Pharmacology of Psychotic Disorders

Question 1

Hypofunctioning of this pathway is believed to cause negative schizophrenia symptoms.

Answer 1

Dopamine mesocortical pathway

Question 2

What is neuroleptic malignant syndrome?

Answer 2

A rare, but life-threatening ADR of typical antipsychotics characterized by fever, muscle rigidity, mental status changes, autonomic dysfunction, elevated creatine kinase, and elevated white blood cells

Question 3

What are the common typical/1st generation antipsychotics?

Answer 3

Chlorpromazine, thioridazine, fluphenazine, haloperidol, pimozide

Question 4

What first-generation antipsychotic is least likely to cause prolactin elevation?

Answer 4

Chlorpromazine

Question 5

What is the most fatal antipsychotic?

Answer 5

Clozapine - also the most effective

Question 6

What antipsychotic is the only drug approved for suicide risk in patients with schizophrenia?

Answer 6

Clozapine

Question 7

For what non-psychiatric conditions may antipsychotics be used?

Answer 7

Nausea, intractable hiccups, pruritus (severe itching)

Question 8

Hyperfunctioning of this pathway is believed to be one cause of psychosis.

Answer 8

Dopamine mesolimbic pathway

Question 9

Many antipsychotics are indicated in weight gain. What antipsychotics are most indicated for use in obese patients and patients at increased risk of diabetes?

Answer 9

Aripiprazole, Pimavanserin, Ziprasidone

Question 10

What is the most effective atypical antipsychotic?

Answer 10

Clozapine - considered last line due to risk of death

Question 11

What are the high potency first-generation antipsychotics?

Answer 11

Fluphenazine, haloperidol, pimozide

Question 12

What is the MOA of clozapine?

Answer 12

Blocks D2 and 5-HT2A receptors

Question 13

What antipsychotic is associated with deposits on the retina?

Answer 13

Thioridazine

Question 14

Atypical antipsychotics target primarily D2 and 5-HT2A receptors. What other receptors may be targeted?

Answer 14

Alpha1, muscarinic, H1 receptors

Question 15

What antipsychotics are available in IM formulations for immediate/emergent use?

Answer 15

Olanzapine, haloperidol, ziprasidone

Question 16

What antipsychotics are most associated with metabolic ADRS, including weight gain and diabetes?

Answer 16

Clozapine, olanzapine

Question 17

What antipsychotic is associated with deposits on the cornea and lens?

Answer 17

Chlorpromazine

Question 19

What antipsychotics are most associated with sedation?

Answer 19

2nd generation - clozapine, olanzipine, quetiapine

Question 20

What chronic ADR of typical antipsychotics may appear months to years after beginning the medication?

Answer 20

Tardive dyskinesia

Question 21

For what other psychiatric conditions may antipsychotics be used?

Answer 21

Intense anxiety, Tourette’s, bipolar disorder, major depressive disorder

Question 22

What antipsychotics are available in long-lasting injectable formations to increase medication adherence?

Answer 22

Haloperidol, risperidone, olanzapine, aripiprazole

Question 23

This atypical antipsychotic has no D2 binding and may be used to treat Parkinson’s-related psychosis.

Answer 23

Pimavanserin

Question 24

What ADRs are associated with typical antipsychotics?

Answer 24

Extrapyramidal side effects, hyperprolactinemia, neuroleptic malignant syndrome

Question 25

What atypical antipsychotic has the highest risk of Parkinsonism and prolactin elevation?

Answer 25

Risperidone

Question 26

What potentially fatal ADR is associated with Clozapine that prevents its widespread use?

Answer 26

Agranulocytosis - dangerously low WBC that increases risk of infection and death

Question 27

What antipsychotics are available as oral-dissolving tablets to increase medication adherence?

Answer 27

Olanzapine, risperidone

Question 28

What first-generation antipsychotic is least likely to cause Parkinsonism-like symptoms?

Answer 28

Thioridazine

Question 29

What class of antipsychotics are generally not recommended for use in patients with dementia?

Answer 29

Atypical antipsychotics

Question 30

Atypical antipsychotics have some D2 binding. To what receptor do most atypical antipsychotics bind?

Answer 30

5-HT2A

Question 31

What is the MOA of typical/1st generation antipsychotics?

Answer 31

D2 receptor antagonists

Question 32

According to this serotonin hypothesis, what receptor is hyperfunctioning to cause hallucinations in patients with schizophrenia?

Answer 32

5-HT2A

Question 33

What adverse effect have some antipsychotics been shown to have on cardiovascular function?

Answer 33

QT prolongation

Question 34

True/False. The effectiveness of antipsychotics is generally similar in treating positive symptoms.

Answer 34

True - drug choice comes down to ADRs and treatment of negative symptoms

Question 35

What antipsychotics are known to have higher risk of QT prolongation?

Answer 35

Ziprasidone (2nd gen), Chlorpromazine, haloperidol, pimozide, thioridazine

Question 36

What is the most common type of ADRs associated with typical antipsychotics?

Answer 36

Extrapyramidal side effects - dystonia, akathisia, pseudoparkinsonism due to blockage of D2 receptors

Question 37

According to the glutamate hypothesis, what is the cause of psychosis and other positive symptoms?

Answer 37

Hypofunctioning of NMDA receptors on GABAnergic interneurons

Question 38

According to this psychotic hypothesis, agonism of D2 receptors causes psychosis and other positive symptoms.

Answer 38

Dopamine hypothesis