Stimulants and Antipsychotics

Question 1

CNS stimulants:

Answer 1

Methylphenidate, dextroampetamine, methamphetmamine, phentermine

Question 2

CNS stimulants mech:

Answer 2

increase catecholamines at synaptic cleft, especially norepinephrine and dopamine

Question 3

CNS stimulants use:

Answer 3

ADHD, narcolepsy, appetite control

Question 4

Mood stabilizers:

Answer 4

Valproic Acid analogs, Carbamazepine, Conazepam are anti-epileptic drugs that appear to be effective in manic depressive disorders.
Tx in bipolar disorder is becoming common

Question 5

Antipsychotics (neuroleptics):

Answer 5

Haloperidol, trifluoperazine, fluphenazine, thiridazine, chlorpromazine
(haloperidol + “azines”)

Question 6

Antipsychotics: mech

Answer 6

All typical antipsychotics block D2 receptors (increase cAMP)

Question 7

Antipsychotics: use

Answer 7

Schizophrenia (primarily positive symptoms), Psychosis, Mania, Tourette syndrome

Question 8

Antipsychotics: toxicity

Answer 8

Highly lipid soluble –> stored in body fat; thus, removed from body slowly
EPS side effects (dyskinesias). Tx: benztropine, diphenhydramine
Endocrine side effects (block dopamine, increase prolactin –> hyperprolactinemia –> galactorrhea
SEs arising from blocking muscarinic (dry mouth, constipation), alpha1 (hypotension), and histamine (sedation) receptors

Question 9

Antipsychotics: other toxicities

Answer 9

Neuroleptic Malignant syndrome (NMS): rigidity, myoglobinuria, hyperpyrexia, autonomic instability.
Tx: dantrolene, D2 agonists (ex. bromocriptine)
Tardive dyskinesia: stereotypic oral-facial movements as a result of long-term antipsychotic use. Potentially irriversible.

Question 10

High potency antipsychotics:

Answer 10

Try to Fly High
Trifluoperazine, Fluphenazine, Haloperadol
Neurologic side effects (EPS)

Question 11

Low potency antipsychotics:

Answer 11

Cheating Thieves are Low
Chlorpromazine, Thioridazine
non-neurologic effects (anticholinergic, antihistamine, alpha1-blockade effects)

Question 12

Chlorpromazine: major side effect

Answer 12

Corneal deposits

Question 13

Thioridazine: major side effect

Answer 13

ReTinal deposits

Question 14

Haloperidol: major side effect

Answer 14

NMS, Tardive dyskinesia

Question 15

Evolution of EPS side effects:

Answer 15

4 hr: acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day: akathisia (restlessness)
4 week: bradykinesia (parkinsonism)
4 month: tardive diskinesia

Question 16

Atypical antipsychotics:

Answer 16

Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone
“It’s atypical for OLd CLosets to QUIETly RISPER from A to Z”

Question 17

Atypical antipsychotics: mech

Answer 17

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

Question 18

Atypical antipsychotics: uses

Answer 18

Schizophrenia - both positive and negative symptoms. Also used for bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome.

Question 19

Atypical antipsychotics: tox

Answer 19

Fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics.

Question 20

Olanzapine/Clozapine: tox

Answer 20

may cause significant weight gain (can precipitate Type II diabetes –> black box warning)

Question 21

Clozapine: tox

Answer 21

Agranulocytosis (requires WEEKLY WBC monitoring) and seizures
Olanzapine is much safer.

Question 22

Risperidone: tox

Answer 22

may increase prolactin (causing lactation and gynecomastia) –> decreased GnRH, LH, and FSH (causing irregular menses and fertility issues)