PSYCHOPHARMACOLOGY UPDATED COMPREHENSIVE
QUESTIONS AND SOLUTIONS GUARANTEE A+
✔What is the cause of tardive dyskinesia? - ✔✔Blockade of D2 receptors in the
nigrostriatal dopamine pathway cause them to upregulate (hypersensitivity) --> tardive
dyskinesia
✔✔What are the effects of hyperprolactinemia? - ✔✔Gynecomastia
Galactorrhea
Sexual dysfunction
Amenorrhea and menstrual irregularities
✔✔Which two typical antipsychotics have high potency, high relative D2 blockade and
high EPS? - ✔✔Haloperidol
Fluphenazine
✔✔Which typical antipsychotic has the lowest potency, lowest relative D2 blockade and
the lowest EPS? - ✔✔Chlorpromazine (Thorazine)
✔✔Which atypical antipsychotic is unique and has partial agonist activity (5HT2A) at D2
receptors? - ✔✔Aripiprazole
✔✔Which atypical antipsychotics have high D2 binding and similar side effects to typical
antipsychotics? - ✔✔Risperidone and paliperidone
✔✔Which drugs have a more narrow therapeutic range: typical or atypical
antipsychotics? - ✔✔Typical
Very narrow difference b/t striatal D2 receptor blockade which causes antipsychotic
effects and EPS and hyperprolactinemia
✔✔What does serotonin do to prolactin release? - ✔✔Stimulates
✔✔What does dopamine do to prolactin release? - ✔✔Inhibits it
✔✔Do typical antipsychotics increase or decrease prolactin release? - ✔✔Increase by
blocking dopamine
✔✔What is the effect of atypical antipsychotics on prolactin release? - ✔✔Net neutral
effect
✔✔What are the 5-HT receptor binding properties of atypical antipsychotics? -
✔✔Highly variable across atypical agents.
May contribute to therapeutic effects.
May contribute to weight gain.
, May decrease some side effects.
✔✔Which atypical antipsychotic has the highest risk of D2-related side effects (EPS,
akathisia, increased PRL)? - ✔✔Risperidone
EPS and Akathisia are dose-related (> 6mg/d)
✔✔Which adverse effects of typical antipsychotic agents are inversely proportional to
potency? - ✔✔Alpha blockade
Muscarinic anticholinergic
Sedation (histamine)
✔✔Which typical antipsychotic agent has the highest alpha blockade, muscarinic
anticholinergic and sedation side effects? - ✔✔Chlorpromazine
✔✔Which atypical antipsychotics have the most anticholinergic side effects? -
✔✔Clozapine
Olanzapine
✔✔What are side effects of atypical antipsychotic medications that the FDA requested
to include a product labeling warning? - ✔✔1) Hyperglycemia (and DM2)
- can occur independent of weight gain
2) QTc interval prolongation (torsades) [ziprasidone]
3) Risk of stroke and increased mortality in individuals with dementia
✔✔Which atypical antipsychotics have the highest risk of hyperglycemia,
hyperlipidemia, weight gain, sedation, decreased BP and anticholinergic side effects? -
✔✔1) Clozapine
2) Olanzapine
✔✔What are the indications for rx clozapine? - ✔✔Treatment-resistant schizophrenia
Reduction in risk of recurrent suicidal behavior
✔✔What do you monitor when a pt takes clozapine? - ✔✔Clozaril registry
CBC weekly x 6 mo, then biweekly for 6-12 mos, then Q4 weeks
✔✔Can you use clozapine with carbamazepine? - ✔✔NO!
Potential WBC effects.
✔✔What are some notable side effects of clozapine? - ✔✔Increased risk for DM, HLD
Sialorrhea
Sweating
Dizziness, sedation, NA, tachy, hypotension
Nausea, constipation, dry mouth, weight gain
QUESTIONS AND SOLUTIONS GUARANTEE A+
✔What is the cause of tardive dyskinesia? - ✔✔Blockade of D2 receptors in the
nigrostriatal dopamine pathway cause them to upregulate (hypersensitivity) --> tardive
dyskinesia
✔✔What are the effects of hyperprolactinemia? - ✔✔Gynecomastia
Galactorrhea
Sexual dysfunction
Amenorrhea and menstrual irregularities
✔✔Which two typical antipsychotics have high potency, high relative D2 blockade and
high EPS? - ✔✔Haloperidol
Fluphenazine
✔✔Which typical antipsychotic has the lowest potency, lowest relative D2 blockade and
the lowest EPS? - ✔✔Chlorpromazine (Thorazine)
✔✔Which atypical antipsychotic is unique and has partial agonist activity (5HT2A) at D2
receptors? - ✔✔Aripiprazole
✔✔Which atypical antipsychotics have high D2 binding and similar side effects to typical
antipsychotics? - ✔✔Risperidone and paliperidone
✔✔Which drugs have a more narrow therapeutic range: typical or atypical
antipsychotics? - ✔✔Typical
Very narrow difference b/t striatal D2 receptor blockade which causes antipsychotic
effects and EPS and hyperprolactinemia
✔✔What does serotonin do to prolactin release? - ✔✔Stimulates
✔✔What does dopamine do to prolactin release? - ✔✔Inhibits it
✔✔Do typical antipsychotics increase or decrease prolactin release? - ✔✔Increase by
blocking dopamine
✔✔What is the effect of atypical antipsychotics on prolactin release? - ✔✔Net neutral
effect
✔✔What are the 5-HT receptor binding properties of atypical antipsychotics? -
✔✔Highly variable across atypical agents.
May contribute to therapeutic effects.
May contribute to weight gain.
, May decrease some side effects.
✔✔Which atypical antipsychotic has the highest risk of D2-related side effects (EPS,
akathisia, increased PRL)? - ✔✔Risperidone
EPS and Akathisia are dose-related (> 6mg/d)
✔✔Which adverse effects of typical antipsychotic agents are inversely proportional to
potency? - ✔✔Alpha blockade
Muscarinic anticholinergic
Sedation (histamine)
✔✔Which typical antipsychotic agent has the highest alpha blockade, muscarinic
anticholinergic and sedation side effects? - ✔✔Chlorpromazine
✔✔Which atypical antipsychotics have the most anticholinergic side effects? -
✔✔Clozapine
Olanzapine
✔✔What are side effects of atypical antipsychotic medications that the FDA requested
to include a product labeling warning? - ✔✔1) Hyperglycemia (and DM2)
- can occur independent of weight gain
2) QTc interval prolongation (torsades) [ziprasidone]
3) Risk of stroke and increased mortality in individuals with dementia
✔✔Which atypical antipsychotics have the highest risk of hyperglycemia,
hyperlipidemia, weight gain, sedation, decreased BP and anticholinergic side effects? -
✔✔1) Clozapine
2) Olanzapine
✔✔What are the indications for rx clozapine? - ✔✔Treatment-resistant schizophrenia
Reduction in risk of recurrent suicidal behavior
✔✔What do you monitor when a pt takes clozapine? - ✔✔Clozaril registry
CBC weekly x 6 mo, then biweekly for 6-12 mos, then Q4 weeks
✔✔Can you use clozapine with carbamazepine? - ✔✔NO!
Potential WBC effects.
✔✔What are some notable side effects of clozapine? - ✔✔Increased risk for DM, HLD
Sialorrhea
Sweating
Dizziness, sedation, NA, tachy, hypotension
Nausea, constipation, dry mouth, weight gain
