Antipsychotic Drugs: Second Generation

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Questions and Answers

What is a common characteristic of second-generation antipsychotics, except for aripiprazole?

They have higher rates of metabolic adverse effects and weight gain

They are associated with lower rates of extrapyramidal adverse effects and TD (correct)

They are anticholinergic antagonists

They are dopamine D2 agonists

What is the primary mechanism of action of clozapine?

Dopamine D1 receptor agonist

Weak D2-receptor antagonist (correct)

Selective serotonin reuptake inhibitor

Strong D2-receptor antagonist

What is a specific use of clozapine in the treatment of schizophrenia?

Reducing the risk of recurrent suicidal behavior (correct)

Managing acute psychotic episodes

Treating EPS in patients with schizophrenia

Improving cognitive function in patients with schizophrenia

What is a common adverse effect of risperidone?

Hypotension Signup and view all the answers

What type of receptors does risperidone have high affinity for?

Serotonin type 2 (5-HT2) receptors Signup and view all the answers

What is a benefit of risperidone in the treatment of psychoses?

Improving negative symptoms Signup and view all the answers

What is a common adverse effect of clozapine?

Sedation Signup and view all the answers

What is a unique characteristic of clozapine compared to other antipsychotics?

It has anticholinergic and antihistaminic effects Signup and view all the answers

What is the mechanism of action of asenapine?

Acts as an antagonist at dopamine D2 and serotonin 5-HT2 receptors Signup and view all the answers

Which of the following is a side effect of olanzapine?

Dry mouth Signup and view all the answers

What is the indication of asenapine?

Acute and maintenance treatment of schizophrenia Signup and view all the answers

What is the mechanism of action of serotonin-dopamine activity modulators (SDAMs)?

Acts as a partial agonist at 5-HT1A and dopamine D2 receptors at similar potency Signup and view all the answers

What is the use of aripiprazole?

Acute and maintenance treatment of schizophrenia and adjunctive therapy for major depressive disorder Signup and view all the answers

What is the side effect of asenapine?

Sedation Signup and view all the answers

What is the mechanism of action of aripiprazole?

Acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and an antagonist at serotonin 5-HT2A receptors Signup and view all the answers

What is the advantage of asenapine compared to typical antipsychotics?

It has less extrapyramidal adverse effects Signup and view all the answers

Study Notes

Second-Generation Antipsychotics (Atypical)

Characterized as dopamine D2 antagonists, except for aripiprazole, with lower rates of extrapyramidal adverse effects and tardive dyskinesia (TD) compared to first-generation antipsychotics.
However, they are associated with higher rates of metabolic adverse effects and weight gain.

Clozapine

Weak D2-receptor antagonist with significant anticholinergic, antihistaminic, and antiserotoninergic (5-HT1C, 5-HT2, 5-HT3) properties.
Used to treat refractory schizophrenia, especially atypical type with negative manifestations, and to reduce the risk of recurrent suicidal behavior in schizophrenia or schizoaffective disorder.
Adverse effects include:
- Neurological: sedation, drooling, dizziness
- Cardiovascular: tachycardia, cardiomyopathy, myocarditis
- Hematological: agranulocytosis (frequent CBC required)
- GIT: constipation
- Metabolic: weight gain

Risperidone

Has high affinity for serotonin type 2 (5-HT2) receptors and binds to dopamine D2 receptors, antagonizing alpha1-adrenergic, alpha2-adrenergic, and histaminergic receptors.
Improves negative symptoms of psychoses and reduces incidence of extrapyramidal symptoms (EPS).
Adverse effects include:
- Mild sedation
- Hypotension
- Akathisia
- Increase in prolactin
- Weight gain

Other Atypical Antipsychotic Drugs

Asenapine

Acts as an antagonist at dopamine D2 and serotonin 5-HT2 receptors, improving negative symptoms of psychoses and reducing incidence of EPS.
Indicated for acute and maintenance treatment of schizophrenia.
Adverse effects include:
- Sedation
- Weight gain
- Dizziness
- Extrapyramidal symptoms

Olanzapine

Acts through combination of dopamine and serotonin type 2 receptor site antagonism.
Side effects include:
- Weight gain
- Sedation
- Akathisia
- Hypotension
- Dry mouth
- Constipation

Aripiprazole (Serotonin-Dopamine Activity Modulator (SDAM))

Acts as a partial agonist at 5-HT1A and dopamine D2 receptors, and as an antagonist at 5-HT2A and noradrenaline alpha1/2 receptors.
Used for acute and maintenance treatment of schizophrenia, acute and maintenance treatment of bipolar I disorder, and adjunctive therapy for major depressive disorder.
Adverse effects include:
- Headache
- Nausea
- Vomiting
- Insomnia
- Tremor
- Constipation

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Description

This quiz covers second-generation antipsychotics, including their characteristics, effects, and potential adverse reactions. Learn about clozapine, dopamine D2 antagonists, and more.