Watts

Question 1

Thioxanthones

Answer 1

Thiothixene: modest EPS

Question 1

Piperidine phenothiazines

Answer 1

Thioridazine:sedation, hypotension, anticholinergic, sexual dysfunction, CV

Fluphenazine: EPS

Prochlorperazine

Perphenazine: anticholinergic properties

Question 2

Butyrophenones

Answer 2

Haloperidol: EPS

Question 3

Misc.

Answer 3

Malidone: modest EPS, weight gain

Pimozide: Tourettes tics, vocalizations

Question 4

Clozapine

Answer 4

5HT2a and D2 antagonists

1st atypical antipsychotic, most effective

SE: agranulocytosis, risk of diabetes, anticholinergic/antihistamine, prolonged QT, low movement disorders

BOXED WARNING: REMS

Monitoring:
weekly x 6 months
biweekly x 6 months
every 4 weeks

Question 5

Olanzapine

Answer 5

5HT2a and D2 receptor antagonist

SE: sedation, weight gain, DRESS warning, risk of diabetes, low movement disorders

Question 6

Loxapine

Answer 6

contains metabolite–>amoxapine

used to treat depression

Question 7

Quetiapine

Answer 7

5HT2a and D2 receptor antagonist

contains metabolite

SE: sedation, weight gain, risk of diabetes, hypotension, low EPS and anticholinergic, prolonged QT interval

BOXED WARNING: Suicidal ideation

Question 8

Asenapine

Answer 8

5HT2a and D2 receptor antagonist

Patch and sublingual: low oral bioavailability

SE: weight gain, prolonged QT, metallic taste

Question 9

Risperidone

Answer 9

5HT2a and D2 receptor antagonist

SE: sedation, weight gain, orthostasis, gynecomastia, low EPS, hyperprolactinemia

Question 10

Paliperidone

Answer 10

9-hydroxyrisperidone formed by CYP2D6

SE: prolonged QT interval, sedation, weight gain, Orthostasis, Gynecomastia, Hyperprolactinemia, Low EPS

Pearls: ghost tablets, renally eliminated with renal dose adjustments

Question 11

Iloperidone

Answer 11

5HT2a and D2 receptor, alpha antagonist

SE: orthostasis, syncope, prolonged QT interval

Question 12

Ziprasidone

Answer 12

5HT2a, D2, alpha antagonist

SE: contraindicated in prolonged QT interval
DRESS WARNING

Take with food to increase bioavailability

Question 13

Lurasidone

Answer 13

5HT2a and D2 receptor antagonist

Fast onset

SE: less weight gain and metabolic effects compared to olanzapine, akathisia

BOXED WARNING: suicidal thoughts

Take with food (350 cal) to increase bioavailability

Question 14

Pimavanserin

Answer 14

5HT2a inverse agonist

Parkinson’s disease psychosis

SE: prolonged QT interval, peripheral edema, nausea, confusion

Question 15

Aripiprazole

Answer 15

5HT2 and D2 receptor antagonist

5HT1a inverse agonist:
low EPS, brings activity up
high EPS, brings activity down

moderate affinity for D4, alpha, histamine receptor

SE: low weight gain, moderate akathisia, low D2 effects

BOXED WARNING: Suicidal thoughts

Question 16

Brexpiprazole

Answer 16

D2/D3 partial agonist
5HT1a and D2 partial agonist
5HT2a antagonist

SE: moderat akathisia, low weight gain

BOXED WARNING: suicidal thoughts

Question 17

Cariprazine

Answer 17

D2/D3 partial agonist (higher for D3)
5HT2 antagonist
5HT1a partial agonist

SE: moderate akathisia, low weight gain

BOXED WARNING: Suicidal thoughts/behaviors

Question 18

Lumateperone

Answer 18

partial D2 agonist at presynaptic
5HT2a and D2 antagonist at postsynaptic

SE: low risk for weight gain, EPS, akathisia