Quiz 1

Question 1

1st Generation Antipsychotics (FGA) classes

Answer 1

1. Phenothiazines
2. NonPhenothiazines

Question 2

Common side effects (nervous system)

Answer 2

1.EPS
2.Tardive Dyskinesia
3.Anticholinergic Side Effects
4.NMS
5.Sedation
6.Confusion
7.Headaches
8.Seizures
9.Sleep Disturbances

Question 3

1.Major components of EPS

Answer 3

• akathisia
• akinesia
• pseudo Parkinsonism
• dystonia

Question 4

What is EPS

Answer 4

group of motor disturbances caused by DOPAMINE being BLOCKED in NIGROSTRIATAL PATHWAY

Question 5

How can EPS be controlled

Answer 5

antiparkinson meds

Question 6

Akathisia

Answer 6

• onset 5-60 days from start
• improves with ⬇ in med or addition of BENZODIAZEPINE or PROPRANOLOL

Question 7

Akinesia/Bradykinesia

Answer 7

↑ dose = ↑ symptoms

Question 8

Pseudo Parkinsonism

Answer 8

• onset is 1st week after start

Question 9

Acute Dystonic Reactions

Answer 9

• onset is 1-5 days after start or increase
• respond well to anticholinergics - BENZTROPINE

Question 10

2.What is Tardive Dyskinesia

Answer 10

• onset occurs late in treatment
• most prominent with HIGH POTENCY & HIGH DOSES of TYPICAL antipsychotics
• believed cause is chronic exposure to DOPAMINE receptor BLOCKING agents in NIGROSTRIATAL PATHWAY
• usually IRREVERSIBLE WITH no EFFECTIVE TREATMENT
• AIMS scale

Question 11

3. What are Anticholinergic Side Effects

Answer 11

• DOPAMINE BLOCKS CHOLINERGIC receptors in NIGROSTRIATAL PATHWAY

Question 12

4. What is NMS

Answer 12

• onset occurs hrs-mo after start
• HYPOdopaminergic state (severe ↓ dopamine)
• risk factors: initiation, ↑, or use of multiple antipsychotic meds
• treatment: immediate discontinuation, prescribed dopamine AGONIST (BROMOCRIPTINE), supportive treatments

Question 13

8. Seizures

Answer 13

• ↑ dose rapidly

Question 14

Common side effects (endocrine system)

Answer 14

1. metabolism
2. sexual hormone dysregulation

Question 15

1. Metabolism

Answer 15

• OLANZAPINE, CLOZAPINE (WBC count) & QUETIAPINE have ↑ risk for metabolic side effects

Question 16

2. Sexual hormone dysregulation

Answer 16

• BLOCKING DOPAMINE in TUBEROINFUNDIBULAR DOPAMINE PATHWAY

Question 17

Common side effects (CV)

Answer 17

1. Orthostatic hypotension
2. QT interval
3. Agranulocytosis

Question 18

1. Orthostatic hypotension

Answer 18

• BLOCKING ADRENERGIC receptors
• MOST common side effect of BOTH types

Question 19

3. Agranulocytosis

Answer 19

• ↓ granulocytes (neutrophils)
• CLOZAPINE

Question 20

Common side effects (exocrine system)

Answer 20

1. Photosensitivity
2. Dermatological/Temperature regulation

Question 21

Common side effects (miscellaneous)

Answer 21

1. GI
2. Ocular

Question 22

Which drugs does smoking ↑ the clearance of

Answer 22

1. Haloperidol
2. Perphenazine
3. Thiothixene
4. Chlorpromazine
5. Fluphenazine
6. Clozapine
7. Olanzapine

Question 23

When does severity of risk INCREASE with antipsychotics

Answer 23

when dosages reach their UPPER limit or SURPASS recommended dosages

Question 24

Which antipsychotics produce the least amount of side effects but are not great for acute treatment

Answer 24

1. Aripiprazole
2. Brexpiprazole

Question 25

General precautions with antipsychotics

Answer 25

• parkinsons disease
• medical conditions such as glaucoma, peptic ulcers, urinary/intestinal obstructions
  seizure disorders
  alcohol misuse

Question 26

Antipsychotic drug interactions

Answer 26

• CNS depressants
• Antidepressants
• Dopamine agonists (levodopa carbidopa)
• Antihypertensive
• HALDOL & LITHIUM = ENCEPHALOPATHY

Question 27

Herbal contraindications with antipsychotics

Answer 27

• kava kava root (liver)
• gotu kola (↑ effects)
• st johns wort (↑ effects)
• valerian (sedative, ↑ effects)
• evening primrose (↑ symptoms of schizophrenia)