Antipsychotic Drugs

(1)_______ is reserved for treatment refractory patients due to its risk of inducing (2)________.

(1) Clozapine (2) Agranulocytosis

High-potency FGAs have a higher incidence of (1)_________ side effects. Low-potency FGAs have a higher incidence of (2)_________ side effects.

(1) Extrapyramidal (2) Anticholinergic

Second generation antipsychotics have a lower incidence of (1)_________ side effects, but an increased risk for (2)_________.

(1) Extrapyramidal (2) Metabolic Syndrome

First generation antipsychotics primarily treat (1)__________ symptoms, with little impact on (2)_________ symptoms.

(1) Positive (2) Negative

Second Generation Antipsychotic Common Name Endings

-idone (iloperIDONE, lurasIDONE, risperIDONE, ziprasIDONE) -apine (asenAPINE, clozAPINE, olanzAPINE, quetiAPINE)

First Generation Antipsychotic Common Name Ending (5 of 9 share this ending)

-zine (fluphenaZINE, perphenaZINE, chlorpromaZINE, thioridaZINE, trifluoperiZINE)

Atypical antipsychotics should be taken for at least ________ weeks before efficacy can be determined.

4 weeks

Second Generation Antipsychotic Mechanism of Action

5-HT2 receptor antagonism D4>D2 receptor antagonism

Neuroleptic Malignant Syndrome

AMS Autonomic instability (high fever, labile BP, tachycardia, tachypnea, diaphoresis) Lead Pipe Rigidity Increased Creatinine Phosphokinase (CPK) Levels Leukocytosis Metabolic Acidosis

Tx of Extrapyramidal Side Effects

Anticholinergics (benzotropine, diphenhydramine) Benzodiazepines/Beta Blockers (specifically for akathisia) Discontinue antipsychotic

Second Generation Antipsychotic List

Aripiprazole Asenapine Clozapine Iloperidone Lurasidone Olanzapine Quetiapine Risperidone Ziprasidone

First Generation Antipsychotic List (Low Potency)

Chlorpromazine Thioridazine

Tardive Dyskinesia

Choreoathetoid movement of face, tongue, and head

First Generation Antipsychotic Mechanism of Action

D2 receptor antagonism

Tx of Tardive Dyskinesia

Discontinue medication in favor of second generation antipsychotic

Anticholinergic Side Effects

Dry mouth Constipation Blurred Vision Hyperthermia

Extrapyramidal Side Effects

Dystonia (spasm) of face, neck, and tongue Parkinsonism (resting tremor, bradykinesia, rigidity) Akathisia (feeling of restlessness)

First Generation Antipsychotic List (High Potency)

Fluphenazine Haloperidol Loxapine Perphenazine Pimozide Thiothixene Trifluoperizine

Metabolic Syndrome

Increased BP Increased blood glucose Excess body fat around waist Abnormal cholesterol levels

Tx of Neuroleptic Malignant Syndrome

Medical emergency Withdraw all antipsychotic meds Dantrolene

Tx of Metabolic Syndrome Side Effect

Switch to first generation antipsychotic OR Switch to weight neutral second generation antipsychotic (aripiprazole or ziprasidone)

Tx of Anticholinergic Side Effects

Treat individual symptoms