PRITE Psychopharmacology Questions and
Answers
What is the MOA of antipsychotics? - Dopamine receptor antagonists
What are the two classes of antipsychotics? - Typicals - antagonize D2 only, greater risk of side
effects
Atypicals - antagonize D2, D4, and 5HTZ, favorable for long term treatment
*Risperidone [Risperdal] - atypical, only acts on D2 and 5HTz
Typical Antipsychotic Rx - Haloperidol [Haldol], Chlorpromazine [Thorazine], Prochlorperazine
[Compazine], Fluphenazine [Prolixin]
Atypical Antipsychotic Rx - Risperidone [Risperdal]
Olanzapine [Zyprexa]
Quetiapine [Seroquel]
Clozapine [Clozaril]
Ziprasidone [Geodon]
Aripiprazole [Abilify]
What are the indications for antipsychotic therapy? - 1. Psychotic disorders
2. Acute agitation - haloperidol, ziprasidone
3. Mood disorders - MDD, BP2 - adjunct to SSRI, esp. Aripiprazole
4. Movement d/o involving excessive dopaminergic stimulation (i.e. Huntington's, Tourette's)
Which antipsychotic is associated with agranulocytosis? - Clozapine [Clozaril]
Which antipsychotic is associated with prolongation of QT interval? - Ziprasidone [Geodon]
, Which antipsychotic is the least sedating? - Risperidone [Risperdal]
What are the AE associated with dopaminergic blockade in patients on antipsychotics? - 1.
Extrapyramidal sx - TD, NMS, akathisia (typicals!)
2. Galactorrhea, gynecomastia, amenorrhea 2' to elevated prolactin
What are the extrapyramidal sx associated with antipsychotic use and how are they managed? -
1. Acute Dystonia - onset w/in hrs to days of tx; sx - torticollis, oculogyric crisis, muscle spasms; tx
- benztropine, benadryl
2. Akathisia - comes on most after tx; sx - restlessness, tremor; tx - monitor dose, change to atypicals
3. TD - irreversible; sx - chorea, involuntary movements (face, jaw); tx - switch to atypicals
What medical emergency is associated with antipsychotic use? - Neuroleptic Malignant Syndrome
(NMS)
Sx - hyperthermia, muscle rigidity, cramps, tremor, severe HTN or hypotenions, tachycardia, delirium,
seizures, agitation
Dx - high suspicion on any pt taking antipsychotics, elevated CPK and WBCs
Tx - d/c tx, start IV Dantrolene
SSRIs - Fluoxetine (Prozac), Escitalopram [Lexapro], Citalopram [Celexa], Fluvoxamine [Luvox],
Paroxetine [Paxil], Sertraline [Zoloft]
What are the indications for SSRIs? - 1. Depression (1st line)
2. Long term management of anxiety disorders
3. Bulimia nervosa
What are the common AE of SSRIs? - 1. Sexual dysfunction
2. GI effects - decrease appetite, diarrhea
Answers
What is the MOA of antipsychotics? - Dopamine receptor antagonists
What are the two classes of antipsychotics? - Typicals - antagonize D2 only, greater risk of side
effects
Atypicals - antagonize D2, D4, and 5HTZ, favorable for long term treatment
*Risperidone [Risperdal] - atypical, only acts on D2 and 5HTz
Typical Antipsychotic Rx - Haloperidol [Haldol], Chlorpromazine [Thorazine], Prochlorperazine
[Compazine], Fluphenazine [Prolixin]
Atypical Antipsychotic Rx - Risperidone [Risperdal]
Olanzapine [Zyprexa]
Quetiapine [Seroquel]
Clozapine [Clozaril]
Ziprasidone [Geodon]
Aripiprazole [Abilify]
What are the indications for antipsychotic therapy? - 1. Psychotic disorders
2. Acute agitation - haloperidol, ziprasidone
3. Mood disorders - MDD, BP2 - adjunct to SSRI, esp. Aripiprazole
4. Movement d/o involving excessive dopaminergic stimulation (i.e. Huntington's, Tourette's)
Which antipsychotic is associated with agranulocytosis? - Clozapine [Clozaril]
Which antipsychotic is associated with prolongation of QT interval? - Ziprasidone [Geodon]
, Which antipsychotic is the least sedating? - Risperidone [Risperdal]
What are the AE associated with dopaminergic blockade in patients on antipsychotics? - 1.
Extrapyramidal sx - TD, NMS, akathisia (typicals!)
2. Galactorrhea, gynecomastia, amenorrhea 2' to elevated prolactin
What are the extrapyramidal sx associated with antipsychotic use and how are they managed? -
1. Acute Dystonia - onset w/in hrs to days of tx; sx - torticollis, oculogyric crisis, muscle spasms; tx
- benztropine, benadryl
2. Akathisia - comes on most after tx; sx - restlessness, tremor; tx - monitor dose, change to atypicals
3. TD - irreversible; sx - chorea, involuntary movements (face, jaw); tx - switch to atypicals
What medical emergency is associated with antipsychotic use? - Neuroleptic Malignant Syndrome
(NMS)
Sx - hyperthermia, muscle rigidity, cramps, tremor, severe HTN or hypotenions, tachycardia, delirium,
seizures, agitation
Dx - high suspicion on any pt taking antipsychotics, elevated CPK and WBCs
Tx - d/c tx, start IV Dantrolene
SSRIs - Fluoxetine (Prozac), Escitalopram [Lexapro], Citalopram [Celexa], Fluvoxamine [Luvox],
Paroxetine [Paxil], Sertraline [Zoloft]
What are the indications for SSRIs? - 1. Depression (1st line)
2. Long term management of anxiety disorders
3. Bulimia nervosa
What are the common AE of SSRIs? - 1. Sexual dysfunction
2. GI effects - decrease appetite, diarrhea
