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for MHD &
Therapeutics
And Now Here
Is The Host . . .
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to present
Dr. Schilling
The categories for today’s
Jeopardy will be:
Dopamine System
FGA’s
SGA’s
Side Effects
Miscellaneous
Dopamine
FGA’s
SGA’s
Side Effects
100
100
100
100
100
200
200
200
200
200
300
300
300
300
300
400
400
400
400
400
500
500
500
500
500
600
600
600
600
600
700
700
700
700
700
800
800
800
800
800
900
900
900
900
900
Miscellaneous
What is mesolimbic?
Antipsychotic medications exert
their antipsychotic effects at
this dopamine tract
Row 1, Col 1
What is nigrostriatal?
EPS and Tardive Dyskinesia result
from excessive D2 blockade
of this tract
1,2
What is 60-65%?
The percentage of D2 occupancy
necessary for an antipsychotic
effect is this
1,3
What is tuberoinfundibular?
Infertility, galactorrhea, and
osteopenia may result from
excessive blockade of this
dopamine tract
1,4
What is nothing?
Blocking 60-65% of receptors
in the nigrostriatal tract
will result in this
1,5
What is tuberoinfundibular?
An increased prolactin level is
caused from excessive D2
blockade of this tract
1,6
What is 80%?
The percentage of D2 occupancy
associated with elevated prolactin
and/or EPS is this
1,7
What is acetylcholine?
Normally suppressed by dopamine,
this neurotransmitter, when
blocked, will treat some EPS
side effects
1,8
What is antipsychotic effect?
Blocking > 80% of D2 receptors
in the mesolimbic tract will
result in this
1,9
What is low potency and high potency?
Correlating with their D2 receptor’s
binding affinity, FGAs are
grouped into these
two categories
2,1
What is dystonia?
Young male patients in particular
are at higher risk at the start of
FGA antipsychotic treatment
for this side effect
2,2
What is chlorpromazine (Thorazine)?
This FGA was not only the first
antipsychotic medication,
but was also the first
psychotropic medication
2,3
What is small/low?
To have a clinical effect, the dose
of antipsychotic medications
with a strong D2 receptor
binding affinity will be this
2,4
What is treatment of EPS side effects?
Low potency FGA’s antagonism of
muscarinic receptors is helpful
because it results in this
2,5
What are H1, M1, & α1?
At clinically effective doses, low
potency antipsychotic block these
types of receptors that high
potency antipsychotics do not
2,6
What is akathisia?
Drug induced Parkinsonism,
Dystonia, and this are often
referred to as Extra Pyramidal
Syndrome or EPS
2,7
What is Typical antipsychotics?
Historically, first generation
antipsychotics (FGA’s) have been
referred as major tranquilizers,
neuroleptics, conventional
antipsychotics, and this
2,8
What are weak?
Antipsychotic medications that
require a large dose to be clinically
effective have this type of D2
receptor binding affinity
2,9
What is aripiprazole (Abilify)?
The SGA with a mechanism of
action of partial dopamine
agonism is this
3,1
What is Clozapine (Clozaril)?
Useful in treatment resistant
schizophrenia, this SGA may
treat negative symptoms, tardive
dyskinesia, and lower the
risk of suicide
3,2
What is hit and run?
The minority view of the SGA’s
mechanism of action where the
drug blocks D2 receptors long
enough for the antipsychotic effect
but not so long as to cause side
effects is this
3,3
What is D2 & 5HT2 receptors?
SGA’s work by blocking these
two types of receptors
3,4
What is  qTc interval?
This cardiac related side effect is most
problematic with ziprasidone (Geodon)
and the FGA thioridazine (mellaril), but
may also be an issue with other
SGA’s and FGA’s
3,5
What is risperidone (Risperdal) & paliperidone
(Invega)?
Of all the SGAs, these two have the
highest risk of causing EPS and
prolactin elevation
3,6
What is ziprasidone (Geodon) or aripiprazole (Abilify)?
The SGA’s with the least risk of the
metabolic syndrome are
lurasidone (latuda),
iloperidone (fanapt),
asenapine (saphris) and
this or this
3,7
What is not causing EPS/TD?
Clozapine (Clozaril) was described as
being atypical because of this
3,8
What is weight gain?
The metabolic syndrome is
comprised of hyperglycemia,
diabetes mellitus, dyslipidemia
and this
3,9
What are none?
Neuroleptic Metabolic Syndrome is a
potential risk from use of all
antipsychotics except this
4,1
What is Parkinsonism?
(bradykinesia, tremor, stiffness)
Extrapyramidal side effects (EPS)
include dystonia, akathisia,
and this
4,2
What is gynecomastia?
(hyperprolactinemia)
As seen here,
antipsychotics can
cause this side
effect
4,3
What is creatine phosphokinase (CPK)?
While not diagnostic, the severity and
prognosis for a patient with NMS,
correlates with the degree of
abnormality of this lab
4,4
What is clozapine (Clozaril)?
Myocarditis, increased seizure risk, and
agranulocytosis are rare but
dangerous side effects of this
antipsychotic medication
4,5
What is dystonia?
As seen here,
antipsychotics
may cause this
side effect
4,6
What is ziprasidone (Geodon)?
Of all the SGA’s, this medication
has the highest risk of causing
qTc prolongation
4,7
What is sudden death?
Use of antipsychotics in elderly
dementia patients results in an
increased risk of this
4,8
What is clozapine (clozaril) & olanzapine (zyprexa)?
Risk of the metabolic syndrome is
greatest from use of these
2 SGA’s
4,9
What is Risperidone (Risperdal)?
and Paliperidone (Invega)
Compared to other SGA’s, this SGA has a
high risk of EPS & hyperprolactinemia,
but virtually no risk of muscarinic or
histaminic side effects
5,1
What is Olanzapine (Zyprexa)?
Compared to other SGA’s, this SGA has a
very high risk of metabolic syndrome,
histamine, & α-1 adrenergic side
effects; a moderate risk of muscarinic
side effects, but no risk of
agranulocytosis
5,2
What is Lurasidone (Latuda)?
Compared to other SGA’s, this SGA has
very low risk of metabolic syndrome,
histamine, α-1 adrenergic, &
muscarinic side effects;
and a moderate risk for akathisia,
5,3
What is quetiapine (Seroquel)?
The –apine group of SGA’s includes
clozapine (clozaril),
olanzapine (zyprexa),
asenapine (saphris),
and this
5,4
What is paliperidone (Invega)?
This atypical has a significant risk of
causing hyperprolactinemia, is the
active metabolite of risperidone
(Risperdal), and needs to be
taken with food for
proper absorption
5,5
What are aripiprazole (Abilify)?
Compared to other SGA’s, this SGA has:
the longest half life;
a very low risk of the metabolic
syndrome, histamine, α-1 adrenergic,
& muscarinic side effects;
but has moderate risk for akathisia,
5,6
What is clozapine (Clozaril)?
Compared to other SGA’s, this SGA has
a high risk of metabolic syndrome,
histamine, α-1 adrenergic, &
muscarinic side effects, but has
virtually no risk for EPS/TD
5,7
What is ziprasidone (Geodon)?
Compared to other SGA’s, this SGA:
needs to be taken with food for proper
absorption;
has a low risk for histaminic side effects &
metabolic syndrome,
but the highest risk for  qTc interval
5,8
What is Iloperidone (Fanapt)?
The –idone group of SGA’s consists
of risperidone (risperdal),
paliperidone (invega),
ziprasidone (geodon),
lurasidone (latuda),
and this
5,9