of α receptor leads to

Answer 12

postural hypotension
reflex tachycardia

Question 13

miscellaneous side effeccts of D2 blockade

Answer 13

cardiotoxic ↑QT
convulsions
corneal-lens deposits
cholestatic jaundice

Question 14

EPS disorders

Answer 14

akathisia
dystonia
parkinsonism
tardive dyskinesia

Question 15

neuroleptic malignant syndrome symptoms

Answer 15

muscle rigidity
hyperpyrexia
altered mental status
stupor
unstable BP
myoglobinemia

Question 16

neuroleptic malignant syndrome occurs due to

Answer 16

rapid excessive central DA blockade in patients sensitive to EPS

Question 17

management of neuroleptic malignant syndrome

Answer 17

discontinue
muscle relaxants
antiparkinsonian drugs
bromocriptine

Question 18

akathisia is characterized by

Answer 18

motor restlessness

Question 19

dystonia is characterized by

Answer 19

muscle spasms
neck torticollis

Question 20

parkinsonism is characterized by

Answer 20

rigidity
hypokinesia
tremors

Question 21

parkinsonism is characterized by

Answer 21

rigidity
hypokinesia
tremors

Question 22

tardive dyskinesia is characterized by

Answer 22

abnormal involuntary movements:
chewing
sucking
fly catching movement of tongue

Question 23

akathisia occurs due to

Answer 23

blockade of D2 receptors in basal ganglia

Question 24

dystonia occurs due to

Answer 24

blockade of D2 receptors in basal ganglia

Question 25

parkinsonism occurs due to

Answer 25

relative increase in cholinergic Ach activity following D2 blockade in basal ganglia

Question 26

tardive dyskinesia occurs due to

Answer 26

upregulation of DA receptors supersensitivity to DA following chronic blockade of D2 receptors in basal ganglia

Question 27

akathisia management

Answer 27

propanolol (DOC)

Question 28

dystonia management

Answer 28

propanolol (DOC)

Question 29

parkinsonism management

Answer 29

anticholinergics (benztropine)

Question 30

tardive dyskinesia management

Answer 30

least possible dose minimal duration replace w/ atypical antipsychotics or clozapine antidyskinesia drugs AVOID ANTICHOLINERGICS

Question 31

tardive dyskinesia is exacerbated by

Answer 31

anticholinergics

Question 32

parkinsonism in EPS is relieved by

Answer 32

anticholinergics

Question 33

low potency typical antipsychotics include

Answer 33

chlorpromazine thioridazine

Question 34

high potency typical antipsychotics include

Answer 34

haloperidol fluphenazine

Question 35

low potency typical antipsychotics side effect

Answer 35

less central side effects more autonomic

Question 36

high potency typical antipsychotics side effect

Answer 36

more central side effects less autonomic

Question 37

high potency typical antipsychotics are preferred in

Answer 37

elderly cardiac patients

Question 38

atypical antipsychotics advantages

Answer 38

-less central side effects -less EPS -less amenorrhea, galactorrhea, -gynecomastia (except w risperidone) -more efficacy

Question 39

more selective on mesolimbic system

Answer 39

atypical antipsychotics

Question 40

improve negative symptoms

Answer 40

atypical antipsychotics

Question 41

improve positive symptoms

Answer 41

typical antipsychotics

Question 42

DOC in resistance cases

Answer 42

clozapine

Question 43

risperidone characteristics

Answer 43

less autonomic less EPS less weight gain ↑QT ↑Prolactin

Question 44

least likely to cause EPS

Answer 44

clozapine

Question 45

clozapine characteristics

Answer 45

↑autonomic side effects ↑ seizures risk nocturnal salivation ↑body weight ↑hyperlipidemia (DM risk) insulin resistance ↑agranulocystosis risk

Question 46

most likely to ↑ body weight

Answer 46

Olanzapine

Question 47

olanzapine differs from clozapine in that

Answer 47

it has no risk of agranulocytosis

Question 48

DOC in psychosis in Parkinson disease

Answer 48

Quetiapine

Question 49

has extrapyramidal effects & causes akathisia

Answer 49

Aripiprazole

Question 50

DOC in children

Answer 50

Aripiprazole

Question 51

DOC in obese & DM patients

Answer 51

Aripiprazole

Question 52

therapeutic uses of antipsychotics (9)

Answer 52

1-Schizophrenia 2-Mania 3-Bipolar disorder 4-Tranquilizer= Haloperidol 5-Intractable hiccups= Chlorpromazine 6-Antiemetic= Chlorpromazine 7-Autism= Aripiprazole 8-Adjuncts in refractory depression= Quetiapine, Aripiprazole 9-off label hypnotics in insomnia= Quetiapine, Clozapine, Chlorpromazine

Question 53

monovalent cation

Answer 53

Li+

Question 54

gold standard in bipolar manic depression

Answer 54

Li+

Question 55

Li+ uses

Answer 55

mood stabilizers antimanic recurrent endogenous depression refractory unipolar depression

Question 56

first line TTT for bipolar depression

Answer 56

Li+ or lamotrigine

Question 57

Li+ onset

Answer 57

5-20 days

Question 58

Li+ T½

Answer 58

24h

Question 59

adverse effects of Li+

Answer 59

-CNS= fine tremors, ↓cognition -GIT= NVD -Renal= antagonizes ADH->polyuria->thirst Renal tubular damage Nephrogenic diabetes insipidus -Thyroid= benign enlargement with/without hypothyroidism

Question 60

Li+ toxicity is due to

Answer 60

Narrow TI Long T½ cumulative

Question 61

precautions to be taken w/ Li+ therapy

Answer 61

monitor kidney function monitor thyroid function monitor serum Li+ adjust dosage in ↓ Li+ excretion

Question 62

↓Li+ excretion can be due to

Answer 62

Na+ depletion renal dysfunction elderly (↓renal function)

Question 63

Lithium toxicity range

Answer 63

toxic: Li+ >1.5 mEq/l lethal: Li+ > 2 mEq/l

Question 64

Lithium toxicity range

Answer 64

toxic: Li+ >1.5 mEq/l lethal: Li+ > 2 mEq/l

Question 65

Li+ toxicity manifestations (11)

Answer 65

1-Vomiting 2-Diarrhea 3-Coarse tremors 4-Convulsions 5-Confusion 6-Coma 7-CV collapse 8-arrhythmia 9-ataxia 10-drowsiness 11-slurred speech

Question 66

Li+ antidote

Answer 66

NONE

Question 67

Li+ toxicity management

Answer 67

Stop intake gastric lavage Activated charcoal in acute ingestion Diuresis (NEVER thiazide/loop D) Hemodialysis

Question 68

hemodialysis is continued for

Answer 68

6-8hr till nontoxic Li+ range

Question 69

Hemodialysis is most effective in

Answer 69

1-Fluid intake is CI (CHF Cirrhosis) 2-severe symptoms 3- Li > 3 mEq/l 4-RF

Question 70

DOC in hepatic impairement

Answer 70

Li+

Question 71

how does the body deal with Li+

Answer 71

excretes it completely no metabolism

Question 72

Li toxicity occurs in Na depletion due to

Answer 72

Li is carried by Na/H exchanger & Na channels in Na depletion, Li is reabsorbed in place of Na= ↑serum Li= TOXICITY