Stahl Chapter 5: Antipsychotics exam questions with verified answers

Stahl Chapter 5: Antipsychotics exam questions with verified answers which FGAs are low potency and which ones are high potency? - Correct Answers Low potency FGAs: - chlorpromazine (thorazine) - mesoridazine (serentil); QTc issues so 2nd line - thioridazine (mellaril); QTc issues so 2nd line High potency FGAs: - Fluphenazine (prolixin); available as LAI - Haloperidol (Haldol); available as LAI - Perphenazine (trilafon) - Pimozide (orap); tx for tourettes but QTc issues so 2nd line - Thiothixene (navane) - Trifluoperazine (stelazine) Note: low potency requires higher doses but tend to have more additional properties (anticholinergic, antihistaminergic, alpha 1 antagonist) so they are usually more sedating. whats neurolepsis? - Correct Answers extreme form of slowness or absence of motor movements as well as emotional quieting and affective indifference. - FGAs are known to cause this, where the term neuroleptic comes from. - its caused by D2 blockade in the NA which is the pleasure center of the brain. This causes pts to not experience any pleasure resulting in apathy, anhedonia, lack of motivation, interest, and joy from social interactions. This may be the reason why schizophrenia has a large comorbidity of smoking and drug abuse. D2 blockade in the mesocortical pathway (where DA is already deficient) worsens negative and cognitive sxs even though theres a low D2 density in PFC. what differentiates FGAs from SGAs? - Correct Answers FGAs act primarily on D2. what causes the SEs with FGAs? - Correct Answers due to blockade of D2 in the mesolimbic DA pathway. This reduces the hyperactivity in this pathway that causes the positive sxs. All FGAs tx positive sxs equally well if dosed to block 60% of D2's in the mesolimbic pathway. In order to do this you have to also block the same D2 receptors throughout the brain which causes the SEs due to D2 blockade in the nigrostriatal pathway in the dorsal striatum (motor), ventral limbic area (the NA in the mesolimbic pathway), the PFC of the mesocortical pathway, and in the pituitary gland of tuberoinfundibular DA pathway. whats the neuroleptic induced deficit syndrome? - Correct Answers adverse behavioral state produced by D2 blockade in FGAs because it looks so much like the negative sxs produced in schizophrenia. This is similar to neurolepsis but specifically the emotional indifference. what causes the parkinsonian sxs? what causes TD? who's at risk for TD? - Correct Answers D2 blockade