Week 13: Antipsychotics: FGAs and SGAs

Question 1

First generation antipsychotics aka typical antipsychotics MOA

Haloperidol (Haldol), Chlorpromazine (Thorazine), fluphenazine (Prolixin), Thioridazine (Mellaril), Trifluoperazine (Stelazine)

Answer 1

reduce dopaminergic neurotransmission in the 4 dopamine pathways by blocking D2 receptors (too much dopamine = sx’s of parkinsonism) has properties of muscarininc, histaminergic, alpha adrenergic receptor antagonism = side effects

Question 2

First generation antipsychotics aka typical antipsychotics indication

Answer 2

meds differ in potency and side effects, all are effective for positive sx’s like psychosis, psychotic thought processes (schizo, bipolar)

Question 3

FGA high potency meds and low potency meds

Answer 3

high potency: haloperidol, fluphenazine higher risk of EPS

low potency: chlorpormazine, thioridazine lower EPS risk but inc risk of anticholinergic effects and antiadrenergic effects (orthostatic)

Question 4

FGA side effects

Answer 4

S.T.A.N.C.E. -sedation, sunlight sensitivity, skin effects, sexual -tardive dyskinesia -anticholinergic, agranulocytosis -neuroleptic malignant syndrome -cardiac arrhythmias (orthostatic) -extrapyramidal sx’s, akathsia, endocrine effects (inc prolactin eye effects)

neuroleptic malignant syndrome (NMS, rare): extreme muscle rigidity, high fevers, coma, death

Question 5

pseudoparkinsonism

Answer 5

stooped posture shuffling gait rigidity bradykinesia tremors at rest pill rolling

Question 6

acute dystonia

Answer 6

facial grimacing

involuntary upward of eye

tongue muscle spasm, face, neck, and back

laryngeal spasms

Question 7

akathisia

Answer 7

restless

trouble standing still

paces floor

feet constant mostion, rocking back and forth

Question 8

how are prolactin levels effected by FGAs?

Answer 8

since they block the dopamine receptors = increase prolactin levels = breast enlargement, galactorrhea, amenorrhea, inhibit orgasms in women and impotence in men

Question 9

tardive dyskinesia

Answer 9

protrusion and rolling of tongue

sucking and smacking movements of lips

chewing motion

facial dyskinesia

involuntary movements of body & extremities

Question 10

when does EPS occur?

Answer 10

Need immediate attention! EMERGENCY!

can be right after admin, hours - 5 days

akathisia: days-months

tardive dyskinesia/dystonia: late onset -months

Question 11

Second generation antipsychotics (SGAs) aka atypical antipsychotics examples and indications

Answer 11

risperidone (Risperdal), quetiapine (Seroquel), clozapine (clozaril)

reduce postive AND negative sx’s, psychotic mania, (controversial to use on anxiety and PTSD??)

low EPS and less hyperprolactinemia

Question 12

SGA moa

risperidone (Risperdal), quetiapine (Seroquel), clozapine (clozaril)

Answer 12

no two meds MOA are the same (FGA all MOA same but diff SE’s)

blockage of D2 dopamine receptors, serotonin dopamine antagonist, block 5 HT2A receptors

Question 13

SGA side effects

risperidone (Risperdal), quetiapine (Seroquel), clozapine (clozaril)

Answer 13

weight gain (obesity), dyslipidemia, diabetes, CVD, premature death

high metabolic risk: clozapine, olanzapine

Question 14

olanzapine associated with

Answer 14

weight gain and metabolic risk

Question 15

quetiapine and risperidone associated with

Answer 15

weight gain and increased triglyceride levels

Question 16

ziprasidone associated with

Answer 16

weight neutral and lower triglyeride levels