Psych - Pharmacology (Antipsychotics)

Question 1

What are 5 examples of Antipsychotics (neuroleptics)?

Answer 1

(1) Haloperidol (2) Trifluoperazine (3) Fluphenazine (4) Thioridiazine (5) Chlorpromazine; Think: “(haloperidol + ‘-azines’)”

Question 2

What is the mechanism of Antipsychotics (neuroleptics), and what effect do they have?

Answer 2

All typical antipsychotics block dopamine D2 receptors (increase [cAMP])

Question 3

What are 4 clinical uses for Antipsychotics (neuroleptics)?

Answer 3

(1) Schizophrenia (primarily positive symptoms) (2) Psychosis (3) Acute mania (4) Tourette syndrome

Question 4

What are 6 categories of toxicities to associate with Antipsychotics (neuroleptics)? Give the mechanism/symptoms of each.

Answer 4

(1) Highly lipid soluble and stored in body fat, thus very slow to be removed from body (2) Extrapyramidal system side effects (e.g., dyskinesias) (3) Endocrine side effects (e.g., dopamine receptor antagonism –> hyperprolactinemia –> galactorrhea). (4) Side effects arising from blocking muscarinic (dry mouth, constipation), alpha1 (hypotension), & histamine (sedation) receptors (5) Neuroleptic malignant syndrome (NMS) - rigidity, myoglobinuria, autonomic instability, hyperpyrexia. (6) Tardive dyskinesia - stereotypic oral-facial movements as a result of long-term psychotic use. Potentially irreversible.

Question 5

What is an example of extrapyramidal system side effects due to use of Antipyschotics (neuroleptics)? What are 2 treatments for such extrapyramidal system side effects?

Answer 5

Extrapyramidal system effects (e.g., dyskinesia); Treatment: Benztropine or Diphenhydramine

Question 6

What is the mechanism behind the endocrine side effects following use of Antipsychotics (neuroleptics)?

Answer 6

Endocrine side effects (e.g., dopamine receptor antagonism => hyperprolactinemia => galactorrhea)

Question 7

What 3 receptors may be blocked as side effects of Antipsychotics (neuroleptics), and what symptoms does each side effect yield?

Answer 7

Side effects arising from blocking muscarinic (dry mouth, constipation), alpha 1 (hypotension), and histamine (sedation) receptors

Question 8

Use of what drugs causes Neuroleptic malignant syndrome (NMS)? What are 4 symptoms associated with it? How is it treated?

Answer 8

Antipsychotics (neuroleptics); Neuroleptic malignant syndrome (NMS) - rigidity, myoglobinuria, autonomic instability, hyperpyrexia; Treatment: dantrolene, D2 agonists (e.g., bromocriptine); Think: “for NMS, think FEVER: Fever, Encephalopathy, Vitals unstable, Enzymes high, Rigidity of muscles”

Question 9

Use of what drugs causes Tardive dyskinesia? What defines it? Is it reversible or irreversible?

Answer 9

Antipyschotics (neuroleptics); Tardive dyskinesia - Stereotypic oral-facial movements as a result of long-term antipsychotic use. Potentially irreversible.

Question 10

What is the evolution of EPS side effects as as a side effect of antipsychotic use?

Answer 10

Evolution of EPS side effects: (1) 4 hr acute dystonia (muscle spasm, stiffness, oculogyric crisis) (2) 4 day akathisia (restlessness) (3) 4 week bradykinesia (parkinsonism) (4) 4 mo. tardive dyskinesia

Question 11

What are at least 2 examples of high versus low potency antipsychotics (neuroleptics)? What side effects are associated with each group?

Answer 11

HIGH POTENCY: Trifluoperazine, Fluphenazine, Haloperidol - neurologic side effects (EPS symptoms); Think: “TRy to Fly HIGH”; LOW POTENCY: Chlorpromazine, Thioridazine - non-neurologic side effects (anticholinergic, antihistamine, and alpha1 blockade effects); Think: “Cheating THieves are LOW”

Question 12

What side effects are specifically associated with each of the following Antipsychotics: (1) Chlorpromazine (2) Thioridazine (3) Haloperidol?

Answer 12

(1) Corneal deposits (2) reTinal deposits (3) NMS, Tardive dyskinesia

Question 13

What are 6 examples of Atypical antipsychotics?

Answer 13

(1) Olanzapine (2) Clozapine (3) Quetiapine (4) Risperidone (5) Aripiprazole (6) Ziprasidone; Think: “it’s ATYPICAL for OLd CLOSets to QUIETly RISPER from A to Z”

Question 14

What is the mechanism of Atypical antipsychotics?

Answer 14

Not completely understood. Varied effects on 5-HT2, dopamine, and alpha- and H1- receptors

Question 15

What are 7 clinical uses for Atypical antipsychotics?

Answer 15

(1) Schizophrenia - both positive and negative symptoms. Also used for (2) Bipolar disorder, (3) OCD, (4) Anxiety disorder, (5) Depression, (6) Mania, (7) Tourette syndrome.

Question 16

In general, how do atypical antipsychotics compare to traditional antipsychotics in terms of toxicity?

Answer 16

Fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics.

Question 17

What toxicity(-ies) is (are) associated with each of the following atypical antipsychotics: (1) Olanzapine/Clozapine (2) Clozapine (3) Risperidone (4) Ziprasidone?

Answer 17

(1) Olanzapine/Clozapine may cause significant weight gain. (2) Clozapine may cause agranulocytosis (requires weekly WBC monitoring) and seizure. (3) Risperidone may increase prolactin (causing lactation and gynecomastia) => low GnRH, LH, and FSH (causing irregular menstruation and fertility issues). (4) Ziprasidone may prolong the QT interval.

Question 18

What kind of drugs are Olanzapine and Clozapine? What toxicity do they both have?

Answer 18

Atypical antipsychotics; Olanzapine/Clozapine may cause significant weight gain.

Question 19

What kind of drug is Clozapine? What toxicities does it have? How is this managed clinically?

Answer 19

Atypical antipsychotic; Clozapine may cause agranulocytosis (requires weekly WBC monitoring) and seizure.; Think: “ must watch CLOZapine CLOZely”

Question 20

What kind of drug is Risperidone? What toxicity does it have? Explain the mechanism of this and the effects it may have.

Answer 20

Atypical antipsychotic; Risperidone may increase prolactin (causing lactation and gynecomastia) => low GnRH, LH, and FSH (causing irregular menstruation and fertility issues).

Question 21

What kind of drug is Ziprasidone? What toxicity does it have?

Answer 21

Atypical antipsychotic; Ziprasidone may prolong the QT interval.